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Gonorrhea

June 4, 2007


Overview

Gonorrhea is a curable sexually transmitted infection (STI). It is the second most commonly reported bacterial STI in the United States following chlamydia. In 2004, 330,132 cases of gonorrhea were reported to the Centers for Disease Control and Prevention (CDC). When examining race and ethnicity, age, and gender, the highest rates of gonorrhea were found in African Americans, 15 to 24 years of age, and women, respectively.

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Gonorrhea can spread into the uterus and fallopian tubes, resulting in pelvic inflammatory disease (PID). PID affects more than 1 million women in this country every year and can cause tubal (ectopic) pregnancy and infertility in as many as 10 percent of infected women. In addition to gonorrhea playing a major role in PID, some health researchers think it adds to the risk of getting HIV infection.


Cause

Gonorrhea is caused by bacteria called Neisseria gonorrhoeae. These bacteria can infect the genital tract, mouth, and rectum of both men and women. In women the opening to the uterus (cervix) is the first place of infection.


Transmission

You can get gonorrhea during vaginal, oral,or anal sex with an infected partner.

If you are pregnant and have gonorrhea, you may give the infection to your baby as it passes through your birth canal during delivery.


Symptoms

The bacteria are carried in semen and vaginal fluids and cause a discharge in men and women. A small number of people may be infected for several months without showing symptoms.

For women, the early symptoms of gonorrhea often are mild. Symptoms usually appear within 2 to 10 days after sexual contact with an infected partner. When women have symptoms, the first ones may include

  • Bleeding during vaginal intercourse
  • Painful or burning sensations when urinating
  • Yellow or bloody vaginal discharge

More advanced symptoms, which may indicate development of PID, include cramps and pain, bleeding between menstrual periods, vomiting, or fever.

Men have symptoms more often than women, including

  • White, yellow, or green pus from the penis with pain
  • Burning sensations during urination that may be severe
  • Swollen or painful testicles

If left untreated, men could experience prostate complications and epididymitis (inflammation of the testicles).

Symptoms of rectal infection include discharge, anal itching, and occasional painful bowel movements with fresh blood in the feces. Symptoms typically appear 2 to 5 days after infection but could appear as long as 30 days.


Diagnosis

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

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

Many providers prefer to use more than one test to increase the chance of an accurate diagnosis.

You usually can get the staining test results while in your doctor's office or in a clinic. This test is quite accurate for men but not so in women. Only one in two women with gonorrhea has a positive stain.

More often, health care providers use urine or cervical swabs for a new test that detects the genes of the bacteria. These tests are more accurate than culturing the bacteria.

The laboratory culture test involves placing a sample of the discharge onto a culture plate. The health care provider also can take a culture to detect gonorrhea in the throat. Culture also allows testing for drug-resistant bacteria.


Treatment

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

  • Cefixime
  • Ceftriaxone
  • Single-dose cephalosporin regimens

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, 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.

For updated information on treatment for gonorrhea, read the CDC Sexually Transmitted Diseases Treatment Guidelines.


Prevention

The surest way to avoid transmission of STIs is to abstain from sexual contact or be in a long-term mutually monogamous relationship with a partner who has been tested and is not infected.

By using latex condoms correctly and consistently during vaginal or rectal sexual activity, you can reduce your risk of getting gonorrhea and developing complications.


Complications

In untreated gonorrhea infections, the bacteria can spread up into the reproductive tract, or more rarely, can spread into the blood stream and infect the joints, heart valves, or the brain.

The most common result of untreated gonorrhea is PID. Gonococcal PID often appears immediately after the menstrual period. PID causes scar tissue to form in the fallopian tubes. If the tube is partially scarred, the fertilized egg may not be able to pass into the uterus. If this happens, the embryo may implant in the tube causing a tubal (ectopic) pregnancy. This serious complication may result in a miscarriage and can cause death of the mother.

In men, gonorrhea causes epididymitis, a painful condition of the testicles that can lead to infertility if left untreated. Also, gonorrhea affects the prostate gland and may cause scarring in the urine canal.

Rarely, untreated gonorrhea can spread through the blood to the joints. This can cause an inflammation of the joints, which is very serious.

If you are infected with gonorrhea, your risk of getting HIV infection increases. Therefore, it is extremely important for you to either prevent yourself from getting gonorrhea or get treated early if you already are infected with it.

Complications in Newborns and Children

If you are pregnant and have gonorrhea, you may give the infection to your baby as it passes through the birth canal during delivery. A health care provider can prevent infection of your baby's eyes by applying silver nitrate or other medicine to the eyes immediately after birth.

Because of the risks from gonococcal infection to both you and your baby, health experts recommend that pregnant women have at least one test for gonorrhea during prenatal care.

When gonorrhea occurs in the genital tract, mouth, or rectum of a child, it is due most commonly to sexual abuse.


Research

The National Institute of Allergy and Infectious Diseases (NIAID) continues to support a comprehensive, multidisciplinary program of research on N. gonorrhoeae (gonococci). Researchers are trying to understand how gonococci infect cells while evading defenses of the human immune system. Studies are ongoing to find

  • How this bacterium attaches to host cells
  • How it gets inside cells
  • Gonococcal surface structures and how they can change
  • Human response to infection by gonococci

Together, these efforts have led to, and will lead to, further improvements in diagnosis and treatment of gonorrhea. They also may lead to development of an effective vaccine against gonorrhea.

Another important area of gonorrhea research concerns antibiotic resistance. This is particularly important because strains of N. gonorrhoeae that are resistant to recommended antibiotic treatments has been increasing and is becoming widespread in the United States. These events add urgency to conduct research on and develop new antibiotics and to prevent antibiotic resistance from spreading.

NIAID also supports research to develop topical microbicides (preparations that can be inserted into the vagina to prevent infection) that are effective and easy for women to use.

Recently, scientists have determined the complete genome (genetic blueprint)for N. gonorrhoeae. They are using this information to help them better understand how the bacterium causes disease and becomes resistant to antibiotics.


Related Links

Government Links

National Library of Medicine
MedlinePlus

8600 Rockville Pike
Bethesda, MD 20894
1-888-FIND-NLM (1-888-346-3656) or 301-594-5983

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-800-CDC-INFO (1-800-232-4636) or 404-639-3534

Non-Government Links

American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-227-8922



  
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See Also
Quiz: Are You at Risk for HIV?
Ten Common Fears About HIV Transmission
Is HIV the Only Incurable Sexually Transmitted Disease?
The HIV-STD Connection
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