26malik
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A 22-year-old woman presents with a 1-week history of mild lower abdominal pain and a yellowish vaginal discharge. She describes the pain as dull in nature, relieved slightly by acetaminophen and worsened by intercourse. Pelvic examination reveals a red, swollen cervix without motion tenderness. The mucosa is friable. Potassium hydroxide (KOH) mount is negative, and wet mount does not reveal clue cells. Gram's stain of the exudate reveals gram-negative cocci. Which of the following procedures would most likely lead to the correct diagnosis?
A. Culture the blood on Thayer-Martin agar
B. Order DNA probe assays of endocervical exudates
C. Order serologic tests to identify specific capsular antigens
D. Order the germ tube test
E. Order the rapid plasma reagin (RPR) test
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| Rana Khan
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A
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| tolito
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A.
n.gon causes cervicitis and PID. we have r/o candida and g.vag. gonorr is the second most common STD. so i will go for NG culture.
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| tolito
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hey, did not see 'blood'!!! A is not answer!!!!
i give up cos i have read only 70 pages!!! will give answer when i have read more.
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| tolito
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B.
OKAY answer not in mrs but in mmi!!! now i am getting worried about text to read for micro.
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| robin082006
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I remembered that This q has been discussed and answer is B.
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| disha
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B IS THE ANSWER BCOZ DNA PROBE IS THE FASTEST AND MOST CONVENIENT METHOD TO DIAGNOSE NEISSERIA INFECTION.
THIS IS INFECTION BY NEISSERIA GONORRHEA.
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| 26malik
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The correct answer is B. 
The symptoms suggest infection with Neisseria gonorrhoeae; however, with Gram's stain results alone, it is not possible to distinguish the gonococcus from normal flora organisms such as Acinetobacter, unless gram-negative diplococci are found within polymorphonuclear leukocytes. The fastest and most reliable assay specific for diagnosis of gonorrhea is the use of commercial DNA probes, with results available in 2-4 hours.
Culture on Thayer-Martin medium (choice A) is indeed the choice for culture of N. gonorrhoeae, but would yield slower results, and therefore be a secondary choice.
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| bactitech
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Don't assume your lab will run the DNA probes continuously. We are a very large lab that does the work for four hospitals. We do not run these tests on weekends. We batch test them on day shift M-F only, as they are expensive to run. They are not considered a STAT test. Theoretically, if you cultured for GC on a Friday night at our place, you could have a culture result by Sunday or Monday. However, the DNA test is much more sensitive and can detect lower numbers of organisms. They also have the great advantage of being able to test for GC and Chlamydia with the same specimen. Chlamydia is very difficult to grow in culture, so the DNA test is a great advantage. We also have many more tests positive for Chlamydia than GC.
Many smaller facilities don't do the DNA probe test. They either still culture or send out the probes to another laboratory. It's worth a call to your laboratory to check out TAT.
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