Gonorrhea

Gonorrhea is a curable bacterial sexually transmitted disease (STD). It occurs frequently among sexually active adolescents and young adults. It is also known as the “clap” or “drip.” Gonorrhea can cause irreversible damage, even when symptoms are not present or noticeable, which includes infertility in women and sterility in men. Pregnant women who have gonorrhea can infect their newborns during birth.

The bacteria Neisseria gonorrhoeae causes gonorrhea and targets the cells of the mucous membrane (the moist layer of tissue lining the respiratory, digestive, urinary, and reproductive tracts). In women it can infection the cervix, vagina, endometrium (mucous membrane that lines the uterus), and the fallopian tubes (tubes in which an egg moves from the ovaries to the uterus). In men the epididymis (tubes that carry sperm from the testis) can be infected. In both men and women the bacteria can infect the rectum, anus, and lining of the eyelid, and less commonly the throat and lungs. Infants infected during childbirth can have infections in their eyes and lungs.

Reporting

While the gonorrhea rate in the United States has declined from 1975 to 1997, gonorrhea is still a common infectious disease. According to the Center for Disease and Control (CDC), 358,366 gonorrhea infections were reported in 2005, (source) but it estimated there are actually over 700,000 new infections occurring each year.
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Transmission

Gonorrhea transmission occurs when the mucous membrane (the moist layer of tissue lining the respiratory, digestive, urinary, and reproductive tracts) comes into contact with infected secretions, vaginal fluid, or semen. This most commonly happens during vaginal or anal sex.

Oral sex is another way transmission can occur. It does not matter if the infected person is giving or receiving. Gonorrhea can be transmitted from infected mouth to penis or infected penis to mouth. Other forms of oral sex that involve mouth to vulva (outer female genital area) or mouth to anus contact can similarly cause transmission in either direction.

Full penetration of the penis or tongue during sexual activity is not required for gonorrhea transmission to occur. As long as the cervix, vagina, penis, anus, or mouth come in contact with infected secretions, vaginal fluid, or semen it is possible to occur.

Women can get gonorrhea in their anus or rectum even if they have not had anal sex. If their vaginal area is infected with the bacteria it can be spread to their anal area, for example, by wiping with toilet paper.

Men who have sex with other men are at risk of being infected from anal and oral sex. Women who engage in oral sex or vulva (outer female genital area) to vulva contact are also at risk.

If an eye comes in contact with infected secretions, vaginal fluid, or semen, an eye infection can occur. The contact can be the result of discharge during sexual activity into the eye or a hand moist with infected fluids touching the eye. However, gonorrhea can not be transmitted through shaking hands, toilet seats, or door knobs.

An infected woman who is pregnant can transmit gonorrhea to her baby during birth when the baby passes through her infected birth canal. Infection in newborns can cause eye infections, pneumonia, or even death. Gonorrhea infections in children can be a sign of possible sexual abuse.

Being treated and cured of gonorrhea does not make a person immune to re-infection. A person who has been cured can be re-infected if he or she is exposed to it again.
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Symptoms

Some people infected with gonorrhea will not have any symptoms. When symptoms do occur, they are often more noticeable in men than women. For men, if symptoms occur, they will occur one to thirty days after exposure to the bacteria, two to ten days after exposure for women.

When women are exposed vaginally, the gonorrhea bacteria will initially infect the cervix and the urethra (urine canal). If symptoms occur at this stage, they can be experienced as an abnormal greenish yellow or whitish vaginal discharge and a need to pass urine more often and/or a burning sensation when urinating. Those symptoms can be mild and may be mistaken for a vaginal or bladder infection. When the bacteria spreads from the cervix to the fallopian tubes (tubes in which an egg moves from the ovaries to the uterus) and infects them, some women still have no symptoms. Those who do have symptoms may experience pain or bleeding during vaginal sex, painful menstrual periods, bleeding between menstrual periods, lower abdominal and/or lower back pain, nausea, or fever. Some women may also experience inflammation of the vulva (external parts of the female genital organs).

Men who have symptoms often experience a tingling sensation in the urethra (urine canal) initially. As the infection spreads, men may also experience a penile discharge that can be white, yellow, or green and a need to pass urine more often and/or a burning sensation when urinating. If the infection spreads to the epididymis (tubes that carry sperm from the testis), pain and swelling around the testicles or pain and swelling of the testicles could occur.

