Gonorrhoea testing and treatment in Taichung: why tablets often fail
Three things decide whether treatment works: the medicine, the sites that are tested, and whether your partner is treated too.
Explained by Dr. Chao-An Chen, urologist, at 昭安泌尿科診所 (Morning Urology Clinic), West District, Taichung.
In short
- In men, symptoms usually start 2 to 7 days after sex. Infection in the throat or rectum usually causes no symptoms at all.
- Oral antibiotics are usually no longer an option here. In the 2024 Taiwan CDC surveillance, 96.8% of the bacteria taken from patients here (called isolates) resisted ciprofloxacin, and 74.5% resisted penicillin.
- For uncomplicated infection, the first choice in the Taiwan 2025 guideline is one injection of ceftriaxone into the muscle — the same for genital tract, rectum and throat.
- A urine test alone cannot find infection in the throat or rectum. The sample must come from that site.
- If only one partner is treated, the infection can easily pass back. Recent partners need testing too. Until treatment is finished and the doctor says it is all right, avoid every kind of sex.
- Doxy-PEP (taking the antibiotic doxycycline after sex) is not advised in Taiwan for preventing gonorrhoea. Close to 80% of the bacteria found here resist the tetracycline class.
How common is gonorrhoea now?
In Taiwan, gonorrhoea is a category 3 notifiable disease: a disease that doctors must report by law. In Taiwan CDC notification data, 7,607 cases of gonorrhoea were notified in 2024, compared with 9,738 cases of syphilis and 1,001 of HIV infection in the same year.
From January to July 2025, 3,627 cases of gonorrhoea were notified, about 18% fewer than the 4,438 in the same months of 2024. In the same period syphilis rose by 7%. So falling gonorrhoea numbers do not mean the overall risk of sexually transmitted infection is falling. The two spread in the same ways and often appear together.
Symptoms: the typical ones, and the less obvious ones
Gonorrhoea is caused by a bacterium called Neisseria gonorrhoeae. In men the commonest form is acute urethritis: inflammation of the urethra, the tube urine passes through. It usually starts 2 to 7 days after sex. That gap is the incubation period: the time between infection and the first symptom. The signs are yellow-green discharge like pus, burning pain when passing urine, and redness at the opening.
Heavy, strongly coloured discharge points towards gonorrhoea, but the look of the discharge cannot tell you which bacterium is causing it. Chlamydia (genital chlamydial infection) and Mycoplasma genitalium infection usually cause thinner discharge, and can be present at the same time.
Without treatment the infection can spread upwards and cause epididymitis (infection of the tube behind the testicle): one side of the scrotum becomes swollen, painful and warm, and fertility can be affected. Sudden scrotal pain must also be separated from testicular torsion (a twisted testicle), a time-critical emergency.
In women the symptoms are often less clear: more vaginal discharge, discomfort when passing urine, lower abdominal pain, or nothing at all. Untreated infection can cause pelvic inflammatory disease, linked with long-term pelvic pain and fertility problems.
Less common forms also exist. Touching discharge and then rubbing the eyes can cause gonococcal conjunctivitis (eye infection). Rarely, the bacteria enter the blood (disseminated infection) and cause joint pain or a rash, and in rare cases affect the brain lining or the heart. These are complicated infections and are treated differently.
Throat and rectum: the quietest sites, and the ones most often missed
Oral sex can cause gonorrhoea in the throat, and anal sex can cause it in the rectum. In most cases these sites cause no symptoms: no pain, no discharge, nothing unusual in the throat. A urine sample cannot detect them.
The throat matters for a second reason. It is where this bacterium most easily exchanges resistance genes with other mouth bacteria, and treatment works less well there. With cefixime, an oral third-generation cephalosporin, the treatment response is over 95% in the genital tract, but about 90.1% in the rectum and only about 63.8% in the throat.
At the consultation you will be asked about oral and receptive anal sex. Those answers decide where the swab is taken. You do not need to wait for symptoms.
Diagnosis: what a NAAT answers, and what a culture answers
| Test | What it answers, and its limits |
|---|---|
| Nucleic acid amplification test (NAAT, a PCR-type test), on first-catch urine or a throat or rectal swab | Answers: Whether the bacterium is there. Very sensitive, and usable on throat, rectum, urethra and cervix. Usually possible about 1 to 2 weeks after the exposure, or at once with symptoms. Limits: It cannot show which antibiotics will work. Shortly after treatment it can still detect genetic material from dead bacteria. |
| Bacterial culture with susceptibility testing (grown in the laboratory) | Answers: Which antibiotics this strain is sensitive to. The main tool when treatment has failed or resistance is likely. Limits: Stricter collection and transport; the result takes time. |
Those 1 to 2 weeks are the window period: the time before a test can reliably show the infection. That is not the incubation period, which is the time before symptoms start.
