An increasing number of pediatricians are following their young patients throughout adolescence. For that reason, I would like to add one more cause of hematuria to the list developed by Kaplan: gonococcal infection. Gonorrhea is the second most common cause of gross hematuria in adults. Recently, our group had the opportunity to describe this same condition in male adolescents. It is important to suspect that gonorrhea may be the cause of macroscopic hematuria in otherwise healthy, sexually active adolescent males who on history or physical examination demonstrate purulent urethral discharge, dysuria, or both. The toxic action of Neisseria gonorrhoeae on the urethral epithelium is sufficient cause to explain the hematuria. A follow-up visit, one week after treatment with 4.8 million units of procaine penicillin and 1 gm of probenecid (or 3 gm of amoxicillin and 1 gm of probenecid) should show resolution of symptoms and clearing of the macrohematuria. Further work-up is needed only if symptoms have not cleared at the time of the test-for-cure visit.

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