{"id":2073,"date":"2023-02-08T17:59:00","date_gmt":"2023-02-08T17:59:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2073"},"modified":"2025-10-01T11:40:32","modified_gmt":"2025-10-01T19:40:32","slug":"usmle-step-1-question-of-the-day-gonorrhea","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Gonorrhea"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#A_Diplococci_within_polymorphonuclear_leukocytes\" >A. Diplococci within polymorphonuclear leukocytes<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#B_Positive_hepatitis_B_surface_antigen\" >B.&nbsp;Positive hepatitis B surface antigen<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#C_Multinucleated_cells_on_Tzanck_smear\" >C. Multinucleated cells on Tzanck smear&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#D_Spirochetes_on_dark_field_microscopy\" >D. Spirochetes on dark field microscopy&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#E_Gram-negative_rods_in_a_%E2%80%9Cschool_of_fish%E2%80%9D_chain\" >E. Gram-negative rods in a \u201cschool of fish\u201d chain&nbsp;<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.<\/em><em>&nbsp;Today&#8217;s case involves a 22-year-old woman who was diagnosed with herpes simplex genital infection two months ago.<\/em><em>&nbsp;<\/em><em>Speculum examination reveals mucopurulent discharge and a friable erythematous cervix. Cervical motion tenderness is absent. Which of the following findings is most likely on laboratory evaluation? Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 22-year-old woman comes to her primary care physician&#8217;s clinic for evaluation of one week of burning urination, increased urinary frequency, and spotting after sexual intercourse. She was diagnosed with herpes simplex genital infection two months ago. She is sexually active with one male partner and uses condoms inconsistently. Temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 90\/min, respirations are 20\/min, and blood pressure is 120\/75 mmHg. On physical exam, the abdomen is soft and nontender. External genital examination reveals three healed, nontender genital ulcers. Speculum examination reveals mucopurulent discharge and a friable erythematous cervix. Cervical motion tenderness is absent. Which of the following findings is most likely on laboratory evaluation?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Diplococci within polymorphonuclear leukocytes<\/strong><strong>B. Positive hepatitis B surface antigen<br><br>C. Multinucleated cells on Tzanck smear<br><br>D. Spirochetes on dark field microscopy<br><br>E. Gram-negative rods in a \u201cschool of fish\u201d chain<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Diplococci_within_polymorphonuclear_leukocytes\"><\/span>A. Diplococci within polymorphonuclear leukocytes<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Positive_hepatitis_B_surface_antigen\"><\/span>B.&nbsp;<strong>Positive hepatitis B surface antigen<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Hepatitis B antigen is diagnostic of hepatitis B infection. Most patients are asymptomatic or present with a febrile illness and icterus. This patient\u2019s presentation is more consistent with acute cervicitis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Multinucleated_cells_on_Tzanck_smear\"><\/span>C. Multinucleated cells on Tzanck smear&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Herpes simplex virus can be diagnosed by performing a Tzanck smear, which will demonstrate the presence of multinucleated cells. Most patients present with painful genital ulcers, dysuria, and tender lymphadenopathy. This patient does not have evidence of an active HSV-2 infection.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Spirochetes_on_dark_field_microscopy\"><\/span>D. Spirochetes on dark field microscopy&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Darkfield microscopy is used to diagnose syphilis. Primary syphilis typically presents with a single nontender genital chancre. This patient\u2019s presentation with vaginal discharge, spotting, and dysuria is more consistent with acute cervicitis secondary to Neisseria gonorrhea or Chlamydia trachomatis.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Gram-negative_rods_in_a_%E2%80%9Cschool_of_fish%E2%80%9D_chain\"><\/span>E. Gram-negative rods in a \u201cschool of fish\u201d chain&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Haemophilus ducreyi presents with painful genital ulcers and suppurative lymphadenopathy. Gram stain reveals gram-negative rods with a \u201cschool of fish\u201d appearance. This patient\u2019s presentation is more consistent with acute cervicitis secondary to Neisseria gonorrhea or Chlamydia trachomatis.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T112410.374.png?w=700\" alt=\"The ultimate guide to the USMLE step 1: Everything you need to know\" class=\"wp-image-2044\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T112410.374.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T112410.374.