For a 22-year-old man with signs of gonorrhea, what is the next best course of action for diagnosis?

The next best course of action for diagnosing gonorrhea in a 22-year-old man presenting with signs of the infection is to perform a NAAT (Nucleic Acid Amplification Test) assay of the penile discharge. This approach is appropriate because NAATs are highly sensitive and specific for the detection of Neisseria gonorrhoeae, the bacteria responsible for gonorrhea.

NAATs can detect the genetic material of the organism, making them more reliable compared to traditional methods, especially when considering asymptomatic infections. This type of testing can be conducted using urine or swab specimens from sites of infection, with results that are generally available quickly.

Additionally, while a Gram stain of penile discharge can provide useful information and results may be available almost immediately, it has a lower sensitivity and specificity compared to NAAT assays, especially in asymptomatic individuals (which could lead to false negatives). Urine cultures are another diagnostic tool; however, NAATs are preferred in most guidelines for their higher accuracy. Lastly, suggesting no further diagnostic testing does not adequately address the need to confirm the diagnosis of gonorrhea, which is crucial for proper treatment and preventing complications. Thus, opting for the NAAT assay is the best practice for accurate diagnosis