Gonorrhea

Definition

Gonorrhea is a highly contagious sexually transmitted disease that is caused by the bacterium Neisseria gonorrhoeae. The mucous membranes of the genital region may become inflamed without the development of any other symptoms. When symptoms occur, they are different in men and women. In men, gonorrhea usually begins as an infection of the vessel that carries urine and sperm (urethra). In women, it will most likely infect the narrow part of the uterus (cervix). If untreated, gonorrhea can result in serious medical complications.

Description

Gonorrhea is commonly referred to as "the clap." The incidence of gonorrhea has steadily declined since the 1980s, largely due to increased public awareness campaigns and the risk of contracting other sexually transmitted diseases, such as AIDS. Still, current estimates range from 400,000 to as many as one million projected cases of gonorrhea in the United States each year. These estimates vary due to the private nature of the disease and the consequent underreporting that occurs. The majority of reported cases of gonorrhea come from public health clinics.

The disease affects people of all ages, races, and socioeconomic levels, but some individuals are more at-risk than others. Adolescents and young adults are the highest risk group, with more than 80% of the reported cases each year occurring in the 15-29 age group. Those individuals with multiple sexual partners and who use no barrier contraception, such as condoms, are most at-risk. Reported rates vary among racial and ethnic groups.

The risk factors for gonorrhea are not unlike those for all sexually transmitted diseases. Both men and women can become infected through a variety of sexual contact behaviors, including oral, anal, or vaginal intercourse. The disease is transmitted very efficiently. In fact, women run a 60-90% chance of contracting the disease after just one sexual encounter with an infected male. The disease can also be transmitted from an infected mother to her infant during delivery.

Causes and symptoms

If treated early, gonorrhea can be cured. Unfortunately, many individuals with gonorrhea, particularly women, will experience no symptoms to alert them to the possibility that they have contracted gonorrhea, and therefore, many do not seek treatment. When present, the symptoms and complications of gonorrhea are primarily limited to the genital, urinary, and gastrointestinal systems and usually begin between one day and two weeks following infection. If left untreated, serious complications can result if the disease spreads to the bloodstream and infects the brain, heart valves, and joints. Untreated gonorrhea can also result in severe damage to the reproductive system, making an individual unable to conceive a child (sterile).

Symptoms of gonorrhea in women

As many as 80% of women with gonorrhea show no symptoms. If present, symptoms may include the following:

• bleeding between menstrual periods
• chronic abdominal pain
• painful urination
• vaginal discharge, often cloudy and yellow
• in the case of oral infection, there may be no symptoms or only a sore throat.
• anal infection may cause rectal itching or discharge.

Because women often do not show any symptoms, complications are more likely to occur as the disease progresses. The most common complication is pelvic inflammatory disease (PID). PID can occur in up to 40% of women with gonorrhea and may result in damage to the fallopian tubes, a pregnancy developing outside the uterus (ectopic pregnancy ), or sterility. If an infected woman is pregnant, gonorrhea can be passed on to her newborn through the birth canal during delivery. These infants may experience eye infections that could lead to blindness.

Symptoms of gonorrhea in men

Men are more likely to experience the following symptoms:

• thick and cloudy discharge from the penis
• burning or pain during urination
• more frequent urination
• in the case of oral infection, there may be no symptoms or only a sore throat
• anal infection may cause rectal itching or discharge

In men, complications can affect the prostate, testicles, and surrounding glands. Inflammation, tissue death and pus formation (abscesses), and scarring can occur and result in sterility.

Diagnosis

The diagnosis of gonorrhea can be made at a public health clinic or a family physician office. First, the doctor will discuss symptoms and the patient's known contact or at-risk behavior. There are three methods available to test for the presence of Neisseria gonorrhoeae. These include a culture, a Gram stain, and an ELISA test. Culture of secretions from the infected area is the preferred method for gonorrhea screening in patients with or without symptoms. A cotton swab can be used to collect enough sample for a culture. The sample is incubated for up to two days, providing enough time for the bacteria to multiply and be accurately identified. This test is nearly 100% accurate.

Gram stains are more accurate in the diagnosis of gonorrhea in men than in women. To perform this test, a small amount of discharge from the infected area will be placed on a slide, stained with a special dye, and examined under a microscope for the presence of the gonococcus bacteria. The advantage to this test is that results can be obtained very quickly at the initial visit. Because it requires that the physician or technician be able to recognize and accurately identify the bacteria simply by looking at it under a microscope, however, this test is only about 70% accurate. As a result, one of the other methods may also be used to confirm the diagnosis.

