Gonorrhea

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    Gonorrhea is a curable sexually transmitted infection (STI) 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, the cervix, is the first place of
    infection. The disease 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 2002, 351,852 cases of gonorrhea were reported to the Centers for Disease
    Control and Prevention (CDC). In the United States, approximately 75 percent of
    all reported cases of gonorrhea are found in people aged 15 to 29 years. The
    highest rates of infection are usually found in 15- to 19-year old women and 20-
    to 24-year-old men.

    SYMPTOMS

    The bacteria are carried in semen and vaginal fluids and cause a discharge.
    Symptoms usually appear within 2 to 10 days after sexual contact with an
    infected partner. For women, the early symptoms of gonorrhea often are mild. A
    small number of people may be infected for several months without showing
    symptoms.

    When women have symptoms, the first ones may include

    • Bleeding associated with 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 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 techniques to diagnose
    gonorrhea.

    • Staining samples directly for the bacterium
    • 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.

    The staining test involves placing a smear of the discharge from the penis or
    the cervix on a slide and staining the smear with a dye. Then the health care
    provider uses a microscope to look for bacteria on the slide. You usually can
    get the test results while in the office or clinic. This test is quite accurate
    for men but is not good 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 and incubating it up to 2 days to allow the bacteria to grow. The
    sensitivity of this test depends on the site from which the sample is taken.
    Cultures of cervical samples detect infection approximately 90 percent of the
    time. 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
    • Ciprofloxacin
    • Ofloxacin
    • Levofloxacin

    If you are pregnant, or are younger than 18 years old, you should not take
    ciprofloxacin or ofloxacin. Your health care provider can prescribe the best and
    safest antibiotic for you.

    Gonorrhea and chlamydia, another common STI, often infect people at the same
    time. Therefore, doctors 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.

    PREVENTION

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