Men's Health Education: Antibiotic Treatment and Diagnostic Points for Gonorrhea and Syphilis

Treatment of Gonorrhea

The history of gonorrhea treatment is long. After the 1940s, antibiotics were used to treat gonorrhea, opening a new chapter in its treatment. However, the emergence of drug-resistant strains in the mid-1970s added new difficulties to gonorrhea treatment. But with continuous improvements in medical technology, new and effective antibiotics for treating gonorrhea are constantly being developed. Currently, gonorrhea is mainly treated with antibiotics. Although the treatment of gonorrhea is relatively complex, as long as the medication is appropriate, taken on time, in sufficient dosage, and regularly, gonorrhea can generally be cured.

1. General Treatment

① Bed rest, avoid all strenuous exercise and factors that can cause mental excitement.

② Avoid stimulating foods, such as alcohol, strong tea, and coffee.

③ Sexual activity should be prohibited during treatment.

④ Pay attention to local hygiene. Soiled clothing should be washed and disinfected promptly.

⑤ Take medication as prescribed, on time, and in sufficient dosage.

⑥ All sexual partners the patient has had contact with within the past 30 days should be tested for gonococci and receive prophylactic treatment.

2. Antibiotic Treatment

① Treatment of acute gonorrhea caused by non-drug-resistant strains: Procaine penicillin G 4.8 million units, once intramuscularly; or amoxicillin 3.0g, once orally; or ampicillin 3.5g, once orally; or cefotaxime 2.0g, once intramuscularly.

Choose one of the above methods, and administer probenecid 1.0g concurrently.

② For patients allergic to penicillin, tetracycline 0.5g, orally, four times daily for 7 days; or doxycycline 0.1g, orally, twice daily for 7 days.

③ For pregnant women or those unwilling to take tetracycline, erythromycin 0.5g, orally, four times daily for 7 days.

④ For those unsuitable for the above methods or those who have failed treatment, spectinomycin

2.0g, once intramuscularly.

⑤ Spectinomycin 2.0g, once intramuscularly; or ceftriaxone 250mg, once intramuscularly. All patients were simultaneously given 1.0g of probenecid orally, followed by 0.1g of doxycycline orally twice daily for 7 days.

⑥ Norfloxacin 800-1000mg, orally once daily; ciprofloxacin 250mg, orally once daily.

⑦ For patients insensitive to spectinomycin, cephalosporins can be used.

⑧ According to foreign reports, ethylsildenafil, aminothiazolinone, pyrimethamine, and subamectin are all effective against penicillin-producing Neisseria gonorrhoeae strains.

⑨ Zinnat 250mg, orally twice daily.

⑩ Ceftriaxone 1-2g, intravenously once daily.

Prevention of Gonorrhea

In addition to measures for preventing sexually transmitted infections, the following should be noted for the prevention of gonorrhea:

1. Patients should pay attention to personal hygiene, and contaminated items should be disinfected promptly. 1. Women with gonorrhea should avoid sharing a bed or bath with children.

2. In areas with high prevalence, a system of administering silver nitrate solution or other effective antibiotic eye drops to newborns should be implemented.

3. Effective immunization methods should be sought, and research on gonorrhea antibodies should be strengthened to achieve planned immunization of susceptible populations.

Diagnosis of Syphilis

Syphilis has a long course, remaining latent for most of the time. Its symptoms are complex and similar to many non-syphilitic diseases, therefore a comprehensive analysis combining medical history, physical examination, and laboratory results is necessary. Follow-up observation, family investigation, and experimental treatment may be required when necessary.

1. Medical History

① History of Infection: History of promiscuity or unprotected sex.

② Course of Sexually Transmitted Diseases: History of chancre, secondary, or tertiary syphilis, or other sexually transmitted diseases.

③ Marital History: Number and duration of marriage, spouse's health status, presence of syphilis or other sexually transmitted diseases.

④ Childbirth history: Married women should be asked about their history of miscarriage and delivery of a child with congenital syphilis.

⑤ If congenital syphilis is suspected, the parents' sexually transmitted disease history, the individual's early and late congenital syphilis symptoms and signs, and the health status of their siblings should be inquired about.

⑥ If latent syphilis is suspected, any diseases that can cause false-positive syphilis serological reactions should also be inquired about.

⑦ Treatment history: What medications have been used in the past, whether they were used regularly, whether the dosage was sufficient, and any history of drug allergies, etc.

2. Physical examination: A comprehensive physical examination should be performed. For patients with a short infection period, the skin, mucous membranes, genitals, anus, and mouth should be examined. For patients with a longer infection period, the heart, nervous system, skin, and mucous membranes should be examined.

3. Laboratory tests: ① Early syphilis should be examined using dark-field microscopy.

② Syphilis serological tests: First, perform non-treponemal antigen tests (such as VDRL test or USR test). If necessary, perform treponemal antigen tests (such as FTA-ABS test or TPHA test).

③ Cerebrospinal fluid examination: To rule out neurosyphilis.

Syphilis Treatment

1. Timely Treatment
Based on 50 years of experience with arsine therapy and penicillin therapy since 1943, early syphilis is curable. With adequate and sufficient treatment, approximately 90% of early-stage patients can achieve a cure, and the earlier the treatment, the better the outcome. For example, the cure rate in the seronegative chancre stage can reach 100%, while the cure rate in the secondary stage may not reach 90%.

2. Regular and Adequate Treatment
In untreated early syphilis, 25% develop serious damage, while inappropriately treated cases have a 35%–40% chance of developing serious damage, a worse outcome than those without treatment. With appropriate treatment, only 5%–10% develop serious damage.