Patient's question:
Is there any magical cure for the root cause?First question supplement: My current situation is that even with a condom during sex, yellow discharge still comes out. However, after taking Sumetham and Fosfomycin twice, it stopped. Two days ago, I took the medicine again, and now there's no discharge. This has happened repeatedly like this, and it seems like it's not treating the root cause. Gonorrhea
Doctor's answer:
Hello, the treatment of gonorrhea should follow the principle of early detection, early diagnosis, and early treatment, with adequate medication and regular dosing.(1) General treatment: Acute-phase gonorrhea patients should rest in bed, maintain a calm mood, avoid spicy and irritating foods and alcohol, refrain from sexual activity, and avoid strenuous exercise. Keep the external genital area clean and change and disinfect underwear and pants promptly.
(2) Medication treatment
① Gonococcal urethritis and cervicitis:
- Oral ciprofloxacin 800–1000 mg once daily for 3 consecutive days;
- Or ciprofloxacin 500 mg twice daily for 3 consecutive days.
Contraindicated in patients with liver and kidney dysfunction, pregnant women, children, and adolescents under 18.
- Alternatively, ceftriaxone 0.5–1 g once daily by intramuscular injection for 3 consecutive days;
- Or cefotaxime 1 g once daily by intramuscular injection for 3 days;
- Or spectinomycin 4 g once daily by intramuscular injection for 3 days.
If the strain of Neisseria gonorrhoeae is penicillin-sensitive, use procaine penicillin 4.8 million units once daily by intramuscular injection, with 2.4 million units injected into each buttock, for 3 consecutive days;
- Or oral amoxicillin 3 g once daily for 3 days.
During treatment with these drugs, take probenecid 1 g as a single dose.
For patients allergic to the above drugs, options include:
- Doxycycline 100 mg orally twice daily for 14 days (contraindicated in pregnant women);
- Or erythromycin 500 mg four times daily for 14 days.
② Adult gonococcal conjunctivitis:
- Ceftriaxone 1 g once daily by intramuscular injection for 5 consecutive days;
- Or cefotaxime 1 g once daily by intramuscular injection for 5 days;
- Or spectinomycin 2 g twice daily for 5 days.
If the isolated strain of Neisseria gonorrhoeae is penicillin-sensitive, use aqueous penicillin G 10 million units intravenously once daily for 5 days.
During treatment, rinse the eyes with normal saline every 5–10 minutes. After the purulent discharge decreases, reduce the frequency to once every 0.5–1 hour. Apply 0.5% erythromycin ophthalmic ointment after rinsing.
③ Gonococcal pharyngitis:
- Ceftriaxone 1 g once daily by intramuscular injection for 3 days;
- Or oral ciprofloxacin 800 mg once;
- Or oral cotrimoxazole 1 g twice daily for 7 days.
Ampicillin, amoxicillin, and spectinomycin are ineffective for this condition.
④ Gonococcal rectitis:
- Ceftriaxone 1 g once daily by intramuscular injection for 3 days.
Ampicillin, amoxicillin, and tetracycline are ineffective for this condition.
⑤ Gonorrhea with complications:
- Ceftriaxone 1 g once daily by intramuscular injection for 10–15 days;
- Or spectinomycin 2 g once daily by intramuscular injection for 10–15 days;
- Or oral ofloxacin 200 mg three times daily for 10–15 days (contraindicated in patients with liver and kidney dysfunction, pregnant women, adolescents under 18, and children).
⑥ Disseminated gonorrhea:
- Ceftriaxone 1 g intravenously every 12 hours for 5 days, then switch to intramuscular injection 1 g once daily for 7 consecutive days;
- Or cefotaxime 1 g intravenously every 8 hours for 5 days, then switch to intramuscular injection 1 g once daily for 7 days.
For patients with meningitis or endocarditis, use ceftriaxone 1–2 g intravenously every 12 hours. For gonococcal meningitis, continue treatment for 2 weeks; for gonococcal endocarditis, treatment should last at least 4 weeks.
(3) Because gonorrhea often co-occurs with Chlamydia trachomatis infection, if the treatment for gonococcal cervicitis or urethritis is ineffective, continue taking doxycycline 100 mg twice daily for 7 days after treatment to prevent possible Chlamydia trachomatis infection. If the patient has gonorrhea with complications and also has Chlamydia trachomatis infection, the duration of doxycycline use should be extended to 100 mg orally twice daily for 15–21 days.
(4) Follow-up examination 4–7 days after treatment.