Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae that can infect the urethra, cervix, rectum, throat and eyes. Men often have clear symptoms while women often have none, and resistance to antibiotics shapes current treatment.
Key symptoms
- Thick yellow or green discharge from the penis
- Burning with urination
- Vaginal discharge, bleeding between periods or pelvic pain
- Rectal pain or discharge, or sore throat after oral sex
- Often no symptoms, mostly in women
What you find on exam
- Purulent urethral discharge
- Friable cervix with discharge; cervical motion tenderness suggests pelvic inflammatory disease
- Tender, swollen epididymis
- Hot, swollen joint or tendon sheath
- Small pustules on the hands or feet
Tests
- NAAT on first-catch urine or a vaginal swab
- Throat and rectal NAAT based on sexual history
- Culture with susceptibility testing if treatment fails; joint fluid if arthritis
- Test for chlamydia, HIV and syphilis
Treatment basics
- Ceftriaxone 500 mg IM single dose, 1 g if 150 kg or more
- Add doxycycline for 7 days if chlamydia is not ruled out
- Treat recent partners and avoid sex for 7 days
- Test of cure 7 to 14 days after treatment for throat infection
- Retest about 3 months after treatment
Red flags
- Fever with a hot, swollen joint or skin pustules
- Pelvic pain with fever
- Pus from a newborn's eyes
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.