A NAAT is usually enough. Two situations also need a culture: symptoms that do not improve after treatment, and a travel history with a risk of resistant bacteria.
Treatment: what the Taiwan 2025 guideline recommends
The reference is the Taiwan guideline for the clinical diagnosis, treatment and prevention of syphilis and gonorrhoea in adults (Taiwan CDC and the Infectious Diseases Society of Taiwan, August 2025).
- Uncomplicated infection of the genital tract or rectum: one injection of ceftriaxone into the muscle is the first choice (recommendation: strong; evidence: moderate).
- Uncomplicated infection of the throat: the same single injection is the first choice (recommendation: strong; evidence: high).
So for uncomplicated infection, wherever it is, the first-line treatment is the same injection. Ceftriaxone is a third-generation cephalosporin, given as an injection and not as a tablet. If you are allergic to it, or it cannot be obtained, the guideline lists alternatives: a single oral dose of cefixime, or an injection of gentamicin with oral azithromycin. They are alternatives, not the first choice, and oral treatment works less well in the throat.
Complicated infection is treated differently. Infection of the eye, or infection that has spread through the blood (joint pain, rash, rarely the brain lining or the heart), needs a different treatment plan and hospital care or referral.
The medicine, dose and length of treatment are decided by a doctor, based on the site of infection, your drug allergy history and your test results.
Why treating yourself with antibiotics does not work in Taiwan
Taiwan CDC monitors resistance in the bacteria taken from patients here. The 2024 analysis:
| Antibiotic | Taiwan isolates (2024) → what it means |
|---|---|
| ciprofloxacin (a quinolone) | 96.8% resistant → Not recommended for gonorrhoea |
| penicillin | 74.5% resistant → Not recommended for gonorrhoea |
| tetracyclines (including doxycycline) | Close to 80% resistant → Also why Doxy-PEP is not used against gonorrhoea here |
| azithromycin | About 0.3% resistant → Still effective, but only inside the alternative combination |
| ceftriaxone and cefixime | Reduced susceptibility (the medicine works less well) in about 2.0% and 2.9% → Ceftriaxone is still first-line (cefixime is an alternative), but susceptibility keeps falling |
Treating yourself has three consequences. It usually does not work, because the oral antibiotics easiest to obtain are the classes with the highest resistance. It can make a later test give the wrong answer: the medicine can push the bacteria below the level the test detects without clearing them, so the report reads negative while the infection remains. And it helps resistant bacteria grow, because too low a dose favours resistant strains.
If you have already taken medicine on your own, please say so, and tell the doctor what you took and for how many days. It changes how the report is read: the test may need to wait for a while, or a culture may be used instead.
After treatment: no sex, repeat testing, and partners
Until both people have finished treatment and the doctor says it is all right, avoid every kind of sex, including oral and anal sex. Throat infection is often passed back this way.
Recent partners also need testing and treatment assessment, even if they have no symptoms. If only one person is treated, it is almost as if no one was treated: the infection can pass back. If you do not know how to tell them, the clinic can write a short testing recommendation to pass on.
A repeat test is needed, or usually advised, when:
- Symptoms do not improve. A culture may be arranged to look for a resistant strain, or another organism considered.
- You had a throat infection. Come back 7 to 14 days after treatment. This clinic uses a nucleic acid test (PCR) to confirm that the bacteria are gone. A PCR test done too early may pick up material from dead bacteria; the US CDC advises 7 to 14 days.
- About 3 months have passed. Screening again is usually advised, to check for a new infection. Being cured does not make you immune.
Infections that often occur together: chlamydia, syphilis and HIV infection
People with gonorrhoea are more likely to have another sexually transmitted infection at the same time, most often chlamydia, which is hard to tell apart and often causes no symptoms. So three tests are usually arranged together: a chlamydia NAAT (the same sample can usually be used), a syphilis blood test, and an HIV test. The guideline advises an HIV test for everyone treated for early syphilis. More generally, when one sexually transmitted infection is diagnosed, the others should be checked too. If the HIV test is negative and the risk stays high, PrEP, medicine that prevents HIV, can be discussed. These infections often come from one exposure, so handling them separately means some are missed.
If you were infected abroad, the follow-up is different
If the sex happened abroad, please say which country. Strains that resist the first-line injection have been reported in Asia:
- Thailand: between January and April 2025, five ceftriaxone-resistant cases carrying the penA-60 gene, in tourist areas in the east and the south.
- Japan: routine monitoring in the Kyoto and Osaka region, 2018 to 2024, again found resistant strains carrying penA-60.001.