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with vaginal discharge, spotting, dysuria, and a friable, erythematous cervix on clinical examination\u2013suggestive of<strong>&nbsp;acute cervicitis<\/strong>. The most common causes of acute cervicitis include&nbsp;<em><strong>Neisseria gonorrhea<\/strong><\/em>&nbsp;and&nbsp;<em><strong>Chlamydia trachomatis<\/strong><\/em>.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In patients with female genitalia, infection with&nbsp;<em>Neisseria gonorrhea<\/em>&nbsp;presents with purulent or mucopurulent cervical discharge and\/or vaginal bleeding. Physical examination findings include a friable, erythematous cervix with&nbsp;<strong>copious purulent discharge<\/strong>. Diagnostic studies include a gram stain and culture of vaginal fluid or an endocervical sample with microscopy and culture. A gram stain will demonstrate&nbsp;<strong>gram-negative diplococci within polymorphonuclear leukocytes.<\/strong>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>NAAT (nucleic acid amplification test)<\/strong>&nbsp;is indicated in the diagnostic evaluation of acute cervicitis to evaluate for the presence of both&nbsp;<em>Neisseria gonorrhea<\/em>&nbsp;and&nbsp;<em>Chlamydia trachomatis<\/em>, which cannot be detected with traditional gram stain and culture. The presentation of cervicitis due to&nbsp;<em>Neisseria gonorrhea<\/em>&nbsp;is similar to that caused by&nbsp;<em>Chlamydia trachomatis<\/em>, although gonorrhea involvement is more likely to cause purulent or mucopurulent discharge. Because coinfection with the two pathogens is common, symptomatic patients are empirically treated for both with intramuscular ceftriaxone and a macrolide or tetracycline (doxycycline).&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Meanwhile, in patients with male genitalia, infection with&nbsp;<em>Neisseria gonorrhoeae<\/em>&nbsp;results in urethritis and copious urethral discharge. Patients may have additional symptoms of dysuria, increased urinary frequency, and pruritus. Diagnostic workup similarly involves gram stain, culture and NAAT evaluation of a urethral sample.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Neisseria gonorrhoeae can cause urethritis in patients with male genitalia and acute cervicitis in patients with female genitalia. Diagnostic evaluation may detect the presence of gram-negative diplococci within polymorphonuclear lymphocytes. NAAT (nucleic acid amplification test) testing is the diagnostic test of choice for both&nbsp;<em>Neisseria gonorrhea<\/em>&nbsp;and&nbsp;<em>Chlamydia trachomatis<\/em>&nbsp;infections, which often occur simultaneously.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">McCormack WM, Stumacher RJ, Johnson K, Donner A.&nbsp;<em>Clinical spectrum of gonococcal infection in women<\/em>. Lancet. 1977 Jun 4;1(8023):1182-5. doi: 10.1016\/s0140-6736(77)92720-9. PMID: 68279.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Barlow D, Phillips I.&nbsp;<em>Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects. Lancet<\/em>. 1978 Apr 8;1(8067):761-4. doi: 10.1016\/s0140-6736(78)90870-x. PMID: 76760.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Platt R, Rice PA, McCormack WM.\u00a0<em>Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea<\/em>. JAMA. 1983 Dec 16;250(23):3205-9. PMID: 6417362.<em><strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0_________________________<\/strong><br><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your\u00a0<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\"><img loading=\"lazy\" decoding=\"async\" height=\"366\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd7ad3.png?w=1024\" alt=\"The most powerful platform for learning medicine. Try it free today\" class=\"wp-image-2092\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd7ad3.png 1400w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd7ad3.png?resize=300,107 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd7ad3.png?resize=768,274 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd7ad3.png?resize=1024,366 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong><a href=\"https:\/\/www.osmosis.org\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/strong><\/em><br><em><strong><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case involves a 22-year-old woman who was diagnosed with herpes simplex genital infection two months ago.&nbsp;Speculum examination reveals mucopurulent discharge and a friable erythematous cervix. Cervical motion tenderness is absent. Which of the following findings is most [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":2083,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1369,44],"tags":[],"class_list":["post-2073","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Gonorrhea - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gonorrhea\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Gonorrhea - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case involves a 22-year-old woman who was diagnosed with herpes simplex genital infection two months ago.&nbsp;Speculum examination reveals mucopurulent discharge and a friable erythematous cervix. Cervical motion tenderness is absent. 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