A 28-year-old woman was admitted to a Wisconsin hospital with a 1-week history of arthritis of the left knee. Four days later, a 32-year-old man was examined for a 2-week history of urethritis and a swollen, painful left wrist. A 20-year-old woman seen in a Philadelphia hospital had pain in the right knee, left ankle, and left wrist for 3 days. Pathogens cultured from synovial fluid or urethral culture were gram-negative diplococci that required proline to grow. Antibiotic sensitivity tests gave the following results:
Antibiotic | MIC Tested (μg/ml) | Susceptible MIC (μg/ml) | |
Cefoxitin | 0.5 | ≤2 | |
Penicillin | 8 | ≤0.06 | |
Spectinomycin | 64 | ≤32 | |
Tetracycline | 4 | ≤0.25 |
What is the pathogen, and how is this disease transmitted? Which of the antibiotics should be used for treatment? What is the evidence that these cases are related?
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