Answer 1 Gram-negative diplococci. This patient has gonorrhea. Men are likely to be symptomatic with a purulent urethral discharge. Neisseria gonorrhoeae is a gram-negative, intracellular, aerobic diplococcus. The presence of typical gram-negative intracellular diplococci on Gram stain establishes the diagnosis of gonorrhea. Culture of the organism is the diagnostic standard but may not be practical in most settings. No other organism would present with a purulent urethral discharge. Urinary tract infection with gram-negative bacilli is unlikely in men and would not present with a purulent urethral discharge. Chlamydia trachomatis could be a consideration in this patient, but purulent discharge would not typically be present. Click here to return to the questions
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