Sexually Transmitted Diseases
Nearly 750,000 cases of gonorrhea are reported annually in the United States. Another 750,000 unreported cases, mostly among teenagers and young adults, are believed to occur each year.
Gonorrhea is caused by the gonococcus, a bacterium that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, or rectum. In women, the cervix is the most common site of infection. However, the disease can spread to the uterus (womb) and fallopian tubes, resulting in pelvic inflammatory disease (PID); this can cause infertility and ectopic (tubal) pregnancy.
Gonorrhea is most commonly spread during genital contact, but it can also be passed from the genitals of one partner to the throat of the other during oral sex (pharyngeal gonorrhea). Gonorrhea of the rectum can occur in people who practice anal intercourse and may also occur in women due to spread of the infection from the vaginal area.
Gonorrhea can be passed from an infected woman to her newborn infant during delivery. When the infection occurs in children, it is most commonly due to sexual abuse.
The early symptoms of gonorrhea often are mild, and most women who are infected have no symptoms of the disease. If symptoms of gonorrhea develop, they usually appear within 2 to 10 days after sexual contact with an infected partner, although a small percentage of patients may be infected for several months without showing symptoms. The initial symptoms in women include a painful or burning sensation when urinating or an abnormal vaginal discharge. More advanced symptoms, which indicate progression to PID, include abdominal pain, bleeding between menstrual periods, vomiting, or fever. Men usually have a discharge from the penis and a burning sensation during urination that may be severe. Symptoms of rectal infection include discharge, anal itching, and sometimes painful bowel movements.
Two techniques, gram stain and culture, are generally used to diagnose gonorrhea. Many doctors prefer to use both tests to increase the chance of an accurate diagnosis. The gram stain is quite accurate for men but less so for women. The test involves placing a smear of the discharge on a slide that has been stained with a dye and then examining it under a microscope for the presence of the gonococcus. Test results usually can be given to the patient at the time of an office or clinic visit.
The culture test, the preferred method of diagnosing gonorrhea in women, involves placing a sample of the discharge onto a culture plate and incubating it for up to 2 days to allow the bacteria to multiply. The accuracy of this test depends on the site from which the sample is taken. Cervical samples are accurate, for example, approximately 90 percent of the time. Throat cultures can also be done to detect pharyngeal gonorrhea.
Ampicillin, amoxicillin, or some type of penicillin used to be recommended for the treatment of gonorrhea. Because penicillin-resistant gonorrhea is increasing, other antibiotics that are given by injection such as ceftriaxone or spectinomycin now are used to treat most gonococcal infections. Other new antibiotics can be taken by mouth.
Gonorrhea often occurs together with chlamydial infection, another common sexually transmitted disease (STD). Therefore, doctors usually prescribe a combination of antibiotics, such as ceftriaxone and doxycycline, to treat both diseases. Women who are pregnant should not take doxycycline and are usually given an alternative antibiotic such as erythromycin.
Regardless of what drug is prescribed, it is important that the patient take the full course of medication and that he or she return to the doctor's office or clinic for followup. All sex partners of a person with gonorrhea should be tested and treated appropriately even if they do not have symptoms of infection.
If gonorrhea is not treated, the bacteria can spread to the bloodstream and infect the joints, heart valves, or the brain. The most common consequence of gonorrhea, however, is PID, a serious infection of the female reproductive organs, that occurs in an estimated 1 million American women each year. PID can scar or damage cells lining the fallopian tubes, resulting in infertility in as many as 10 percent of women affected. In others, the damage prevents the proper passage of the fertilized egg into the uterus. If this happens, the egg may implant in the tube; this is called an ectopic or tubal pregnancy and is life-threatening to the mother if not detected early.
An infected woman who is pregnant may give the infection to her infant as the baby passes through the birth canal during delivery. Most states require that the eyes of newborns be treated with silver nitrate or other medication immediately after birth to prevent gonococcal infection of the eyes, which can lead to blindness. Because of the risk of gonococcal infection to both mother and child, doctors recommend that a pregnant woman have at least one test for gonorrhea during her pregnancy.
Because gonorrhea is highly contagious and yet may cause no symptoms, all men and women who have sexual contact with more than one partner should be tested regularly for the disease. Using condoms (rubbers) during sexual intercourse is very effective in preventing the spread of infection. Diaphragms may also reduce the risk of transmission. Constant awareness and precautions are necessary because a person who has once contracted the disease does not become immune--many people acquire gonorrhea more than once.
Scientists supported by NIAID are continuing to learn more about the organism that causes gonorrhea and are working on better methods to prevent, diagnose, and treat it. The dramatic rise of antibiotic-resistant strains of the gonococcus underscores the need for a means of preventing gonorrhea. A method has been developed to detect these resistant strains, which helps the physician select an appropriate treatment.
An effective vaccine against gonorrhea remains a key research priority for NIAID-supported scientists. This work is complicated by the fact that the gonococcus is a complex organism that infects only humans. It has a remarkable ability to protect itself by changing or mutating. The gonococcus also uses a protein on its surface that "tricks" the immune system into protecting the invading organism. Excluding this protein from any future vaccine will be critical. Several experimental vaccines are being developed by NIAID-supported investigators.
By using protective measures during sexual activity, by being tested for gonorrhea whether or not symptoms are present, by taking medication promptly and properly if infection occurs, and by abstaining from intercourse until the infection is cured, sexually active people can reduce their risk of gonorrhea and its complications.
This article was provided by U.S. National Institute of Allergy and Infectious Diseases.