Gonorrhea (gah-nuh-REE-uh) is a sexually transmitted infection (STI) and is spread through all forms of sexual intercourse. It can also be passed from an infected mother to her baby during childbirth. Gonorrhea primarily affects the mucous membranes of the genital and urinary tracts (including the urethra * ). Nongenital sites of infection include the rectum * , eyes, throat, other organs and tissues of the body, and (in cases of gonococcal arthritis) joints.
Gonorrhea is an infection caused by the bacterium Neisseria gonorrhoeae (nye-SEER-e-uh gah-no-REE-eye), which can colonize and multiply in the body's mucous membranes, especially the mucous membranes of the male and female genital * tracts. It affects primarily the cervix and the male urethra. There are nongenital sites of infection: The bacterium can also affect the mucous membranes of the rectum, eyes (the conjunctiva), and throat. In the female, the cervix is the most common site of infection and the vagina is generally spared.
In gonorrhea infection, there may be a discharge from the penis or vagina and pain during urination.
In women, the first site of infection is usually the cervix * ; if untreated, infection can spread to the uterus * and the fallopian tubes * and result in pelvic inflammatory disease (PID), a severe infection of a woman's reproductive organs, including the fallopian tubes, uterus, and ovaries * , sometimes with spread of the infection to other body tissues near these organs. Babies born to mothers who have gonorrhea can develop an eye infection that can lead to blindness and other complications if it is not treated.
Gonorrhea is the second most commonly reported STI in the United States, according to the Centers for Disease Control and Prevention (CDC); chlamydial infection * is number one. The CDC states that after a period of several years in which the annual number of cases of gonorrhea declined, the number began to increase again in 2010. In 2013, there were 333,004 cases of gonorrhea reported in the United States; however, many more went unreported. The rate has decreased by 0.6 percent since 2012; however, the rate increased 8.2 percent overall during the period between 2009 and 2013. The rate decreased in the 15- to 24-year age group but increased among those age 25 years or older. Some experts estimate that as many as two million cases occur per year.
Gonorrhea is most common in highly populated urban areas and in people who have more than one sexual partner; however, anyone who has sexual relations with an infected person can contract gonorrhea. In 2013, rates of reported gonorrhea cases were highest among adolescents and young adults, with the highest rates among women and men age 20 to 24 years.
In 2013, for the first time since 2000, the rate of reported gonorrhea cases among men was higher than the rate among women. Gonorrhea in children almost always points to sexual abuse.
Gonorrhea is highly contagious. The risk of contracting the disease is increased in sexually active people who do not use condoms during sexual activity and in people who have multiple sexual partners. A person who has gonorrhea even in the absence of symptoms can transmit the disease to others starting at the time of initial infection.
The bacteria that cause gonorrhea are transmitted via direct contact (mucous membrane-to-mucous membrane and mucous membrane-toskin) during all types of sexual activity. The bacteria are also carried in vaginal fluids and semen * , and transmission as a result of contact with these fluids is also possible. Infected women can pass the infection to their babies during childbirth.
People can infect themselves if they touch an infected body part of another person and then rub or scratch their eyes. Gonorrhea can also be spread through kissing; however, this method of transmission is rare.
Many people who contract gonorrhea have only mild symptoms or even none at all. Males are much more likely than females to know they have gonorrhea, but up to 20 percent of males do not experience any symptoms. Within two weeks after being infected, males often have a burning sensation during urination. They may have pain in or a greenish discharge from the penis. The lymph nodes * in the groin may swell, and the urethral meatus (the external opening of the urinary tract at the head of the penis) may become irritated and red.
Between 30 and 60 percent of infected women may not have any noticeable symptoms of infection. Those who develop symptoms usually begin to experience them within two to three weeks after contact with the bacterium. Symptoms may include a 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.
Because the symptoms of gonorrhea are similar to those of chlamydial infection, doctors usually test a person experiencing symptoms that point to gonorrhea for both of these STIs. In addition, doctors usually test a patient who has suspected gonorrhea or chlamydial infection for syphilis and ask him or her to be tested for HIV * infection. In September 2006, the CDC revised its recommendations for HIV testing to include yearly HIV screening for people at high risk of infection—which includes those diagnosed with other STIs—unless the patient refuses testing.
A sample of fluid or discharge obtained from the vagina, cervix, tip of the penis, or rectum can be cultured and tested for N. gonorrhoeae bacteria. Results are usually known within 48 hours. Another test, the polymerase (pah-LIM-er-ace) chain reaction (PCR), can be used to look for the presence of the bacterium's DNA * in urine, fluid from the cervix, or fluid discharge from the urethra. This test gives faster and more accurate results.
