Objective To explore the clinical application of direct smear in the diagnosis of gynecological diseases caused by gonococcal infection. Methods 106 patients with suspected gonococcal infection admitted to our hospital from May 2022 to February 2024 were selected as the study objects. The results of bacterial culture method were analyzed and the bacterial culture method was taken as the gold standard. To analyze the diagnostic efficacy of direct smear in gonorrhea. Kappa test was used to analyze the consistency between direct smear method and bacterial culture method. Results Of 106 suspected cases of gonococcal infection, 40 cases were confirmed to have gonococcal infection (26 cases of acute gonorrhea, 14 cases of chronic gonorrhea), 66 cases were not gonococcal infection (30 cases of non-gonococcal urethritis, 21 cases of bacterial vaginitis, 15 cases of trichomonas vaginitis). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of direct smear were 76.00%, 96.43%, 86.79%, 95.00% and 81.82%, respectively. According to Kappa test, there was high consistency between direct smear method and bacterial culture method in the diagnosis of gonococcal infection (Kappa=0.847, P<0.05). Conclusion The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of direct smear in the diagnosis of gonococcal infection were 76.00%, 96.43%, 86.79%, 95.00% and 81.82%, respectively. The diagnosis of gonococcal infection by direct smear method was consistent with that by bacterial culture method.