ELISA, or enzyme-linked immunosorbent assay, has emerged as a rapid and sensitive test for gonorrhea. It is much more sensitive than the gram stain and is more convenient than the culture test, which involves the transport and storage of samples. As of late 1997, several other diagnostic tests were being researched with the goal of providing a cost-effective method of screening for a variety of sexually transmitted diseases. One of the most interesting of these is a home test that can be taken by the patient themselves, allowing for a degree of privacy and confidentiality.

When a patient suspects exposure to or experiences symptoms of gonorrhea, he or she may see a public health provider or family practice physician. Physicians trained in obstetrics or gynecology may also be involved, particularly if gynecological complications occur. Men who experience complications may be referred to a urologist. There are also infectious disease physicians who specialize in the treatment and research of all infectious diseases, including those transmitted sexually. All physicians must report this highly contagious disease to public health officials, and patients are asked to provide the names of sex partners during the suspected period of infection so that they can be notified of the risk.

Treatment

Gonorrhea has become more difficult and expensive to treat since the 1970s, due to the increased resistance of gonorrhea to certain antibiotics. In fact, according to projections from the Centers for Disease Control and Prevention, 30% of the strains of gonorrhea were resistant to routine antibiotics in 1994, and resistance has been increasing steadily. Furthermore, many patients have both gonorrhea and chlamydial infections. Therefore, two drug treatment regimens are common. Medications used to treat gonorrhea include ceftriaxone, cefixime, spectinomycin, ciprofloxacin, and ofloxacin. Ceftriaxone and doxycycline or azithromycin are often given simultaneously to treat possible co-existing chlamydia (in pregnant women, erythromycin should be substituted for the aforementioned anti-chlamydial agents). In 2004, reports said that oral antibiotics were preferred over intramuscular forms of the drugs. Also, researchers reported that cefixime had not been available and that fluoroquinolone had been used by more physicians to treat gonorrhea. However, fluoroquinolone resistance was rising among patients with gonorrhea, and in June 2004 the Centers for Disease Control recommended that clinicians no longer prescribe the drug as first-line treatment for gonorrhea in men who have sex with men.

An extremely important consideration is to make sure that all of the prescribed medication is taken. If a course of antibiotics is not completed, the medication will only kill those organisms that are susceptible to the antibiotic, allowing those that are resistant to the effects of that particular antibiotic to multiply and possibly cause a new infection that will be more difficult to treat. Patients should refrain from sexual intercourse until treatment is complete and return for follow-up testing. Any sexual partners during the time of infection, even if those partners do not show symptoms, should be notified and treated when any sexually transmitted disease is involved.

Alternative treatment

Although there is no known alternative to antibiotics in the treatment of gonorrhea, there are herbs and minerals that may be used to supplement antibiotic treatment:

• Lactobacillus acidophilus or live-culture yogurts are helpful, while taking antibiotics, to replenish gastrointestinal flora.
• The following supplements may be used to improve the body's immune function: zinc, multivitamins and mineral complexes, vitamin C, and garlic (Allium sativum ).

• Several herbs may reduce some symptoms or help speed healing: kelp has balanced vitamins and minerals. Calendula (Calendula officinalis ), myrrh (Commiphora molmol ), and thuja (Thuja occidentalis ) may help reduce discharge and inflammation when used as a tea or douche.
• Hot baths may also help reduce pain and inflammation.
• A variety of herbs may help with symptoms of the reproductive and urinary systems.
• If a physician approves, fasting, combined with certain juices, may help cleanse the urinary and gastrointestinal systems.
• There may be acupressure and acupuncture points that will help with system cleansing. These exact pressure points can be provided and treated by an acupressurist or acupuncturist.

Prognosis

The prognosis for patients with gonorrhea varies based on how early the disease is detected and treated. If treated early and properly, patients can be entirely cured of the disease. Up to 40% of female patients who are not treated early may develop pelvic inflammatory disease (PID) and the possibility of resulting sterility. Although the risk of infertility is higher in women than in men, men may also become sterile if the urethra becomes inflamed (urethritis ) as a result of an untreated gonorrhea infection. Following an episode of PID, a woman is six to 10 times more likely, should a pregnancy occur, to have a pregnancy develop outside the uterus (ectopic pregnancy), which can result in death. Liver infection may also occur in untreated women. In approximately 2% of patients with untreated gonorrhea, the gonococcal infection may spread throughout the body and can cause fever, arthritis-like joint pain, and skin lesions.

KEY TERMS

Cervix— The narrow part or neck of the uterus.

Chlamydia— The most common bacterial sexually transmitted disease in the United States that often accompanies gonorrhea and is known for its lack of evident symptoms in the majority of women.

