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Gonorrhea: Treatment, Procedure, Cost and Side Effects

What is the treatment? How is the treatment done? Who is eligible for the treatment? (When is the treatment done?) Who is not eligible for the treatment? Are there any side effects? What are the post-treatment guidelines? How long does it take to recover? What is the price of the treatment in India? Are the results of the treatment permanent? What are the alternatives to the treatment?

What is the treatment?

Treatment for gonorrhoea can be done by using oral and injectable antibiotic prescribed by your doctor. It is also important for your sexual partners to be test and treated too even if there are no symptoms evident in him/her. This is because if the partner is also infected but not treated along with you, you might get re-infected. After the patient has been diagnosed with gonorrhoea, decision has to make for whether the patient has to be hospitalised to be treated as an outpatient. Males are always treated as outpatient for their genital infection. But if they come with complications like gonococcal arthritis or gonococcal infection (DGI), hospitalisation would be required. This decision making is q little difficult in females because of high risk of complications. Female with pelvic inflammatory disease (PID) or similar complications are normally avoided by doctor for treatment because of high rate of reinfection, poor follow-up and noncompliance. Gonorrhoea can also be treated by surgical procedures. Patient must not share their medication with another patient with gonorrhoea because the treatments are individual and damage type specific. Re-evaluation might be required if even after the commencement of the treatment, symptoms continue to prevail. Infants may also require medication for conjunctivitis or any other eye disease which may be caused due to the mother’s gonorrhoeal infection.

How is the treatment done?

Gonorrhoea is usually treated with dual therapy of antibiotics- azithromycin (Zmax , Zithromax) or doxycycline(Vibramycin, Monodox) and ceftriaxone. Also, the combination of either injectable gentamicin or oral gemifloxacin (Factive) and oral azithromycin has been proved very effective in the treatment of gonorrhoea. People who are allergic to ceftriaxone (cephalosporin antibiotics) find this combination of treatment beneficial. In the treatment of gonorrhoea, antimicrobial resistance is of growing concern thereby rendering successful treatment difficult. In case of complications like gonococcal arthritis, 1g of ceftriaxone as IV/IM daily coupled with a single dose of 1g azithromycin treatment should be given for a day or two after there has been improvement in the symptoms. The gonococcal conjunctivitis complication in adults can be treated by a single dose of azithromycin 1g PO and ceftriaxone 1g IM along with saline drip. Pelvic inflammatory disease due to gonorrhoea is effectively treated by a single dose of doxycycline 100mg PO BID and ceftriaxone 2g IM for a fortnight in combination with metronidazole 500mg PO BID. Therapy recommended for treating gonococcal epididymitis is a single dose of ceftriaxone 250mg with doxycycline 100mg twice orally every day for 10 consecutive days. For the treatment of gonococcal meningitis and endocarditis, it is advised to use azithromycin 1mg PO as a single dose with ceftriaxone 1-2g IV for every 12 to 24 hours. An alteration in the therapy and its duration must be consulted with your physician, patient’s medical response to the therapy and his/her antimicrobial susceptibility testing must be evaluated with utmost importance. The gonococcal meningitis and endocarditis have been recommended for specific number of days of parenteral therapy, that is, 10-14 days for meningitis and 4 weeks for endocarditis.

Who is eligible for the treatment? (When is the treatment done?)

People who get infected with Neisseria gonorrhoeae bacterium and have symptoms like burning with urination, testicular pain, penile discharge in men and vaginal discharge and bleeding other than in periods with pelvic pain in women are eligible for treatment. Also, the partners of the patients who may not show evident symptoms but might be infected with the bacteria must also go for a diagnostic test and thereafter for its treatment. A child born from a gonorrhoea infected woman may also get infected affecting its eyes developing a condition called ophthalmia neonatorum.

Who is not eligible for the treatment?

Diagnostic test for gonorrhoea must be accompanied by a pregnancy test in women and must be taken care that the treatments and medications are not given to the pregnant women.

