American Board of Internal Medicine (ABIM) Certification Practice Exam

What causes acute hyperpurulent ocular discharge in a sexually active adult?

1. Chlamydia trachomatis

2. Neisseria gonorrhoeae

3. Herpes simplex virus

4. Staphylococcus aureus

The correct answer is: Neisseria gonorrhoeae

Acute hyperpurulent ocular discharge in a sexually active adult is most commonly caused by Neisseria gonorrhoeae. This organism is a significant cause of bacterial conjunctivitis, particularly in individuals who are sexually active. The discharge is typically profuse, purulent, and can occur rapidly, often associated with conjunctival redness and inflammation. Neisseria gonorrhoeae can lead to a severe form of conjunctivitis known as gonococcal conjunctivitis, which can be particularly dangerous, as it may result in corneal ulceration and blindness if not treated promptly. It is usually seen in cases where there has been direct contact with the bacteria, often during sexual activities, which is why its association with sexually active individuals is pertinent. In contrast, while Chlamydia trachomatis can also cause conjunctivitis, especially in neonates or through autoinoculation, it typically results in a less purulent discharge compared to that seen with Neisseria gonorrhoeae. Herpes simplex virus would cause a different clinical picture, often presenting with vesicular lesions and possibly keratitis rather than hyperpurulent discharge. Staphylococcus aureus, while capable of causing conjunctivitis, does not typically present in the extreme purulent form that