Ectopic pregnancy— A pregnancy that occurs outside the uterus, such as in the fallopian tubes. Although the fetus will not survive, in some cases, ectopic pregnancy can also result in the death of the mother.

ELISA— Enzyme-linked immunosorbent assay. This test has been used a screening test for AIDS for many years and has also been used to detect gonorrhea bacteria.

HIV— Human immunodeficiency virus, the virus that causes AIDS. The risk of acquiring AIDS is increased by the presence of gonorrhea or other sexually transmitted diseases.

Neisseria gonorrhoeae — The bacterium that causes gonorrhea. It cannot survive for any length of time outside the human body.

Pelvic inflammatory disease (PID)— An infection of the upper genital tract that is the most serious threat to a woman's ability to reproduce. At least 25% of women who contract the disease, which can be a complication of gonorrhea, will experience long-term consequences such as infertility or ectopic pregnancy.

Sexually transmitted diseases (STDs)— A group of diseases which are transmitted by sexual contact. In addition to gonorrhea, this groups generally includes chlamydia, HIV (AIDS), herpes, syphilis, and genital warts.

Sterile— Unable to conceive a child.

Urethra— The canal leading from the bladder, and in men, also a path for sperm fluid.

Urethritis— Inflammation of the urethra.

Prevention

Currently, there is no vaccine for gonorrhea, but several are under development. The best prevention is to abstain from having sex or to engage in sex only when in a mutually monogamous relationship in which both partners have been tested for gonorrhea, AIDS, and other sexually transmitted diseases. The next line of defense is the use of condoms, which have been shown to be highly effective in preventing disease (and unwanted pregnancies). To be 100% effective, condoms must be used properly. A female birth-control device that blocks the entry of sperm into the cervix (diaphragm ) can also reduce the risk of infection. The risk of contracting gonorrhea increases with the number of sexual partners. Any man or woman who has sexual contact with more than one partner is advised to be tested regularly for gonorrhea and other sexually transmitted diseases.

Resources

BOOKS

Sparling, P. Fredrick. "Gonococcal Infections." In Cecil Textbook of Medicine, edited by Russel L. Cecil, et al. Philadelphia: W.B. Saunders Company, 2000.

PERIODICALS

"Fluoroquinolone-resistant Gonorrhea on the Rise: Exposure History is Critical." Emergency Medicine Alert July 2004: 11-12.

Georgia, Kristen. "Revised Approach to Gonorrhea Treatment." Patient Care July 2004: 11.

ORGANIZATIONS

American Foundation for the Prevention of Venereal Disease, Inc. 799 Broadway, Suite 638, New York, NY 10003. (212) 759-2069.

National Institute of Allergy and Infectious Diseases. National Institutes of Health, Bethesda, MD 20892.

Gonorrhea

Definition

Gonorrhea is a highly contagious sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae bacterium. The genitourinary tract is the main system that is usually affected, but gonorrhea can also spread to the rectum, the throat, and the eyes. Left untreated, gonorrhea can spread through the bloodstream and infect the brain, heart valves, joints, and the reproductive system. Exposure to an infected mother during birth may cause permanent blindness in the newborn.

Description

Gonorrhea, commonly referred to as "the clap," is the most prevalent reportable disease in the United States. Adolescents and young adults are in the highest risk category, with more than 80% of gonorrhea cases affecting the 15–29 year-old age group. Individuals living in urban areas who have multiple sex partners have the highest risk of contracting the disease. Still, the incidence of gonorrhea has been steadily declining since 1987. This appears to be largely due to increased public awareness about the risks and prevention of contracting STDs such as herpes and HIV. However, in 2002, the Centers for Disease Control (CDC) expressed concern about rising rates of gonorrhea in certain urban areas during 1999 and 2000. About 650,000 new cases of gonorrhea occur every year in the United States. In particular, rates of gonorrhea were increasing substantially among men who have sex with men.

Causes & symptoms

Gonorrhea is transmitted very efficiently. It can be spread by merely contacting the fluids of an infected person as well as by sexual contact. A person runs a 60–90% chance of contracting the disease after just one sexual encounter with an infected person. The symptoms usually begin between one day and two weeks after the initial encounter with the infection.

People who are infected with gonorrhea commonly experience increasingly frequent and painful urination, and

the urethra may be painful and swollen. There may be a thick white, yellowish, or bloody discharge from the penis or vagina. Other symptoms may include nausea, vomiting, fever, chills , and pain during intercourse. In the case of oral infection, there may be a sore throat or pain during swallowing. An anal infection may cause rectal itching , rectal discharge, and a constant urge to move the bowels. Women who show symptoms of gonorrhea often have abdominal pain and breakthrough bleeding (spotting) between menstrual periods. However, many women who have gonorrhea do not experience any symptoms.