Pharyngeal (fair-un-JEE-ul), or throat, gonorrheal infection can be established by doing a throat culture. In newborns at risk for gonorrheal eye infection, 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.
Gonorrhea is curable when treated with antibiotics, although some strains * of the bacteria are increasingly resistant to medication. In April 2007, the CDC added gonorrhea to the list of so-called superbugs, that is, diseases that are resistant to most antibiotics in common use.
It is important for individuals who are diagnosed with gonorrhea to discontinue all sexual activity during the period of illness. All sexual partners should be made aware of the diagnosis and should undergo testing, 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; people diagnosed with gonorrhea alone are often treated for chlamydial infection as well, since gonorrhea has a shorter incubation * period and its symptoms typically start a week or so earlier than those of chlamydial infection. Newborns infected with gonorrheal conjunctivitis are given antibiotics intravenously (directly into a vein).
With appropriate antibiotic treatment, gonorrhea usually clears up within two weeks. It is important to take all of the medication even if the symptoms improve prior to completion of the full course and to contact the doctor if they do not. When treated early, patients do not usually have any long-term complications.
If a person has had gonorrhea before, he or she can become infected again. In fact, the reinfection increases the likelihood of complications. In women, untreated gonorrhea can lead to PID, which can cause ectopic pregnancy * , and sometimes can lead to infertility (the inability to become pregnant). Women have a 15 percent likelihood of becoming infertile after a single episode of PID; if they have another episode, the likelihood rises to 50 percent. Ectopic pregnancies require emergency surgery; an ectopic pregnancy in which the fallopian tube bursts can cause massive bleeding and even death.
Without treatment, the bacteria can spread throughout the body, to the blood, and via the bloodstream to the joints, heart, and brain, although these complications rarely occur 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.
Unfortunately, as of 2015, there was no vaccine against gonorrhea. The best way to avoid contracting gonorrhea is to suspend or discontinue all forms of sexual activity. For those persons who are sexually active, the proper use of latex condoms during all forms of intercourse is important. Doctors advise women who are sexually active to have a yearly gynecological exam with STI screening. They also recommend that people with any symptoms of gonorrhea or who are at risk for STIs see a doctor. If a person is found to have gonorrhea, all their sexual partners must also be tested and treated. Doctors in the United States are required by law to report cases of gonorrhea to the CDC and to local public health departments.
See also AIDS and HIV Infection • Chlamydial Infections • Sexually Transmitted Infections (STIs): Overview • Syphilis
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Wetzstein, Cheryl. “Alarms raised again on drug-resistant gonorrhea.” The Washington Times, August 27, 2014. http://www.washingtontimes.com/news/2014/aug/27/alarms-raised-again-drug-resistant-gonorrhea (accessed October 21, 2015).
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American Social Health Association. PO Box 13827, Research Triangle Park, NC 27709. Telephone: 919-361-8400. Website: http://www.ashastd.org (accessed October 21, 2015).
Centers for Disease Control and Prevention. 1600 Clifton Rd., Atlanta, GA 30333. Toll-free: 800-232-4636. Website: http://www.cdc.gov (accessed October 21, 2015).
National Institute of Allergy and Infectious Diseases. Office of Communications and Public Liaison, 6610 Rockledge Dr., MSC 6612, Bethesda, MD 20892-6612. Telephone: 301-496-5717. Website: http://www.niaid.nih.gov (accessed October 21, 2015).
* 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 colon that terminates at the anus.
* genital (JEH-nih-tul) refers to the external sexual organs.
* 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 tubes (fa-LO-pee-an 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 female reproductive organs from which ova, or eggs, are released in women.
* chlamydial infection (kla-MIHdee-ul) infection is infection by bacteria of the genus Chlamydia. The microorganisms 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 infection (STI), usually passed from one person to another through unprotected sexual intercourse.
* semen (SEE-men) is the sperm cell–containing whitish fluid that is produced by the testes, travels in the male reproductive tract, and is discharged from the penis during ejaculation.
* lymph (LIMF) nodes are small bean-shaped masses of tissue that contain immune system cells that fight harmful microorganisms.
* abdominal (ab-DAH-mih-nul) refers to the body cavity below the ribs and above the hips that contains the stomach, intestines, and other organs.
* HIV or human immunodeficiency (HYOO-mun ih-myoo-no-dih-FIH-shen-see) virus is the virus that causes AIDS (acquired immunodeficiency syndrome).
* 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.
* strains are various subtypes of organisms, such as viruses or bacteria.
* incubation (ing-kyoo-BAY-shun) is the period of time between infection by a germ and when symptoms first appear. Depending on the germ, this period can be from hours to months.
* ectopic (ek-TAH-pik) pregnancy is an abnormal pregnancy in which the fertilized egg lodges and grows outside the uterus, usually within one of the fallopian tubes.