Case Study #9: A 22-year-old woman presents at the walk-in health clinic with slightfever (38.5C), a complaint of frequent urination, burning on urination, vaginal dischargeand a small lesion on the labia. The woman reported that she was moderately sexuallyactive and had three sexual partners in the past six months. Her last sexual contactswere about 7 days earlier. She had developed mild symptoms about 5 days earlier,beginning with a discharge from the vagina. She began having pain on urination about 3days earlier. Urine analysis revealed a pH of 8.2, some white cells and a few red bloodcells. There was protein in the urine. A smear of the vaginal secretion showed a numberof Gram-negative cocci mainly in pairs.1. What is your presumptive diagnosis for this patient?2. What is the name of the most likely causative bacterium?3. What clinical features are critical to your diagnosis?4. Lab test(s) to confirm diagnosis? Expected results?

Details from the question about the patient: fever (38.5C), frequent urination, burning on urination, vaginal discharge a small lesion on the labia. moderately sexually active Urine pH of 8.2, some white cells and a few red blood cells and protein. Gram-negative cocci in urine smear.1. From the symptoms the disease Gonorrhea is diagnosed. Gonorrhea is a sexually transmitted disease caused by a gram negative bacteria. 2. It is caused by Neisseria gonorrhoeae bacterium which is a gram negative diplococci. 3. Clinical features Frequent urination (dysuria) Burning on urination Vaginal discharge Lesion on labia Gram negative stain 4. Gonorrhea nucleic acid amplification testing. This test detects the genetic material of the N. gonorrhoeae. It is considered the optimal test for gonorrhea infection. This test can be performed on a sample of urine or a swab taken from a site of potential infection. Expected result - If in the sample N. gonorrhoeae bacteria is detected then the patient is positive for the infection. If the genetic material of the bacteria is not detected then the patient is negative for the infection.