In infants and children, irritation, redness, swelling with a pus-like discharge, and possibly pain and a change in urination may point to a gonorrhea infection. The infection may be due to child abuse or exposure to infected materials. An in-depth history should be taken if gonorrhea is suspected.

Diagnosis

The initial diagnosis of gonorrhea will be based on symptoms, sexual history, and at-risk behavior. One laboratory test for diagnosis involves the observation of a gram-stained sample of the discharge under a microscope. In the gram stain test, the sample is dyed, washed with various solutions, and dyed with a different color. The final color identifies the class of bacteria present in the sample. The advantage of this test is that results can be obtained very quickly so that treatment can commence at the initial visit. In the vast majority of men, it is quite accurate; however, the test is not very accurate for women.

For all women and for men with a questionable gram-stain reading, samples of the discharge from the infected area can be collected and cultured. The sample is incubated for up to two days, which provides enough time for the bacteria to multiply and be accurately identified. This test is very accurate and specific for gonorrhea, but improper handling can lead to a false-negative reading. Other tests coming into favor include the ELISA (enzyme-linked immunosorbent assay) antibody test and DNA probe testing of genetic material from the discharge, both of which are quite accurate in identifying Neisseria gonorrhoeae.

Treatment

Although there is nothing that can totally replace antibiotics in the treatment of gonorrhea, certain herbs and minerals may be used to supplement the treatment. These may be used to improve the body's immune function: zinc , multivitamins and mineral complexes, vitamin C , and garlic (Allium sativum ). Lactobacillus acidophilus in supplements and live-culture yogurts help replenish gastrointestinal flora that may be destroyed by the intake of antibiotics.

Several herbs may reduce symptoms and help speed healing. These include kelp (Macrocystis pyrifera and related species), Calendula officinalis, myrrh (Commiphora molmol ), and Thuja occidentalis. These herbs can be taken by the mouth or used as a douche. The Chinese herb Coptis chinensis, used for damp-heat infections , is helpful in treating the genitourinary tract, especially if pelvic inflammatory disease (PID) develops. An herbalist should be consulted to make recommendations for further complications. Some recommend a three-day cleansing fast to quicken and support healing. Fasting should be done only with the approval and supervision of a physician. Referral to an acupuncturist is also recommended, as there may be acupressure and acupuncture points that will help with system cleansing.

Allopathic treatment

The typical treatment for gonorrhea is penicillin or a penicillin derivative, given orally or by injection. If the patient is pregnant or allergic to penicillin, erythromycin may be substituted. Gonorrhea has become more difficult and expensive to treat since the 1970s because it has become increasingly resistant to certain antibiotics. In fact, according to projections from the Centers for Disease Control and Prevention, 30% of the strains of gonorrhea were resistant to routine antibiotics in 1994, and resistance has been increasing steadily. Because of this, the doctor may also prescribe probenecid, which will increase the antibiotic activity.

In 2002, the Centers for Disease Control (CDC) updated guidelines concerning antibiotics for treating gonorrhea. Resistance of the infection has increased to certain classes of drugs, particularly when gonorrhea was contracted in certain states, particularly California. Guidelines had already warned against use of these drugs, called fluoroquinolones, in Hawaii, other Pacific islands, and Asia.

Since other STDs, such as chlamydia and syphilis , often occur with gonorrhea, patients may also be tested and treated for these related infections. Patients should refrain from sexual intercourse until treatment is complete and should return for follow-up testing. Anyone the patient has had sexual contact with during the time of infection should be notified and treated, even if those persons do not show symptoms. Doctors are required to report this disease to public health officials.

More than one health care provider may have to be consulted. Physicians trained in obstetrics or gynecology may be involved if gynecological complications occur. Men who experience complications may be referred to a urologist. There are also infectious disease doctors who specialize in the treatment of infectious diseases, including STDs.

Expected results

The prognosis for patients with gonorrhea varies based on how early the disease is detected and treated. Patients who are treated early and properly can be entirely cured of the disease. The most common complication is PID. PID can occur in up to 40% of women with gonorrhea and may result in damage to the fallopian tubes, an ectopic pregnancy , or sterility. If an infected woman is pregnant, gonorrhea can be passed on to the eyes of the newborn during delivery. This can lead to infection and blindness.

