Gonorrhea

Microscopic gonorrhea cellsGonorrhea 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

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 known to be uninfected.

By using latex condoms correctly and consistently during vaginal or rectal
sexual activity, you can reduce your risk of getting gonorrhea and its
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, a serious infection of
the female reproductive tract. 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 causes 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 (HIV, human immunodeficiency virus, causes AIDS). 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.

TRANSMISSION TO NEWBORN BABIES OR
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 worker
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
(gonoccoci). Researchers are trying to understand how gonococci
infect cells while evading defenses of the human immune system. Studies are
ongoing to determine

  1. How this bacterium attaches to host cells
  2. How it gets inside cells
  3. Gonococcal surface structures and how they can change
  4. 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 will lead to development o

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