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Gonorrhea in Kathmandu: Treatable, But Not Trivial

Gonorrhea — the infection behind "Dhatu Rog" anxieties across Nepal — causes the classic picture of thick yellow-green discharge and painful urination, but also produces silent infection, especially in women and in throat/rectal sites. It is the second most common bacterial STI we see, and it frequently travels together with chlamydia.

What makes choosing a clinic genuinely important is antibiotic resistance. Neisseria gonorrhoeae has defeated drug after drug globally — penicillin, ciprofloxacin, and most oral cephalosporins — and resistance rates in South Asia are among the highest in the world. The medicine a pharmacist hands you may be a drug this bacterium learned to beat years ago. Correct modern treatment is a ceftriaxone injection, given at the right dose, after the right test.

This page covers the complete gonorrhea service at our Kathmandu clinic: how we diagnose it, how we treat it correctly, what resistance means for your care, and why partner management is part of every cure.

Recognizing Gonorrhea

Symptoms typically appear 2–7 days after exposure — but a significant minority of infections, especially in women, stay silent:

• Men: thick yellow/green penile discharge, burning urination, testicular pain or swelling, rectal symptoms after anal sex.
• Women: often none — or increased discharge, burning urination, bleeding between periods, pelvic pain. Easily mistaken for routine vaginal upset.
• All genders: rectal pain/discharge/bleeding; sore throat after oral sex (usually asymptomatic); rarely, eye infection or joint infection (disseminated gonorrhea).
• Emergency signs: high fever with joint pain and skin pustules — disseminated infection needing same-day care.

How We Diagnose It

Diagnosis combines clinical assessment with PCR/NAAT testing — the same gold standard used for chlamydia, usually run as a dual test from one sample. Because gonorrhea is site-specific, exposure history determines sampling: urine for urethral, plus rectal and pharyngeal swabs where indicated.

Microscopy (Gram stain) can support a same-day presumptive diagnosis in symptomatic men, but PCR confirmation remains standard — it detects silent infection and works at all sites.

• First-catch urine PCR — urethral infection.
• Vaginal/cervical, rectal, pharyngeal swab PCR — site-matched to exposure.
• Dual chlamydia + gonorrhea PCR — standard pairing, one sample.
• Culture where treatment failure is suspected — the only way to test antibiotic sensitivity.

Correct Treatment in the Resistance Era

The WHO/CDC-standard treatment for uncomplicated gonorrhea is ceftriaxone 500 mg as a single intramuscular injection (1 g for patients ≥150 kg) — given in clinic. Oral cefixime is a fallback, not a first choice, because resistance to oral cephalosporins is established in this region. Where chlamydia has not been excluded by testing, doxycycline is added.

You should feel symptom relief within 2–3 days. Persistent symptoms, a positive follow-up, or infection after prior treatment elsewhere prompts a proper failure work-up — including culture with antibiotic sensitivity testing, the only way to prove resistance.

• Abstain from sex for 7 days after treatment — and until partners are treated.
• All partners from the last ~60 days should be tested and treated — confidentially arranged through us.
• Pharyngeal infection gets a test-of-cure — throat gonorrhea is harder to clear and drives resistance.
• Retest at 3 months — reinfection is common; surveillance is standard of care.

Antibiotic Resistance: Why Your Pharmacy Medicine Fails

South Asia has among the world's highest rates of gonorrhea resistance to ciprofloxacin (often >70%), and significant resistance to oral cephalosporins and azithromycin monotherapy. Every partially-treated course applies selection pressure. This is why we insist on injectable ceftriaxone as first-line, culture testing when failure is suspected, and never recycling the same drug a patient already failed on.

What Untreated Gonorrhea Does

• Women: PID, fallopian scarring, infertility, ectopic pregnancy risk.
• Men: epididymitis, urethral stricture (difficulty passing urine), rarely infertility.
• All patients: disseminated gonococcal infection — bloodstream spread causing joint and skin disease.
• Pregnancy: transmission at delivery causing newborn eye infection (ophthalmia neonatorum) — preventable with screening.
• HIV risk: gonorrhea inflames mucosa and markedly increases HIV acquisition and transmission.

Gonorrhea Services & Indicative Costs

Call for today's lab pricing — injection and consultation are provided in clinic.

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