33/M HIV(-) MSM is back w persistent urethral pain/discharge. 2 wks ago, got azithromycin 1g for same sx (urethral swab >25 WBC but GC NAAT neg). Rpt now: swab >25 WBC & GC NAAT neg still. Exam: no ulcer/rash. No new sexual activity. W/c of the ff is a reasonable approach for pt?
(1/5) Answer: 41% got it right, moxifloxacin x 7 days. Recap, what I meant with GC in the quiz is gonorrhea and Chlamydia testing, thanks @rexjustinlim for clarifying this. NAAT for GC is higly sensitive and specific. #IDMedEd
(2/5) Most common cause of persistent/recurrent non-gonococcal urethritis (NGU) in men is M. genitalium (up to 30%). Trichomonas vaginalis, also a cause and should be a consideration in men who have sex with women. Recent FDA approval for M. gen NAAT test fda.gov/news-events/pr…
(3/5) If testing not available, reasonable to empirically Tx for M gen. There is emerging M gen resistance to azithro, responsibile for a cure rate of as low as
40%. Moxifloxacin has emerged as Tx of choice for azithro failure (almost 100% effective). journals.plos.org/plosone/articl…
(4/5) This case provides guidance on treatmentn of persistent NGU. If presumptive Tx for M gen with moxi and for T vaginalis w metonid/tinidazole not effective, consider Urology consultation to rule out other causes. #IDMedEd
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