Gonococcal urethritis is a urethral infection caused by Neisseria gonorrhoeae, which typically involves the mucous membranes of the urogenital tract. Neisseria gonorrhoeae is a gram-negative diplococcus. Humans are the only natural host for N. gonorrhoeae, with susceptibility to the pathogen being notable. Following infection, immunity to reinfection is extremely low, and reinfection often occurs. Gonococcal urethritis is primarily transmitted through direct sexual contact but can occasionally be spread indirectly via contact with contaminated objects such as clothing, towels, bathtubs, toilets, or hands. Mixed infection with nongonococcal urethritis can also occur. Infected pregnant women may infect their newborns during childbirth.
Clinical Manifestations
After an acute gonococcal infection, symptoms typically emerge following an incubation period of 2–5 days. In the early stages, the mucosa at the urethral meatus becomes red, swollen, itchy, and mildly painful. A large amount of purulent discharge is excreted from the urethra, accompanied by discomfort during urination. As the condition progresses, inflammation and swelling may extend along the entire anterior urethra, causing penile swelling, pronounced urinary urgency, frequency, and dysuria, sometimes accompanied by hematuria. Bilateral inguinal lymph nodes may exhibit acute inflammatory reactions. In individuals receiving timely treatment, symptoms generally improve after about one week, with reductions in urethral swelling and discharge as well as a return of normal urination. In some cases, secondary infections may involve conditions such as acute posterior urethritis, prostatitis, seminal vesiculitis, or epididymitis. Untreated conditions may progress to chronic gonococcal urethritis. Recurrent relapses can lead to inflammatory urethral stricture.
Diagnosis
Diagnosis is based on typical clinical manifestations combined with a history of unprotected sexual activity. Smears of urethral discharge frequently reveal gram-negative diplococci located within polymorphonuclear leukocytes. In the chronic phase, the gonococcus may persist in nearby glands or structures, making detection more challenging. The three-glass test often shows that the first urine sample contains the most evident pyuria.
Treatment
Medication therapy is primarily based on ceftriaxone, though spectinomycin and other drugs can also be used. In the early stages, administration of a single dose of ceftriaxone at 1.0 g via intramuscular or intravenous injection achieves high drug concentrations, curing approximately 99% of patients with uncomplicated gonorrhea. For more severe conditions, particularly with involvement of the reproductive system, the antibiotic course may need to be extended, with additional oral administration of quinolones, cephalosporins, or trimethoprim-sulfamethoxazole. In these cases, the typical treatment course lasts 7–14 days. The sexual partner should undergo simultaneous treatment. Management of gonococcal urethral stricture involves regular urethral dilation along with the use of antimicrobial therapy. In severe cases, surgical intervention, such as meatal incision for urethral stenosis or internal urethrotomy for extensive anterior urethral stricture, may be required.