Gram-negative cocci that occur in pairs with their adjacent sides flattened, giving them a "coffee bean" appearance, are typical of the genus Neisseria. The presence of intracellular gram-negative diplococci on a smear made from a purulent urethral discharge from a male can be confirmatory of the diagnosis of gonorrhea. In this case, cultures may not even be needed unless susceptibilities are required. However, if the genital specimen is from a female (cervical specimen), the presence of gram-negative diplococci is not specific enough to confirm the diagnosis, and a culture or other confirmatory testing must be performed. Organisms such as Acinetobacter sp. and Moraxella sp. may mimic the appearance of N. gonorrhoeae and can lead to false-positive results.
Direct smears read specifically for the presence of Neisseria gonorrhea should include a direct reference to gram-negative intracellular diplococci.