- Europe: several countries have reported cases linked to travel in Southeast Asia.
Bacteria found in Taiwan are still mainly sensitive to ceftriaxone. But with a relevant travel history the follow-up is different: for example, a culture after treatment may be arranged to confirm the bacteria are gone, instead of closing the case once the injection is given. Travelling is not the problem; not mentioning it is, because then no follow-up happens.
Prevention: condoms, and two options that are often misunderstood
Doxy-PEP means taking a single dose of doxycycline after sex that carried a risk. In the Taiwan 2025 guideline it is a strong recommendation with high quality of evidence for preventing syphilis in men who have sex with men and in transgender women. There is no recommendation for cisgender women (women whose gender matches the sex recorded at birth) or heterosexual men. For preventing gonorrhoea it is not recommended (weak recommendation against; evidence: high), because close to 80% of the bacteria found in Taiwan resist the tetracycline class. Trials abroad showed some protection, but the results cannot be applied directly to Taiwan.
The four-component meningococcal B vaccine (4CMenB) has been discussed as possible cross-protection, because some of its antigens resemble those of the gonorrhoea bacterium. The Taiwan 2025 guideline concludes that present evidence does not support using it against gonococcal infection (weak recommendation against; evidence: high).
What does help: condoms, including for oral sex; regular screening, with samples taken from the sites where sex actually took place; treating partners at the same time; and an assessment for PrEP if HIV risk keeps returning.
Getting tested in Taichung
This clinic is on two Taiwan CDC rosters, under medical institution code 3503241524:
- Roster of anonymous HIV screening facilities — a rapid blood test for HIV. For this service we do not check your National Health Insurance card or any identity document, so it is open to you regardless of nationality. There is no charge for it. No formal report can be issued, because no identifying information is recorded.
- Anonymous syphilis screening for young people and students aged 24 or under — a rapid test for syphilis. It is a separate service for people aged 24 or under or students, with no charge. Kit supply from Taiwan CDC can vary.
The rosters can be checked on the Taiwan CDC page for anonymous counselling and screening for sexually transmitted infections.
Gonorrhoea is not part of the free services at this clinic. The anonymous screening at this clinic, and the monthly joint session held here with the Taiwan Base Association, test for HIV and syphilis. Gonorrhoea, chlamydia and Mycoplasma genitalium need a separate registration and test, and the sample site depends on the kind of sex you had. So if your symptom is discharge or pain when passing urine, these free services do not cover it. The free HIV and syphilis tests and the self-paid gonorrhoea test can be done on the same day.
You can walk in for testing; no appointment is needed. Three things are usually enough to decide what to test: how long ago the exposure was, what kind of sex it was, and whether you have symptoms. Please bring your passport or resident certificate; it is needed to create the medical record. If you are not enrolled in Taiwan’s National Health Insurance, the consultation and tests are self-paid. Costs are explained at the consultation.
We are required by law to report certain infections to the health authority. Your personal information is protected by the Communicable Disease Control Act, Article 10. The clinic uses separate consulting rooms and patient routes, so you do not have to explain why you are here in the waiting area.
If you have symptoms, or you had sex that worries you, book a consultation and say what kind of sex it was: that decides which sites are sampled.
Related pages
Appointments and access
Consultations are conducted in Mandarin, and can also be conducted in English.
昭安泌尿科診所 (Morning Urology Clinic)
No. 98, Boguan 2nd St., West District, Taichung City 403, Taiwan（403 臺中市西區博館二街98號）
Consulting hours: Monday to Saturday (closed Sunday). Online booking is open 24 hours.
This page was produced by 昭安泌尿科診所 (Morning Urology Clinic). Medical content last updated: October 2026 (same as the Traditional Chinese version). English version published: 4 September 2026; revised 31 October 2026. Medically reviewed by Dr. Chao-An Chen, urologist.
Sources: Taiwan guideline for the clinical diagnosis, treatment and prevention of syphilis and gonorrhoea in adults, 1st edition, August 2025 / Taiwan CDC, gonorrhoea: national antimicrobial resistance monitoring, 2024 analysis / Emergence of Ceftriaxone-Resistant Neisseria gonorrhoeae penA-60-Carrying Strains, Thailand, 2025. Emerg Infect Dis. / Workowski KA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(4):1-187. For medicines, the Chinese-language product information approved by the Ministry of Health and Welfare applies.
This page provides general medical information and does not replace an individual diagnosis or treatment plan. Sampling sites, medicine, dose, length of treatment and follow-up are decided by a doctor. Case numbers and resistance figures are Taiwan CDC data for 2024 and for January to July 2025; for the latest statistics, please see Taiwan CDC.