December 3, 2021





Often, gonorrhea has no symptoms. Most people are not aware that they have the infection — especially women.
Four out of five women with gonorrhea have no gonorrhea symptoms.
One out of 10 men with gonorrhea has no gonorrhea symptoms.
If you do get gonorrhea symptoms, they may begin in as little as 1–14 days after you got the infection.
Gonorrhea symptoms in women
● abdominal pain
● bleeding between menstrual periods
● fever
● menstrual irregularities
● painful intercourse
● painful urination
● swelling or tenderness of the vulva
● the urge to urinate more than usual
● throwing up
● yellowish or yellow-green vaginal discharge
Gonorrhea symptoms in men
● pus-like discharge from the penis
● pain or burning feeling while urinating
● more frequent urination than usual

In both women and men, gonorrhea may cause the anus to itch. It can also result in a discharge and painful bowel movements. 
Itching and soreness of the throat with trouble swallowing may be symptoms of an oral infection. 
Nine out of 10 oral infections show no symptoms at all.

To diagnose gonorrhea, your doctor will use a swab to take a sample of fluid from the urethra in men or from the cervix in women.
The specimen will then be sent to a lab to be analyzed. 
You also may be given a throat or anal culture to see if the infection is in your throat or anus.
 There are other tests which check a urine sample for the presence of the bacteria. 
You may need to wait for several days for your tests to come back from the lab.

Therapy typically is administered before antimicrobial susceptibilities are known. The choice of which regimen to use should be based on the national prevalences of antibiotic-resistant organisms. 
Nationwide, strains of gonococci that are resistant to penicillin, tetracycline, or ciprofloxacin have been increasingly observed. 
Consequently, these drugs can no longer be considered first-line therapy. All sexual partners should be treated and tested for HIV infection and syphilis, as should the patient.
A. Uncomplicated Gonorrhea
Treatment for gonorrhea should include a higher dose of intramuscular ceftriaxone in combination with a second drug (azithromycin or doxycycline) regardless of concern for possible secondary infection with chlamydia. 
For uncomplicated gonococcal infections of the cervix, urethra, and rectum, the recommended treatment is ceftriaxone (250 mg intramuscularly) plus either azithromycin (1000 mg orally as a single dose) or doxycycline (100 mg twice daily for 7 days). 
In cases where an oral cephalosporin is the only option, cefixime, 400 mg orally as a single dose, can be combined with azithromycin or doxycycline as above but a “test of cure” is recommended 1 week after treatment. Fluoroquinolones are no longer recommended for treatment due to high rates of microbial resistance. 
Spectinomycin, 1 g intramuscularly once, may be used for the penicillin-allergic patient but is not currently available in the United States.
Pharyngeal gonorrhea is also treated with ceftriaxone (250 mg intramuscularly) plus either azithromycin (1000 mg orally as a single dose) or doxycycline (100 mg twice daily for 7 days). All women should have a pregnancy test before a tetracycline (such as doxycycline) is prescribed.
B. Treatment of Other Infections
Disseminated gonococcal infection should be treated with ceftriaxone, 1 g intravenously daily, until 48 hours after improvement begins, at which time therapy may be switched to cefixime, 400 mg orally daily to complete at least 1 week of antimicrobial therapy. 
An oral fluoroquinolone (ciprofloxacin, 500 mg twice daily, or levofloxacin, 500 mg once daily) for 7 days also is effective, provided the isolate is susceptible. 
Endocarditis should be treated with ceftriaxone, 2 g every 24 hours intravenously, for at least 3 weeks. Postgonococcal urethritis and cervicitis, which are usually caused by chlamydia, are treated with a regimen of erythromycin, doxycycline, or azithromycin as described above.
Pelvic inflammatory disease requires cefoxitin, 2 g parenterally every 6 hours, or cefotetan, 2 g intravenously every 12 hours plus doxycycline 100 mg every 12 hours. 
Clindamycin, 900 mg intravenously every 8 hours, plus gentamicin, administered intravenously as a 2-mg/kg loading dose followed by 1.5 mg/kg every 8 hours, is also effective.
 Ceftriaxone 250 mg intramuscularly as a single dose (or cefoxitin, 2 g intramuscularly, plus probenecid, 1 g orally as a single dose) plus doxycycline, 100 mg twice a day for 14 days, with or without metronidazole, 500 mg twice daily for 14 days, is an effective outpatient regimen.
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