A 35-Year-Old Man Comes to the Emergency Department Due to Urinary

question 265

Multiple Choice

A 35-year-old man comes to the emergency department due to urinary urgency, a burning sensation on urination, and urethral discharge.  The patient had similar symptoms 3 months ago, and urethral swab microscopy showed numerous neutrophils and intracellular gram-negative diplococci.  The symptoms resolved after treatment with ceftriaxone and doxycycline but recurred 4 days ago.  The patient was advised to use condoms but has had unprotected sexual encounters recently.  He has no other medical conditions.  The patient occasionally drinks alcohol and smokes cigarettes.  Temperature is 37.1 C (98.8 F) .  BMI is 18.8 kg/m².  No suprapubic or flank tenderness is present.  Mild erythema is noted at the urethral meatus.  Nucleic acid amplification testing of a clean catch urine specimen is positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis.  Which of the following is the most likely reason for the recurrence of infection in this patient?

• A)Absence of memory T cells
• B)Decreased antibody production due to malnutrition
• C)High variability of microbial antigenic structure
• D)Poor antigen recognition due to antigenic mimicry
• E)Resistance to antimicrobial agents

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Definitions:

Sense of Identity

An individual's perception of self, encompassing personal values, beliefs, and personality traits.

Personality Disorders

Mental health conditions characterized by enduring patterns of behavior, cognition, and inner experience that deviate markedly from the expectations of the individual's culture, are pervasive and inflexible, and lead to distress or impairment.

Maladaptive Pattern

Behavior patterns that are counterproductive to an individual's well-being or ability to fulfill goals and adapt to the demands of life.

Rigid

Lacking flexibility; not able to be bent or easily adapted to changes in circumstance or perspective.