Are there any side effects?

Side effects of medication by IV/IM include headache, nausea, pain and reddening of the injection spot and itching. Side effects of oral medications are usually mild abdominal pain, diarrhoea and nausea too. To be more specific, injection of ceftriaxone can cause several side effects like diarrhoea, weakness, pale skin, shortness of breath while exercising, tenderness, pain, warmth or hardness at the injection site. Some serious side effects can also be experienced like stomach ache and tenderness, heartburn, nausea, vomiting, rashes on the body stomach cramps, watery stools with blood, fever, chest pain, painful and decreased urination, pain below the ribs, red, pink, brown or cloudy urine which can also be foul smelling, peeling and blistering of the skin, swelling of the legs, throat, tongue, seizures and difficulty in breathing and swallowing. The gonorrhoea bacterium has grown resistance towards certain drugs like penicillin and tetracyclines.

What are the post-treatment guidelines?

After the treatment is complete you must abstain from sexual contact for at least a week. This will surely reduce the risk of transmission of the disease to your partner. You should also advise your partner(s) to go for gonorrhoea diagnostic test and treatment at the same time. Condoms must be used while having sex or even during oral sex because the bacteria can infect the throat too. If symptoms persist after the treatment, doctor must be consulted soon to prevent the condition to get aggravated. A follow-up treatment done every 2-4 weeks is always good with ‘test of cure’ to be sure that you are completely clear of the bacteria or any sexually transmitted infection.

How long does it take to recover?

It normally takes a week to get rid of the infection completely meanwhile abstaining from sexual activity with your partner. In some cases where the patient suffer from bleeding between the periods, it takes almost another menstrual cycle to get completely rid of the bacteria and improve the bleeding issue.

What is the price of the treatment in India?

The cost of treatment for gonorrhoea can range from Rs.300 to Rs.2000 including consultation fees for the doctor. The STD test can be done for about Rs. 2050.

Are the results of the treatment permanent?

The treatment cannot be termed permanent because re-infection can occur as the transmission of the virus does not just depend upon one person’s hygiene. So, use of protection barriers like condoms must always be used during sexual intercourse to keep infection at bay.

What are the alternatives to the treatment?

Alternative treatment options for gonorrhoea are single dose of cephalosporin injection, cefoxitin or cefotaxime for urogenital and anorectal infections. Cephalosporin allergic patients can get different therapy with a single dose of gemifloxacin PO 320 mg with azithromycin 2g PO. Gentamicin 240 mhg IM with azithromycin 2g PO is also recommended for ones who are allergic to cephalosporin. In case of azithromycin allergy, doxycycline 100 mg PO BID can be prescribed for a week coupled with ceftriaxone.

Popular Questions & Answers

I am 26/f .had my last sex 4 months back. I noticed a gray patch outside vagina .no itching no discharge .no pain. Doctor said it was a hypopigmented keratinised patch and gave me nadibact plus for 2 weeks .but still it's present.

M.B.B.S, Post Graduate Diploma In Maternal & Child Health
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A patch should not be ignored. If it is fungal, anti fungal medication will work well but to be on the safe side, it is important to get venereal infection ruled out. Please get a vdrl test done. It is a simple blood test. Depending on the result ...

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M.B.B.S, MD - Psychiatry
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There are lots of possibilties with pimecrolimus ranging from a normal inflammatory state to an infective state. It's in your best interest to get it examined by a dermatologist to confirm the diagnosis so that a definite management plan can be fo...

Had sex with a masseuse. Used condom, but she did sucked my penis for about 30 seconds. We kissed tongue to tongue, 3-4 times. Took shower twice after all this. Washed my mouth with listerine. Any chance of getting hiv or other std’s.

