Gonococcal urethritis is caused by Neisseria gonorrhoeae, which is transmitted through sexual contact and vertically. Gonorrhea remains a major public health problem. Gonorrhea manifests in men as acute anterior urethritis with dysuria and profuse and purulent discharge. The diagnosis of gonococcal infection is based on the identification of the microorganism in secretions from infected sites using Gram stain, culture, and/or molecular biology techniques. No test offers 100 % sensitivity and specificity.

Neisseria gonorrhoeae has developed resistance to multiple classes of antibiotics, and recently resistance and even clinical failures to ceftriaxone and cefixime have been confirmed. According to the European guidelines for the diagnosis and treatment of gonorrhea in adults, uncomplicated gonococcal urethritis should be treated with ceftriaxone 500 mg intramuscularly (IM) as a single dose together with azithromycin 2 g as a single oral dose. Sexual partners in the preceding 60 days should be treated as well, and a test of cure is recommended in all cases. Treatment failures and resistant strains should be reported to health authorities.


Gonorrhea Neisseria gonorrhoeae Gonococcal urethritis Cephalosporins Treatment failure Resistance 

Further Reading

  1. Bignell C, Unemo M. European guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS.
  2. Bignell C, IUSTI/WHO. 2009 European (IUSTI/WHO) guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2009;20:453–7.CrossRefGoogle Scholar
  3. Cámara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, Ardanuy C. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother. 2012;67:1858–60.CrossRefGoogle Scholar
  4. CDC. Sexually transmitted diseases treatment guidelines, 2010. MMWR. 2010;59(No. RR-12):49–55.Google Scholar
  5. CDC. Update to CDC’s sexually transmitted diseases treatment 2010 guidelines: oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal Wkly Rep. 2012a;61:590–4.Google Scholar
  6. CDC. Cephalosporin-resistant Neisseria gonorrhoeae public health response plan. US Department of Health and Human Services, CDC; 2012b. Available at
  7. Centers for Disease Control and Prevention (CDC). CDC Grand Rounds: the growing threat of multidrug-resistant gonorrhea. MMWR Morb Mortal Wkly Rep. 2013;62:103–6.Google Scholar
  8. Dowell D, Kirkcaldy RD. Effectiveness of gentamicin for gonorrhoea treatment: systematic review and meta-analysis. Sex Transm Infect. 2012;88:589–94.CrossRefGoogle Scholar
  9. European Centre for Disease Prevention and Control (ECDC). Gonococcal antimicrobial susceptibility surveillance in Europe 2010. Stockholm: ECDC 2012. Available from:…/1206-Gonococcal-AMR.pdf
  10. European Centre for Disease Prevention and Control (ECDC). Response plan to control and manage the threat of multidrug-resistant gonorrhoea in Europe. Stockholm: ECDC; 2012. p. 1–23. Available from:
  11. Garcia AL, Madkan VK, Tyring SK. Gonorrhea and other venereal diseases. In: Wolf K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick’s dermatology in general medicine. 7th ed. New York: McGraw-Hill; 2008. p. 1993–6.Google Scholar
  12. Hottes TS, Lester RT, Hoang LM, McKay R, Imperial M, Gilbert M, Patrick D, Wong T, Martin I, Ogilvie G. Cephalosporin and azithromycin susceptibility in Neisseria gonorrhoeae isolates by site of infection, British Columbia, 2006 to 2011. Sex Transm Dis. 2013;40:46–51.CrossRefGoogle Scholar
  13. Katz AR, Lee MV, Wasserman GM. Sexually transmitted disease (STD) update: a review of the CDC 2010 STD treatment guidelines and epidemiologic trends of common STDs in Hawai’i. Hawaii J Med Public Health. 2012a;71:68–73.PubMedPubMedCentralGoogle Scholar
  14. Katz AR, Komeya AY, Soge OO, Kiaha MI, Lee MV, Wasserman GM, Maningas EV, Whelen AC, Kirkcaldy RD, Shapiro SJ, Bolan GA, Holmes KK. Neisseria gonorrhoeae with high-level resistance to azithromycin: case report of the first isolate identified in the United States. Clin Infect Dis. 2012b;54:841–3.CrossRefGoogle Scholar
  15. Kidd S, Kirkcaldy R, Weinstock H, Bolan G. Tackling multidrug-resistant gonorrhea: how should we prepare for the untreatable? Expert Rev Anti Infect Ther. 2012;10:831–3.CrossRefGoogle Scholar
  16. Stary A, Stary G. Sexually transmitted infections. In: Bolognia JL, Jorizzo J, Shaffer JV, editors. Dermatology. 3rd ed. Philadelphia: Elsevier; 2012. p. 1379–83.Google Scholar
  17. Unemo M, Nicholas RA. Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhoea. Future Microbiol. 2012;7:1401–22.CrossRefGoogle Scholar
  18. Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant N. gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56:1273–80.CrossRefGoogle Scholar
  19. Unemo M, Golparian D, Skogen V, Olsen AO, Moi H, Syversen G, Hjelmevoll SO. Neisseria gonorrhoeae strain with high-level resistance to spectinomycin due to a novel resistance mechanism (mutated ribosomal protein S5) verified in Norway. Antimicrob Agents Chemother. 2013;57:1057–61.CrossRefGoogle Scholar
  20. World Health Organization (WHO), Department of Reproductive Health and Research. Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Geneva: WHO; 2012. p. 1–36. Available from:

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of DermatologyAndreas Sygros Hospital, University of Athens Medical SchoolAthensGreece

Personalised recommendations