Although the risk of infertility due to gonorrhea is higher in women than in men, men may also become sterile if urethritis (inflammation of the urethra) develops. Complications of gonorrhea can affect the prostate, testicles, and surrounding glands as well. In either gender, inflammation, abscesses, and scarring can occur. In approximately 2% of patients with untreated gonorrhea, the infection may spread throughout the body and can cause fever, arthritis-like joint pain, and skin lesions.

Prevention

Currently, there is no vaccine for gonorrhea. The best prevention is to abstain from having sex, or to engage in sex only when in a mutually monogamous relationship in which both partners have been tested for STDs. The next line of defense against gonorrhea is the use of condoms, which have been shown to be highly effective in preventing disease. The use of a diaphragm can also reduce the risk of infection. Since the risk of contracting gonorrhea increases with the number of sexual partners, those who have sexual contact with more than one partner are advised to be tested regularly for gonorrhea and other STDs.

Resources

BOOKS

Burton Goldberg Group, comp. Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing, 1995.

Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life Books, 1996.

Segen, Joseph, M.D., and Joseph Stauffer. The Patient's Guide to Medical Tests: Everything You Need to Know About the Tests Your Doctor Prescribes. New York: Facts On File, 1998.

PERIODICALS

"Gonorrhea Rates Rising Among Hardest Hit: HIV Infection Implications are Ominous." TB Monitor (May 2002):57.

Mahoney, Diana. "STD Guide Urges Rescreening After Chlamydia Therapy: CDC Also Updates Its Recommendations on Gonorrhea, Genital Herpes, and Nonoxydnol-9." Family Practice News (June 15, 2002):1.

ORGANIZATIONS

American Foundation for the Prevention of Venereal Disease, Inc. 799 Broadway, Suite 638, New York, NY 10003. (212) 759-2069.

American Social Health Association. P.O. Box 13827, Research Triangle Park, NC 27709. (919) 361-8400. Fax: (919) 361-8425. http://www.ashastd.org.

National Institute of Allergy and Infectious Diseases, Office of Communications and Public Liaison. Building 31, Room 7A-50, 31 Center Drive MSC 2520, Bethesda, MD 20892-2520. http://www.niaid.nih.gov.

OTHER

"Gonorrhea." The Merck Manual Online. http://www.merck.com/pubs/mmanual/section13/chapter164/164b.htm.

Patience Paradox

Teresa G. Odle

Gonorrhea

Gonorrhea is among the most common sexually transmitted diseases (STD) and is also among the most common bacterial infections in adults. In the United States, between 2.5 and 3 million cases are reported each year, most occurring in people under age 30. In its early stages, gonorrhea may cause no symptoms and therefore, can be spread by unsuspecting victims. In females, gonorrhea often remains asymptomatic but can lead to vaginal itching, discharge, or uterine bleeding and other serious complications. An infected woman who gives birth can transmit the disease to her infant, often resulting in childhood blindness. As a precaution, silver nitrate is routinely administered to the eyes of newborns to prevent this condition. In males, gonorrhea causes infection of the urethra and painful urination. Though not deadly, the disease if untreated can infect other genital organs. If the infection spreads throughout the blood stream, it can cause an arthritis-dermatitis syndrome.

Gonorrhea was described in early writings from Egypt, China, and Japan. Warnings against "unclean discharge from the body" appear in the Bible. A diagnostic description of the disease was written in the Middle Ages. In the late fifteenth century, a syphilis epidemic raged throughout Europe, though at that time, syphilis was often confused with gonorrhea and some physicians assumed that gonorrhea was the first stage of syphilis. The gram-negative bacterium that causes gonorrhea was discovered in 1879 by Albert Neisser (1855–1916), a German physician who went on to identify the bacterial cause for leprosy . German immunologist Paul Ehrlich named the bacterium Gonococcus. Since then, five types of the Gonococcus organism have been identified.

A test for the presence of Gonococcus bacterium serves as the diagnostic tool. The first effective treatments for gonorrhea were the sulfonamides, which became available in 1937. During World War II, penicillin became widely available for the treatment of gonorrhea and other bacterial disease. However, while penicillin and related antibiotics are effective in about 90% of cases, some strains of the Gonococcus are becoming resistant to penicillin.

