title: A misleading urethral smear with polymorphonuclear leucocytes and intracellular diplococci; case report of urethritis caused by Neisseria meningitidis.
abstract: The primary pathogens found in men with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Rapid diagnosis of N. gonorrhoeae infection can be made based on a Gram- or methylene blue-stained urethral smear. We describe a case of a man with purulent penile discharge, in which microscopic examination led to the presumptive diagnosis of gonorrhoea. A nucleic acid amplification test was negative for N. gonorrhoeae but positive for C. trachomatis. Culture showed Gram-negative diplococci which were identified as Neisseria meningitidis. N. meningitidis can be sporadically pathogenic in the genito-urinary tract and mimicks gonococcal urethritis, and appears identical by microscopy. When a gonococcal urethritis is suspected based on clinical signs and microscopic examination, but investigatory tests cannot confirm the diagnosis, a N. meningitidis infection should be considered.
authors.affiliation: Department of Dermatology, Roosevelt Clinic, Leiden, The Netherlands.|Municipal Health Services of The Hague, Sexually Transmitted Disease Clinic, The Hague, The Netherlands.|Department of Dermatology, LUMC, Leiden, The Netherlands.
authors.forename: R E
authors.initials: RE
authors.lastname: Genders
authors.affiliation: Municipal Health Services of The Hague, Sexually Transmitted Disease Clinic, The Hague, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Spitaels
authors.affiliation: Department of Medical Microbiology, Medical Center Haaglanden Westeinde Hospital, The Hague, The Netherlands.
authors.forename: C L
authors.initials: CL
authors.lastname: Jansen
authors.affiliation: Department of Dermatology, Medical Center Haaglanden Westeinde Hospital, The Hague, The Netherlands.
authors.forename: Th W
authors.initials: TW
authors.lastname: van den Akker
authors.affiliation: Department of Dermatology, LUMC, Leiden, The Netherlands.
authors.forename: K D
authors.initials: KD
authors.lastname: Quint
mesh_terms: D002690:Chlamydia Infections / Q000175:diagnosis / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D006069:Gonorrhea / Q000175:diagnosis / Q000382:microbiology; D006801:Humans; D008297:Male; D008585:Meningitis, Meningococcal / Q000175:diagnosis* / Q000382:microbiology; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D009345:Neisseria meningitidis / Q000302:isolation & purification*; D009504:Neutrophils / Q000382:microbiology*; D014521:Urethra / Q000382:microbiology*; D014526:Urethritis / Q000175:diagnosis / Q000382:microbiology