Chapter 26, Problem 2CAE

A 28-year-old woman was admitted to a Wisconsin hospital with a 1-week history of arthritis of the left knee. Four days later, a 32-year-old man was examined for a 2-week history of urethritis and a swollen, painful left wrist. A 20-year-old woman seen in a Philadelphia hospital had pain in the right knee, left ankle, and left wrist for 3 days. Pathogens cultured from synovial fluid or urethral culture were gram-negative diplococci that required proline to grow. Antibiotic sensitivity tests gave the following results:

Antibiotic	MIC Tested (μg/ml)		Susceptible MIC (μg/ml)
Cefoxitin	0.5		≤2
Penicillin	8		≤0.06
Spectinomycin	64		≤32
Tetracycline	4		≤0.25

What is the pathogen, and how is this disease transmitted? Which of the antibiotics should be used for treatment? What is the evidence that these cases are related?