M.B.B.S, MD - Psychiatry
Psychiatrist, Ghaziabad
Stds like chlamydia, herpes, gonorrhoea, syphilis and hpv can all be transmitted orally, meaning they can pass from one person's mouth to their partner's genitals or anus, or vice versa. It better to wait and watch for the symptoms as there is som...

My questions are described as below. 1. If one having chronic psychological stress "while" receiving primary series of anti rabies vaccination which is 5 arv doses on post exposure prophylaxis, will high level of cortisol hormone or this chronic psychological stress during those times prevent our immune system to mount a proper response to the vaccine? 2. I believe reduction of antibodies level overtime is a normal process. Chronic psychological stress will be elevated cortisol hormone, does this high level of cortisol or chronic psychological stress causes formerly protected level 0.5iu of rabies antibodies drop to unproductive level? (hope to understand more about antibodies during this event as I ever administered 5 doses of arv 3 years ago) 2. If one having protective rabies antibodies level 0.50iu or more, our antibodies kill the virus instantly once it's in site before it enters the nerve? How long does it take for our antibodies to kill the virus? Assume the virus already entered the nerve and spinal cord but it hasn't reached the brain will our antibodies still be able to kill it? 3. Will chronic psychological stress or high cortisol level affect or alter hepatitis c antibodies and hiv antibodies "seroconversion" process? (means production of antibodies affected therefore unable to properly seroconvert of antibodies due to severe level of stress or chronic psychological stress) 4. For hiv infection I have seen few discussions from Dr. h. Hunter handsfield (hiv expert) through medhelp forum with his patients that antibodies will clear p24 out of the blood until p24 no longer detectable and excess antibodies will start detectable through serology blood test afterward as part of seroconversion. A. For hiv if one having psychological stress or chronic psychological stress or high cortisol level will production level of antibodies that produce by our immune system stop or delay while in the middle of clearing p24 due to stress? I seen some of this p24 discussion from h. Hunter handsfield m.d (hiv expert) with his patient which I screenshot their conversation in the attachment above (kindly refer to the attachment in the above for more detail) he mentioned "in other words, the p24 cannot become negative until at least several days (typically a couple of weeks) after antibody appears" by h. Hunter handsfield m.d. B. I'm concern about will antibodies stop or delay production during that stressful event due to stress which causes improper seroconversion? (probably similar questions to no. 3 but a little more detail:) 5. If one having chronic psychological stress and high cortisol level, will one seropositive infections such as hiv or hcv (hepatitis c) "seroreversion" to seronegative? (i do understand for hiv positive patient seroreversion for hcv is common, although i'm not hiv positive and read some cases mentioned antibodies for hcv persist for life, some said persist for many years or up to decades. 6. If one having psychological stress such as anxiety which is either chronic or not chronic does it affects seroconversion process of antibodies for treponemal test on infection like syphilis (such as tpha, fta-abs) or non treponemal test on syphilis? (such as vdrl, rpr). 7. If one having severe psychological stress anxiety or chronic psychological stress does it causes syphilis treponemal test or non treponemal test antibodies seroreversion? (despite I seen some expert discussed overtime seroreversion for non treponemal test which test turning to negative overtime is normal and is the only issue for non treponemal that might be due to the nature of the test itself which does not happen to treponemal test).

PhD - Psychology
Psychologist, Patna
If you have psychological stress you need psychological counseling services through the online or offline process for the positive attitude that will be better for recovery of your problem thank you.

I have small brown herpes under my foreskin. It's very itching ,sometimes burning. Currently I am facing fungal infection on finger of my leg. So i'm taking fungicam-100 tab & using ebernet cream .what should I do now? Should I use ebernet cream on my penis? Pls reply.

MBBS Bachelor of Medicine and Bachelor of Surgery, MD - Dermatology
Dermatologist, Ghaziabad
Hi. Ebernet cream is antifungal cream. As you are saying that you are suffering from herpes, it will not work upon herpes infection. You need proper consultation to confirm your diagnosis and treatment.

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