Both men and women who have received anal sex may develop a rectal infection of gonorrhea. In most of cases of rectal infection, symptoms do not usually occur. Those who do develop symptoms may experience rectal pain or itching, bleeding, discharge, or painful bowel movements. Men and women who perform oral sex on an infected partner may experience soreness and redness in the mouth or throat. Another possible symptom both men and woman may have is conjunctivitis (pink eye), experienced as inflammation of the lining of the eye, if an eye has become infected.

Symptoms in infected infants may include conjunctivitis or pneumonia.
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Testing / Diagnosis

Laboratory tests are used to diagnose gonorrhea. Testing is done on a specimen taken with a swab or a urine sample. It may be helpful to speak to a health care provider to find out what testing options are available.

People who are experiencing a vaginal or penile discharge or other symptoms of gonorrhea should be tested. If there is concern a sexual partner could have been exposed to infection or a sexual partner has been diagnosed, testing should also be preformed. Women who are pregnant should be tested to avoid the complications that gonorrhea can cause in pregnancy.

Gonorrhea will show up on tests right after exposure and often before symptoms occur. Since the symptoms of gonorrhea are so similar to the symptoms of Chlamydia, being tested for both at the same time can save time and prevent extra hassle.
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Treatment

Gonorrhea can be treated and cured with antibiotics. A health care provider decides which antibiotic is best, based on the patient’s needs. However, drug resistant strains of gonorrhea are increasing in many areas of the world. These drug resistant strains are most commonly found in Asian countries. They can also be found in Hawaii and on the West Coast in the United States. To ensure proper treatment, people diagnosed with gonorrhea should tell their health care provider if they or their sexual partners have recently traveled to any of these areas.

It is recommended that all sexual partners also be tested and treated if infected. Being cured of gonorrhea will not reduce the risk of re-infection.

Testing to make sure the infection is cured is recommended, particularly if sexual partner(s) have not been tested or treated. Sex should be avoided with those who refuse to get tested and treated and while undergoing treatment.
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Complications

In women, gonorrhea infections left untreated can spread through the uterus to the fallopian tubes (tubes in which an egg moves from the ovaries to the uterus) and cause salpingitis (inflammation of the fallopian tubes), which is a painful condition that can result in infertility and ectopic pregnancy (pregnancy outside the uterus that can be potentially fatal). If the infection spreads to the whole reproductive system, pelvic inflammatory disease (PID) can occur. PID can permanently damage the fallopian tubes, uterus, and surrounding tissue. This damage can lead to chronic pelvic pain, and also infertility and ectopic pregnancy.

Gonorrhea increases the risk of pregnant women having a miscarriage, and when birth does occur, the infection can be passed on to the newborn. Other complications include chronic menstrual difficulties, postpartum endometrtis (inflammation of the lining of the uterus after childbirth), cystitis (inflammation of the urinary bladder), and mucopurulent cervicitis, a condition characterized by a yellow discharge from the cervix.

In men gonorrhea infections left untreated can cause epididymitis (inflammation of the epididymis, a tube that carries sperm from the testis), causing pain, fever, and sterility. It can also cause prostatitis (inflammation of the prostate gland) and scarring of the urethra.

In about 1% of men and women, untreated gonorrhea infections can lead to Disseminated Gonococcal Infection (DGI), also known as gonococcal arthritis. DGI symptoms include arthritis (painful swelling of the joints), fever, multiple skin lesions, infection of the inner lining of the heart, and meningitis (inflammation of the membrane covering the brain and spiral cord).

Leaving gonorrhea infections untreated in infants can lead to blindness and pneumonia, which can cause death. It can also lead to DGI, whose symptoms in infants include arthritis, meningitis, and sepsis (a bacterial infection of the blood).
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Prevention

Abstaining from sexual contact is the surest way to avoid the transmission of gonorrhea. A mutual monogamous relationship with a trusted partner known to be tested and uninfected is another way.

Correctly using latex condoms during vaginal, anal, or oral sex can reduce the risk of transmission. Correctly using a condom can also reduce the risk of transmission during oral sex (mouth to penis). For other forms of oral sex (mouth to vulva, the outer female genital area, or oral to anal, also known as rimming) using a dental dam, plastic wrap, or a latex condom cut up and opened flat can be risk reducers.

It is recommended to use latex condoms or any of the above methods at the very beginning of sexual contact, because transmission of gonorrhea can occur even if the penis or tongue do not fully penetrate the vagina, rectum, or mouth. To best keep the risk of transmission low, the protection used should be kept on till there is no longer any skin contact.
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