Diagnosis and treatment of Neisseriae Infection
In acute gonoccocal disease, stained smears of fresh exudate will often reveal the presence of intracellular gram-negative diplococci. This finding, together with a convincing clinical history may permit the physician to make the provisional diagnosis of acute gonorrhoea and institute antibiotic therapy. Wherever possible, the exudate should be cultured for gonococci before treatment. The diagnosis is established by the recovery of typical gram-negative oxidase-positive diplococci that ferment glucose but not maltose, sucrose or lactose. Rectal cultures are sometimes positive when urethral and cervical cultures are negative. Because gonococci are not hardy, specimens should be cultured immediately or placed in special transport media. Penicillin is the drug of choice but resistance is being increasingly encountered. Tetracycline may be used instead with the added bonus that it is effective against chlamydia.