bubble_chart Overview

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, or 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

Disease cause: Humans are the only host of gonococcus. Gonococcus lacks pathogenicity in lower animals. Multiple attempts to transplant pus containing gonococci from human urethra into rabbit eyes to induce gonococcal conjunctivitis have consistently failed, indicating that humans lack the ability to kill gonococci. Therefore, gonococci can only infect humans and have no invasive capability in lower animals.

bubble_chart Diagnosis

Symptoms: Acute prostatitis is caused by gonococci entering the excretory ducts and glands of the prostate, presenting with fever, chills, perineal pain, and urinary tract infection symptoms such as dysuria. Upon examination, the prostate is swollen and tender. However, gonococci are not a common cause of acute prostatitis. Gonococcal prostatitis primarily manifests as a chronic sexually transmitted condition, with mild symptoms including perineal discomfort, penile pain, and a "sticky" urethral discharge in the morning. Gonorrheal threads may be observed in the urine, and prostatic massage fluid shows pus cells and reduced lecithin. Gonococci can be identified via smear or culture. Digital rectal examination may reveal small nodules on the prostate, accompanied by discomfort or pain. Scarring and contraction near the excretory ducts due to pus expulsion can impair ejaculation, leading to infertility.

bubble_chart Treatment Measures

1. Treatment Principles:

   (1) Early diagnosis and early treatment;

   (2) Timely, adequate, and standardized medication;

   (3) Adopt different treatment methods according to varying conditions;

   (4) Track and treat sexual partners simultaneously;

   (5) Follow-up and re-examination after treatment;

   (6) Pay attention to possible concurrent infections such as chlamydia, mycoplasma, and other STDs.

2. Treatment Plan:

   (1) Gonococcal urethritis and cervicitis: Procaine penicillin G, 4.8 million units added to 100 ml of saline for intravenous drip; or ampicillin 4.0 g taken orally once, or administered via intravenous drip; or amoxicillin 4.0 g administered at once. Choose one of the three drugs above. For those allergic to penicillin, tetracycline 0.5 g/dose can be taken every 6 hours for 7 days; erythromycin-class drugs such as Lijunsha, azithromycin, or roxithromycin can be taken as instructed for 7 days.

For penicillinase-producing Neisseria gonorrhoeae (PPNG), i.e., penicillin-resistant gonococci, when the prevalence of penicillin-resistant gonococci exceeds 5%, penicillin should be combined with sulbactam sodium. Alternatively, other drugs may be selected.

1. Cephalosporins: ceftriaxone 3.0 g intravenous drip, cefotaxime sodium 4.0 g intravenous drip.
2. Spectinomycin, also known as Trobicin, 2 g intramuscular injection once; some recommend 4 g intramuscular injection once for females.
3. Quinolone drugs: ofloxacin, also called Tarivid, 600 mg taken orally once; or ofloxacin 200 mg intravenous drip.
4. β-lactamase inhibitors combined with penicillin drugs: Unasyn, a combination of penicillin sulbactam and ampicillin, 1.5 g intramuscular injection once; Timentin, 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 intravenous drip, oral azithromycin, or roxithromycin 250 mg twice daily in treatment.