See also History of the development of antibiotics; History of public health

GONORRHEA

Gonorrhea is a sexually transmitted disease (STD) caused by Neisseria gonorrhoeae, a bacterium. Gonorrhea is spread through sexual contact (vaginal, oral, or anal). The organism can grow easily in mucous membranes of the body, including the cervix, uterus, and fallopian tubes in women, and the urethra, mouth, throat, and rectum in women and men. It can also invade the conjunctiva (e.g., during childbirth). Each year approximately 650,000 persons in the United States get gonorrhea. Approximately 75 percent of gonorrhea cases are found in persons age fifteen to twenty-nine years. About 50 percent of men have some initial symptoms, typically a burning sensation when urinating and a discharge from the penis. Many infected women are asymptomatic or have only mild symptoms. Initial symptoms include a painful or burning sensation when urinating and a vaginal discharge that is yellow or bloody. Untreated gonorrhea in women can develop into pelvic inflammatory disease (PID), which can cause infertility or increase the future risk of ectopic pregnancy. An infected pregnant woman can transmit the infection to her newborn during vaginal delivery.

N. gonorrhoeae in the male or female genital tract can be diagnosed in a laboratory using a urine specimen. Many of the currently used antibiotics can successfully cure gonorrhea. Persons who engage in sexual behaviors that place them at risk of STDs should use latex or polyurethane condoms every time they have sex, limit the number of sex partners, and not go back and forth between partners. All young, sexually active, nonmonogamous persons who do not use condoms every time they have sex should consider being screened for gonorrhea yearly. Infected persons should notify all sex partners so they can receive treatment.

Allison L. Greenspan

Joel R. Greenspan

(see also: Sexually Transmitted Diseases )

Bibliography

Centers for Disease Control and Prevention (1998). "1998 Guidelines for Treatment of Sexually Transmitted Diseases." Morbidity and Mortality Weekly Report 47(RR-1):59–70.

Hook, E. W., III, and Handsfield, H. H. (1999). "Gonococcal Infections in the Adult." In Sexually Transmitted Diseases, 3rd edition, eds. K. Holmes, P. Mardh, P. Sparling et al. New York: McGraw-Hill.

gonorrhea , common infectious disease caused by a bacterium ( Neisseria gonorrhoeae ), involving chiefly the mucous membranes of the genitourinary tract. It may occasionally spread to membranes in other parts of the body, especially those of the joints and the eyes. Since the principal mode of transmission is sexual contact, gonorrhea is classified as a sexually transmitted disease . Gonorrheal conjunctivitis was once a prominent cause of blindness in the newborn, the infection being transmitted during delivery. Routine use of silver nitrate solution in the eyes of every infant at birth has largely overcome this problem.

The usual site of infection in women is the cervix. From there it can spread to the uterus and fallopian tubes and cause pelvic inflammatory disease, ectopic pregnancy, or infertility. Other complications, in both sexes, include infection of the joints, heart valves, and brain. Women are often asymptomatic, but may have a vaginal discharge or burning sensation on urination; men may have a discharge from the penis and pain on urination. Examination of the discharge reveals the presence of the bacteria. In most cases, the disease can be cured by adequate treatment with a fluoroquinolone or cephalosporin antibiotic such as ciprofloxacin or ceftriaxone. Failure of treatment is usually due to resistant strains (see drug resistance ). Prior infection does not confer resistance and reinfection is common.

gonorrhoea (gon-ŏ-ree-ă) n. a sexually transmitted disease, caused by the bacterium Neisseria gonorrhoeae, that affects the genital mucous membranes of either sex. Symptoms include pain on passing urine and discharge of gleet. In untreated cases, the infection may spread throughout the reproductive system, causing sterility; severe inflammation of the urethra in men can cause stricture. If a pregnant woman has gonorrhoea, her baby may contract ophthalmia neonatorum. Later complications can include arthritis, endocarditis, and infection of the eyes, causing conjunctivitis. Treatment with ciprofloxacin, ofloxacin, or cefotaxime is usually effective.
—gonorrhoeal adj.

Gonorrhea

What Is Gonorrhea?

How Common Is Gonorrhea?

Is Gonorrhea Contagious?

How Do People Know They Have Gonorrhea?

How Do Doctors Diagnose and Treat Gonorrhea?

Can Gonorrhea Be Prevented?

Resources

Gonorrhea (gah-nuh-REE-uh) is a sexually transmitted disease (STD) spread through all forms of sexual intercourse. It also can be passed from an infected mother to her baby during childbirth. Gonorrhea can affect the genitals, urethra*, rectum*, eyes, throat, joints, and other organs and tissues of the body.

*urethra

(yoo-REE-thra) is the tube through which urine passes from the bladder to the outside of the body.

*rectum

is the final portion of the large intestine, connecting the colon to the anus.

KEYWORDS

for searching the Internet and other reference sources

Antibiotic resistance

Chlamydia

Neisseria gonorrhoeae

Ophthalmia neonatorum

Pelvic inflammatory disease (PID)

Sexually transmitted diseases

Venereal diseases

What Is Gonorrhea?

