Gonorrhea remains a significant public health issue in Indonesia, especially among high-risk groups such as individuals with multiple sexual partners, sex workers, and intravenous drug users. While urban centers generally have more healthcare resources, rural areas face challenges with limited access to testing and treatment for STIs. The stigma surrounding STIs also discourages people from seeking medical help, which contributes to underreporting and continued spread of the infection. In response, the Indonesian Ministry of Health collaborates with various NGOs to promote awareness, increase testing accessibility, and provide education on safe sex practices. However, challenges remain, particularly with the rise of antibiotic-resistant gonorrhea strains in certain regions.

Gonorrhea is primarily transmitted through sexual contact, including vaginal, anal, and oral sex, with an infected individual. The bacterium Neisseria gonorrhoeae infects mucous membranes, making it highly contagious through sexual exposure. Gonorrhea can also be transmitted from mother to child during childbirth, leading to serious eye infections in newborns if untreated. Unlike other infections, gonorrhea is not spread through casual contact, such as sharing utensils or surfaces. Safe sexual practices, including consistent condom use, are essential to prevent transmission, as gonorrhea is highly transmissible and can spread even if symptoms are absent.

Gonorrhea symptoms vary by infection site and differ between men and women. In men, the infection typically incubates for 2 to 5 days and affects the urethra, causing itching, burning, painful urination, discharge (sometimes with blood), and pain during erections. Over 90% of men experience noticeable symptoms. In women, more than 50% of cervix infections are asymptomatic, but symptoms, when present, can include vaginal or urethral discharge, painful urination, frequent urgency, back pain, and abdominal cramps. Gonorrhea in the anal area is usually less severe but can still cause a thick discharge, soreness, and pain. Pharyngeal gonorrhea, which affects the throat, occurs in 3-7% of heterosexual men, 10-20% of heterosexual women, and 10-25% of homosexual men. It often causes no symptoms or just a mild sore throat.he high rate of asymptomatic cases, particularly in women, increases the risk of undiagnosed and untreated infections, which can lead to serious complications like pelvic inflammatory disease (PID) in women and epididymitis in men. If left untreated, gonorrhea can spread and cause systemic infections.

Gonorrhea is diagnosed by testing samples from affected areas such as urine, the vagina, rectum, or throat. It’s important to test all potential contact sites, especially since many infections are asymptomatic. Individuals showing symptoms should avoid sex and seek testing from a healthcare provider or STI clinic. Asymptomatic individuals, particularly those at higher risk—such as pregnant women, those under 25, people with new or multiple partners, men who have sex with men, and those with HIV—should also be screened.

The CDC recommends treating uncomplicated urogenital, rectal, or pharyngeal gonorrhea with a single dose of intramuscular ceftriaxone. If chlamydia hasn’t been excluded, doxycycline is recommended for 7 days. For individuals allergic to cephalosporins, gentamicin plus azithromycin can be used as an alternative. If ceftriaxone is unavailable, oral cefixime is an option, though it is less effective for pharyngeal infections. Both sexual partners should be tested and treated to prevent reinfection or further spread. For the partners of infected individuals, treatment with cefixime can be provided, as long as chlamydia is not present. In cases of suspected treatment failure, clinicians should consult an expert and conduct susceptibility testing. A test-of-cure, which involves testing again 7 to 14 days after treatment is recommended for pharyngeal gonorrhea but not for urogenital or rectal infections. Patients should be retested 3 months after treatment to check for reinfection, which occurs in 7% to 12% of cases. Regular follow-ups are essential to confirm the infection has been eliminated. Monitoring antibiotic resistance trends is crucial as new drug-resistant strains continue to emerge, complicating future treatment options and necessitating ongoing research for effective therapies.

Preventing gonorrhea involves practicing safe sex, particularly consistent use of condoms, and regular STI testing, especially for individuals with multiple partners. Reducing the number of sexual partners and having open communication about STIs can further reduce the risk. For pregnant women, early testing is essential to prevent neonatal transmission and complications. Public health efforts focus on raising awareness about gonorrhea, promoting testing, and reducing stigma around STIs, which encourages individuals to seek treatment. Education on safe sex practices and access to STI clinics are vital for effective prevention and control of gonorrhea.