Methicillin-resistant Staphylococcus aureus non-gonococcal urethritis.

A 25-year-old unmarried man presented with urethral discharge and pain during micturition for the last 2 days. He had had a single unprotected penovaginal sexual encounter with a female sexworker 5 days earlier. He had a history of many heterosexual exposures with multiple partners during the past 5 years, but no history of any previous sexually transmitted diseases. Examination revealed copious, purulent urethral discharge with marked erythema and oedema of the meatus, prepuce and penile skin. Gram-stained urethral smear showed many polymorphonuclear cells, gram-positive cocci but no Gramnegative diplococci. Urethral discharge cultures were put on Modi®ed Thayer-Martin medium, Chocolate agar, MacConkey agar and Brain Heart Infusion agar supplemented with haemin and vitamin K. Cultures were negative for Neisseria gonorrhoeae. Pure growth of Staphylococcus aureus was obtained, and showed antimicrobial resistance to penicillin, tetracycline, erythromycin, chloramphenicol, streptomycin, cephalexin, ceftriaxone, oxacillin and susceptibility to amikacin and vancomycin by stokes disc diffusion technique. The organism also demonstrated b lactamase production, NCCLS breakpoint oxacillin MIC of w2 mg/ml and susceptibility to amoxycillinclavulanic acid (augmentin) disc thus indicating a low level methicillin resistance probably due to hyperproduction of b lactamase (2). Chlamydia trachomatis antigen detection by DIF test was negative. VDRL and TPHA were non-reactive and ELISA for HIV I and II was negative. The patient was given ceftriaxone 250 mg i.m. and showed no response when seen after 48 h. He was, then, treated with 2 tablets orally of amoxycillin 250 mg with clavulanic acid 125 mg (augmentin) every 8 h with marked improvement in symptoms and signs within 48 h and continued the medication for 10 days with clinical and microbial clearance both on smear and culture. His sexual partner did not attend for examination.