• Fever
• Chills, malaise
• Joint pain, either single or multiple joints (knee pain, wrist pain, ankle pain)
• Joint swelling (knees, wrists, ankles)
• Skin rash: begins as flat, pink-to-red spots that evolve into raised, pus-filled bumps
• Painful tendons of wrists or heels
• A combination of skin rash and aching, swollen tendons -- sometimes known as tenosynovitis-dermatitis syndrome

• Blood culture
• Skin lesion culture
• Culture of synovial fluid from joints
• Urethral discharge culture
• Culture from endocervix
• Throat culture
• Anal culture

There are two aspects of treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first aspect is to cure the affected person. The second is to locate and test all of the other sexual contacts and to treat them to prevent further spread of the disease.

That is why mandatory reporting has been instituted and has, until recently, held the number of cases of gonorrhea at a low level. However, the incidence is once again rising.

Beginning about the time of the Vietnam War, the United States saw the appearance of penicillin- and tetracycline-resistant strains of gonorrhea. These resistant strains have been increasing over the last few years. Because of this, a new standardized treatment regimen has now been recommended by the Centers for Disease Control (CDC).

Instead of the standard penicillin treatment, gonorrhea is now treated by a large number of new and very potent antibiotics, including ceftriaxone and levofloxacin. For gonococcemia, treatment is usually begun with intravenous antibiotics.

A follow-up visit after treatment to recheck cultures and confirm the cure of infection is important.

• Gonococcal endocarditis
• Gonococcal meningitis