Gonorrhea is an infection caused by the bacterium Neisseria gonorrhoeae (nye-SEER-e-uh gah-no-REE-eye), which can grow in moist areas of the body including the vagina, penis, rectum, eyes, and throat. Gonorrhea may cause a discharge from the penis or vagina and pain while urinating. In women, the infection usually starts within the vagina at the cervix*; if untreated, infection can spread to the uterus* and fallopian tubes* and result in pelvic inflammatory disease (PID); PID refers to an infection of a woman’s reproductive organs, including the fallopian tubes, uterus, cervix, and ovaries*, sometimes with spread of infection to other body tissues near these organs. Babies born to mothers who have gonorrhea can develop eye infection which, if untreated, can lead to blindness and other complications.

*cervix

(SIR-viks) is the lower, narrow end of the uterus that opens into the vagina.

*uterus

(YOO-teh-rus) is the muscular, pear-shaped internal organ in a woman where a baby develops until birth.

*fallopian

(fah-LO-pee-uhn) tubes are the two slender tubes that connect the ovaries and the uterus in females. They carry the ova, or eggs, from the ovaries to the uterus.

*ovaries

(O-vuh-reez) are the sexual glands from which ova, or eggs, are released in women.

How Common Is Gonorrhea?

Gonorrhea is the second most commonly reported STD in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC); chlamydial infection* is number one. The CDC reports that the number of cases has been decreasing since the mid-1980s. However, up to 400,000 new cases are reported every year in the United States, and many more go unreported. Some experts estimate that as many as 2 million cases occur per year.

*chlamydial

(kla-MIH-dee-ul) infection can occur in various forms in which the bacteria can invade the urinary and genital systems of the body, as well as the eyes and lungs. One of its most common forms is a sexually transmitted disease (STD), usually passed from one person to another through unprotected sexual intercourse.

Gonorrhea is most common in highly populated urban areas and in people who have more than one sexual partner, but anyone who has sexual relations with an infected person can contract gonorrhea. Most men who contract the disease are ages 20 to 24; most women are under 21.

Is Gonorrhea Contagious?

Gonorrhea is contagious. When people do not use condoms or other protective measures when having sex or have multiple sexual partners, their risk of contracting the disease increases. From the time someone is infected with the gonorrhea bacterium, that person can spread the disease until properly treated.

The bacteria that cause gonorrhea are spread through body fluids, such as fluid from the vagina or semen*, that are passed from one person to another during vaginal, anal, or oral intercourse. Infected women can pass the infection to their babies during childbirth.

*semen

(SEE-men) is the sperm-containing whitish fluid produced by the male reproductive tract.

People can infect themselves if they touch an affected area and then rub or scratch their eyes. Gonorrhea can also be spread through kissing if one partner has a cut on the lip, but this way of becoming infected is rare. Sharing towels and sitting on toilet seats that have come in contact with the bacteria do not spread the disease.

How Do People Know They Have Gonorrhea?

Many people who contract gonorrhea do not have any symptoms. For those who do, the symptoms often are mild. Males are much more likely to know they have gonorrhea than females, but up to 20 percent of males do not experience any symptoms at all. Within 2 weeks after being infected, males often feel burning when urinating and have pain or a greenish discharge from the penis. The lymph nodes* in the groin may swell, and the head of the penis may become irritated and red.

*lymph

(LIMF) nodes are small, bean-shaped masses of tissue that contain immune system cells that fight harmful microorganisms. Lymph nodes may swell during infections.

Neisseria gonorrhoeae bacteria can be seen in this microscopic image of discharge from the urethra, the tube through which urine passes from the bladder to the outside of the body. Visuals Unlimited, Inc.

Although many women with gonorrhea have mild or no symptoms, those who do develop symptoms usually begin to experience them within 2 to 3 weeks after contact with the bacteria. These include bloody or greenish-yellow discharge from the vagina, pain during urination and/or sexual intercourse, and itching, soreness, or redness in the genital area. Other symptoms, including abdominal* pain, bleeding during or after intercourse, and bleeding between periods may mean a woman has PID.

*abdominal

(ab-DAH-mih-nul) refers to the area of the body below the ribs and above the hips that contains the stomach, intestines, and other organs.

How Do Doctors Diagnose and Treat Gonorrhea?

Because the symptoms of gonorrhea are similar to those of chlamydial infection, doctors usually test a person experiencing symptoms for both of these STDs.

