Gonorrhea

Gonorrhea is a sexually transmitted disease (STD) caused by bacteria called Neisseria gonorrhoeae. These bacteria can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacteria can also grow in the mouth, throat, eyes, and anus.

Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery. It is estimated that more than 700,000 persons in the U.S. get new gonorrheal infections each year.

Symptoms and Diagnosis

Although many men with gonorrhea may have no symptoms at all, some men have some signs or symptoms that appear two to five days after infection; symptoms can take as long as 30 days to appear. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles.

In women, the symptoms of gonorrhea are often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may cause no symptoms. Infections in the throat may cause a sore throat but usually causes no symptoms.

Health care providers usually use three laboratory techniques to diagnose gonorrhea.

• Staining samples directly for the bacterium
• Detecting bacterial genes or DNA in urine
• Growing the bacteria in laboratory cultures

The staining test works better for men than for women.

Complications

Untreated gonorrhea can cause serious and permanent health problems in both women and men.

In women, gonorrhea is a common cause of pelvic inflammatory disease (PID). About one million women each year in the United States develop PID. Women with PID do not necessarily have symptoms. When symptoms are present, they can be very severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled "pockets" that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube.

If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby. A health care provider can prevent infection of the baby's eyes by applying silver nitrate or other medicine to the eyes immediately after birth.

In men, gonorrhea can cause epididymitis, a painful condition of the testicles that can lead to infertility if left untreated.

Gonorrhea can spread to the blood or joints. This condition can be life threatening. In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are more likely to transmit HIV to someone else.

Treatment

Health care providers usually prescribe a single dose of one of the following antibiotics to treat gonorrhea.

• Cefixime
• Ceftriaxone
• Ciprofloxacin
• Ofloxacin
• Levofloxacin

If you are pregnant, or are younger than 18 years old, you should not be treated with certain types of antibiotics. Your health care provider can prescribe the best and safest antibiotic for you. Gonorrhea and chlamydia often infect people at the same time. Therefore, health care providers usually prescribe a combination of antibiotics, such as ceftriaxone and doxycycline or azithromycin, which will treat both diseases.

If you have gonorrhea, all of your sexual partners should get tested and then treated if infected, whether or not they have symptoms. Health experts also recommend that you not have sex until your infected partners have been treated.

References:

Centers for Disease Control and Prevention, USA.
National Institute of Allergy and Infectious Diseases, USA.