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Background
Gonorrhea is a preventable and curable sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. The bacteria primarily infect the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in both women and men, as well as the mucous membranes of the mouth, throat, eyes, and rectum.

Men commonly experience urethral discharge (which can be white, yellow, or green), a burning sensation during urination, and testicular pain. Women are frequently asymptomatic or present with non-specific symptoms, such as increased vaginal discharge or dysuria. If left untreated, it can lead to severe complications and sequelae like pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. In rare untreated cases, the bacteria can spread through the bloodstream, causing disseminated gonococcal infection, which presents with fever, skin rash, and joint involvement.
(Case Definition)

Epidemiology
In Taiwan, healthcare facilities that diagnose a case of gonorrhea must report it within one week in accordance with the Communicable Disease Control Act. Based on surveillance data, a total of 6,417 cases of gonorrhea were reported in Taiwan in 2025. The male-to-female ratio was 9:1. The majority of cases occurred in the 25 to 34 age group (37%), followed by the 13 to 24 age group (29%). (See Figure 1)

Figure 1. Statistics on age groups of gonorrhea cases in Taiwan, 2019-2025

Prevention and Control

1. Safe sex: Most cases of gonorrhea can be prevented with consistent and correct condom use in every sexual encounter, paired with water-based lubricants.
2. Reduce risky behaviors: Avoid risky behaviors such as having multiple sexual partners or engaging in sexual activities with strangers.
3. Avoid substance abuse: Avoid the use of addictive drugs. Substance use can impair your judgment or cause a loss of consciousness, leading to unsafe sexual behaviors and significantly increasing the risk of gonorrhea infection.
4. Partner services management: Early diagnosis and treatment are crucial. Healthcare providers strongly encourage STI partner services(contact tracing and treatment) to ensure that sexual partners are also tested and treated. This breaks the chain of transmission and prevents re-infections between partners.
5. STI screening: Routine screening for target population helps identify asymptomatic cases early. High-risk pregnant women should also be screened to prevent mother-to-child transmission.
6. Neonatal care: To prevent neonatal conjunctivitis (eye infection), antibiotic eye ointment is routinely administered to newborns immediately after birth.

FAQs
1.How is gonorrhea spread?
You can get gonorrhea by having vaginal, anal, or oral sex with someone who is infected, or by coming into contact with infected mucosal exudates (such as semen or vaginal fluids) through skin wounds or mucous membranes. Sharing uncleaned sex toys can also transmit the bacteria. Furthermore, a pregnant woman with gonorrhea can pass the infection to her baby during childbirth as the baby passes through the birth canal.

2.What happens if gonorrhea is left untreated?
Untreated gonorrhea can cause serious and permanent health problems. In women, it can lead to complications and sequelae such as pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. In men, it may cause scrotal swelling, urethral stricture, and infertility. Occasionally, the bacteria can spread to the blood and joints, causing a severe condition known as disseminated gonococcal infection.

3.Should I get tested even if I do not have symptoms?
Yes. Many gonorrhea infected individual experience no symptoms. You can still transmit the bacteria to your sexual partner(s) without knowing you are infected. Routine asymptomatic screening is strongly recommended for at-risk populations, sexually active youths, and pregnant women to prevent adverse health outcomes.

4.What is the treatment for gonorrhea?
The recommended treatment for uncomplicated gonorrhea is an intramuscular injection of a third-generation cephalosporin, such as Ceftriaxone. Because co-infection with Chlamydia trachomatis is common, concurrent treatment must be adopted. Due to high antimicrobial resistance rates, penicillin and quinolones (e.g., ciprofloxacin) are no longer recommended for empirical treatment. 

5.What are Partner Services and why are they important?
To prevent continuous "ping-pong" re-infections between partners, Partner Services are an essential component of comprehensive gonorrhea treatment. Patients are strongly encouraged to notify any sexual partners they had contact with during the 60 days prior to symptom onset or diagnosis. Both the patient and their partner(s) must strictly avoid any sexual contact until the full course of treatment is completed to prevent further transmission.

6.Can gonorrhea be cured?
Yes, gonorrhea can be cured with the correct medical treatment. However, curing the infection does not provide lifelong immunity. Re-infection is very common if you are exposed again. Furthermore, the emergence of antimicrobial resistance is a critical global health threat. You must complete your prescribed medication. If your symptoms persist for more than a few days after receiving treatment, you should return to a healthcare provider to be evaluated again (test of cure), as you may have a drug-resistant strain or have been re-infected

More Information

1. WHO - STIs
2. STI (Sexually Transmitted Infections) Online 
3. USCDC - STD treatment guideline 2021