Diagnosis

A sample of genital fluid or discharge from the tip of the penis, vagina, cervix, or rectum can be tested for Neisseria gonorrhoeae bacteria by doing a culture. Results are usually known within 48 hours. Another test, polymerase (pah-LIM-er-ace) chain reaction (PCR), can be used to look for DNA* from the bacteria in urine, fluid from the cervix, or from swabs taken from the urethra. This test gives faster, accurate results.

*DNA ,

or deoxyribonucleic acid (dee-OX-see-ry-bo-nyoo-klay-ik AH-sid), is the specialized chemical substance that contains the genetic code necessary to build and maintain the structures and functions of living organisms.

Pharyngeal (fair-un-JEE-ul), or throat, gonorrhea can be detected by doing a throat culture. In newborns at risk for the disease, doctors swab the baby’s eye discharge and do a culture to confirm the diagnosis. Gonorrheal eye infection is uncommon in U.S. infants because newborns routinely receive antibiotic eye drops or ointment at birth to prevent infection.

Treatment

Gonorrhea is curable when treated with antibiotics, although some strains* of the bacteria are becoming resistant to medication. It is important to stop having sexual relations while infected, and all sexual partners should be told and tested, even if they do not have symptoms. If they have the disease they should also be treated with antibiotics. People who have both gonorrhea and chlamydial infection are treated with a combination of antibiotics. Infected newborns are given antibiotics intravenously (directly into a vein).

*strains

are various subtypes of organisms, such as viruses or bacteria.

With antibiotic treatment, gonorrhea usually clears up within 2 weeks. It is important to take the full course of medication even if the symptoms get better, and to contact the doctor if they do not. When treated early, there are usually no long-term complications.

Complications

If a person has had gonorrhea before, it does not reduce the chances of becoming infected again. In fact, it increases the likelihood that complications may occur. In women, untreated gonorrhea can lead to PID, which can cause ectopic pregnancy* and sometimes lead to infertility (the inability to become pregnant). Ectopic pregnancies require emergency surgery; an ectopic pregnancy that bursts can cause massive bleeding and even death.

*ectopic

(ek-TAH-pik) pregnancy is an abnormal pregnancy in which the fertilized egg develops outside the uterus, usually within one of the fallopian tubes.

Without treatment, gonorrhea can spread throughout the body, through the blood, and to the joints, heart, and brain, although this rarely occurs in young people who are in good health. Newborns who are not treated for gonorrheal eye infection are at risk for blindness. People with untreated gonorrhea are more likely to contract HIV* if they have unprotected sex with someone who is HIV-positive.

*HIV ,

or the human immunodeficiency (HYOO-mun ih-myoo-no-dih-FIH-shen-see) virus, is the virus that causes AIDS (acquired immunodeficiency syndrome).

Can Gonorrhea Be Prevented?

The best way to avoid contracting or spreading gonorrhea is to abstain from sexual intercourse. For those who do have sex, using a latex condom properly during all forms of intercourse is important. Doctors advise women who are sexually active to have a yearly gynecological exam with STD screening. They also recommend that people with any symptoms of gonorrhea or who are at risk for STDs see a doctor. If a person is found to have gonorrhea, all sexual partners also need to be tested and treated.

See also

AIDS and HIV Infection

Chlamydial Infections

Sexually Transmitted Diseases

Syphilis

Resources

Organizations

U.S. National Institute of Allergy and Infectious Diseases (NIAID), Building 31, Room 7A-50, 31 Center Drive MSC 2520, Bethesda, MD 20892-2520. The NIAID posts fact sheets about many STDs, including gonorrhea, at its website.

Telephone 301-496-5717 http://www.niaid.nih.gov

Planned Parenthood Federation of America, 810 Seventh Avenue, New York, NY 10019. Planned Parenthood posts information about sexually transmitted infections at its website.

Telephone 212-541-7800 http://www.plannedparenthood.org

Website

KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children’s health. It contains articles on a variety of health topics, including gonorrhea and other STDs.

http://www.KidsHealth.org

gonorrhoea Sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae, giving rise to inflammation of the genital tract. Symptoms include pain on urination and the passing of pus. Some infected women experience no symptoms. The condition is treated with antibiotics. If not treated, it may spread, causing sterility and ultimately threatening other organs in the body.

gon·or·rhe·a / ˌgänəˈrēə/ (Brit. gon·or·rhoe·a) • n. a venereal disease involving inflammatory discharge from the urethra or vagina. DERIVATIVES: gon·or·rhe·al adj.

gonorrhoea XVI. — late L. — Gr. gonórrhoia, f. gónos semen (cf. KIN) + rhoía flux, rel. to rhein flow.

gonorrhoea See sexually transmitted disease.

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