Gonorrhea is caused by Neisseria gonorrhea, affecting primarily the rectum, leading to severe proctitis with a yellow mucopurulent discharge. The diagnosis is confirmed by a swab and culturing of the rectal discharge using Thayer-Martin medium. The treatment is instituted empirically with 4.8 million units of intramuscular aqueous procaine penicillin G and 1 g oral probenecid. Due to the high penicillin resistance, a single dose of 250 mg intramuscular ceftriaxone (Rocephin) followed by 100 mg oral doxycycline bid for 7 days may be used as a first choice. Recurrence rates may be high (up to 35%), therefore, the patient is instructed to return for follow-up for smears and cultures to confirm remission. Because patients with gonorrhea may have associated chlamydial infection, treatment for chlamydia is instituted as well.
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