Gonorrhea is a purulent infection of the genitourinary system caused by Neisseria gonorrhoeae. It is one of the most common sexually transmitted diseases, primarily manifesting as gonococcal urethritis and cervicitis. The gonococcus can also spread locally from the urethra or cervix, causing epididymitis and pelvic inflammatory disease; it can also disseminate through the bloodstream, leading to disseminated gonorrhea. Additionally, it can cause infections in the eyes, throat, and rectum. Some individuals may be infected with gonococcus without showing clinical symptoms, known as asymptomatic gonorrhea.

bubble_chart Etiology

Humans are the only host of gonococcus. Gonococci are not pathogenic to lower animals. Attempts have been made multiple times to transplant pus containing gonococci from human urethra into rabbit eyes to induce gonococcal conjunctivitis, but these efforts have consistently failed, indicating that humans lack the ability to kill gonococci. Therefore, gonococci can only infect humans and have no invasive capability against lower animals.

bubble_chart Clinical Manifestations

It usually occurs after acute urethritis and is mostly unilateral. Symptoms include low-grade fever, swollen and painful epididymis, referred cramping pain in the ipsilateral groin and lower abdomen. Initially, the boundary with the testis is clear but gradually becomes indistinct. The testis is tender, swollen, and extremely sensitive to touch. The urine is often turbid. Concurrent prostatitis and seminal vesiculitis may also be present.

bubble_chart Treatment Measures

Principles of treatment:

1. Early diagnosis and early treatment;
2. Timely, adequate, and standardized medication;
3. Adopt different treatment methods according to different conditions;
4. Track and treat sexual partners simultaneously;
5. Follow-up and re-examination after treatment;
6. Pay attention to concurrent infections such as chlamydia, mycoplasma, and other STDs.

Treatment plans:

(1) Gonococcal urethritis and cervicitis: Procaine penicillin G, 4.8 million units added to 100 ml of normal saline for intravenous drip; or ampicillin 4.0 g taken orally once, or administered via intravenous drip; or amoxicillin 4.0 g administered at draught. For penicillinase-producing Neisseria gonorrhoeae (PPNG), i.e., penicillin-resistant gonococci, when the prevalence of penicillin-resistant gonococci reaches 5% or higher, sulbactam sodium should be added to penicillin. Other alternative drugs include:

1. Cephalosporins, ceftriaxone 3.0 g for intravenous drip, cefotaxime sodium 4.0 g for intravenous drip.
2. Spectinomycin, also known as Trobicin, 2 g intramuscular injection once, with some advocating 4 g intramuscular injection once for females.
3. Quinolones: Ofloxacin, also known as Tarivid, 600 mg taken orally once; or ofloxacin 200 mg for intravenous drip.
4. β-lactamase inhibitors combined with penicillin drugs, Unasyn as a combination of penicillin sulbactam and ampicillin, 1.5 g intramuscular injection once; Timentin as a combination of piperacillin sodium and sulbactam sodium, 3.0 g intramuscular injection or intravenous drip once.

Since some gonorrhea patients also have concurrent chlamydia infections, we commonly use ceftriaxone sodium 3.0 g for intravenous drip, oral azithromycin, or roxithromycin 250 mg twice daily in treatment.

(2) Gonococcal pharyngitis: Ceftriaxone sodium 3.0 g for intravenous drip; or ofloxacin 250 mg taken orally three times daily, or compound formula sulfamethoxazole 1 g/dose, twice daily for 7 days.

(3) Gonococcal proctitis: Ceftriaxone sodium 3.0 g for intravenous drip, or Rocephin 3.0 g for intravenous drip, or Tazocin 3.0 g for intravenous drip.

(4) Gonococcal conjunctivitis in adults: Aqueous penicillin G 10 million units for intravenous drip once daily for 5 days.

(5) Pediatric gonorrhea: For children weighing ≥45 kg, administer adult doses. Weight <45kg的兒童按以下方法給藥：頭孢曲松鈉125mg，一次肌肉注射；或樂施福定25mg/kg，一次肌肉注射；或壯觀黴素40mg/kg，一次肌肉注射。

(6) Complicated gonorrhea:

1. Gonorrhea complicated with salpingitis, epididymitis, or seminal vesiculitis: Aqueous procaine penicillin G 4.8 million units for intravenous drip twice daily for 7 days. For PPNG-induced cases, Timentin 3.0 g once daily for 7 doses, spectinomycin 2 g intramuscular injection once daily for 10 days, or ceftriaxone sodium, Tazocin, or Rocephin 3.0 g for intravenous drip once daily for 7 days.
2. Disseminated gonorrhea: Aqueous penicillin G 10 million units for intravenous drip once daily for 7 days, or ceftriaxone sodium 3.0 g for intravenous injection once daily for 7 days.