American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary diagnostic approach for suspected disseminated gonococcal infection (DGI)?

1. Urine analysis

2. Blood cultures

3. X-ray imaging

4. Serologic testing

The correct answer is: Blood cultures

The primary diagnostic approach for suspected disseminated gonococcal infection (DGI) is through blood cultures. This is because DGI can cause systemic symptoms and complications, indicating that the causative organism (Neisseria gonorrhoeae) has spread beyond the genitourinary tract into the bloodstream. Blood cultures allow for the direct isolation of the bacterium from the bloodstream, confirming the diagnosis of DGI. Culturing the organism is critical since DGI can present with a variety of clinical manifestations, including arthritis, dermatitis, and tenosynovitis, which might not directly be linked to a visible infection at another site that is usually sampled. In contrast, urine analysis is primarily useful for diagnosing localized gonococcal infections, not for systemic infections. X-ray imaging can help evaluate joint involvement or other complications, but it does not provide a definitive diagnosis of DGI. Serologic testing is generally not used for acute diagnosis of gonorrhea since it detects antibodies rather than the presence of the organism itself. Therefore, blood cultures are the most effective and reliable diagnostic method for confirming disseminated gonococcal infection.