Gonorrhea
What is Gonorrhea?
Gonorrhea, also called “the clap,” is a type of sexually transmitted disease (STD) caused by bacteria. The bacteria that cause gonorrhea (Neisseria gonorrhoeae) thrive in moist areas of the body in both women and men. Gonorrhea can be spread through any kind of sexual contact (vaginal, oral or anal) with an infected person. Ejaculation is not necessary to spread gonorrhea. Physical contact with the infected area may also spread the disease (e.g., touching the genitals and then touching the inside of the mouth or an eye). It is not spread by kissing.
In women, the gonorrhea bacteria usually enter the body during vaginal intercourse. The cervix (entrance to the uterus) is the most likely site of a gonorrhea infection in women and may become inflamed. Bacteria may also reach the urethra (tube leading to the bladder) and cause inflammation there. Gonorrhea bacteria may also lodge in the vagina and glands near the entrance to the vagina. This can result in painful swelling of the gland. However, this type of gonorrhea is uncommon in adult women.
In men, gonorrhea bacteria are transmitted into the urethra during intercourse, where the bacteria cause inflammation to occur. The most common indication of a gonorrhea infection in men is discharge from the penis and a burning sensation when urinating.
Gonorrhea can also occur in the anus, either from anal sex or by bacteria transmitted to the anus from the genitals. Infection of the anus is rare in heterosexual men and most often occurs in men and women who engage in receptive anal intercourse. People may also contract a gonorrhea infection in the throat by having oral sex with an infected partner. If a person touches an infected area and then touches the eyes, gonorrhea may spread to the eyes, a condition called gonococcal conjunctivitis. However, the gonorrhea bacteria can only survive for brief periods of time away from moist surfaces. The bacteria cannot survive or be transmitted from inanimate objects or surfaces.
In extreme cases when gonorrhea is left untreated, infection can spread to other parts of the body, causing inflammation of areas such as the brain and spinal chord (meningitis), heart (endocarditis) or joints (arthritis). In women, gonorrhea can spread to the upper reproductive organs where it can cause pelvic inflammatory disease (PID). PID that is not treated in a timely manner can scar the tissue within the fallopian tubes and can cause infertility. In men, gonorrhea can cause epididymitis, a condition that causes painful swelling of the scrotum.
Epididymitis can also lead to infertility. Gonorrhea can also increase the risk of becomingThe HIV virus, which causes acquired immune deficiency syndrome (AIDS), attacks the body's immune sy infected with human immunodeficiency virus (HIV), the virus that leads to acquired immune deficiency syndrome (AIDS). Some studies suggest that a history of gonorrhea may increase a man's risk of developing prostate cancer. This risk may be even higher if the man has a history of multiple gonorrhea infections.
More than 330,000 cases of gonorrhea were reported to the U.S. Centers for Disease Control and Prevention (CDC) in 2004, the last year for which figures are available. However, the CDC estimates that this number accounts for only half of the nation's gonorrhea cases since many of the cases go unreported. Because gonorrhea in women is frequently asymptomatic, an important element in controlling the spread of gonorrhea is to screen women who are at risk for STDs. African-Americans are most affected by the disease, with almost 20 times the incidence in 2004 than was found among white Americans. Other minority groups, including Hispanics, may also have a higher rate of incidence. For the past four consecutive years, the gonorrhea rate has been higher for women than men.
How is it diagnosed?
Physicians begin diagnosis of gonorrhea by compiling a complete medical history of the patient. This may include questions about the patient's sexual activity and sexual partners. A physician will also perform a physical examination and, for women, a pelvic examination. In men, gonorrhea is determined by the presence of symptoms and a positive result of one or more laboratory tests. In women, because gonorrhea is often asymptomatic, several laboratory tests may be conducted to confirm a diagnosis of gonorrhea.
Several laboratory tests are available to diagnose gonorrhea, including:
Gram stain test
Involves taking swabs of cells from the infected area. The cells are stained with dye and the bacteria can be identified under a microscope. This quick test is the most effective way of confirming the presence of gonorrhea in men. However, it is reliable in only about 50 percent of women with gonorrhea. It is also not effective for testing for gonorrhea in the throat or the anus.Nucleic acid amplification test (NAAT)
This test uses a urine sample or a sample of discharge from the infected area and is able to detect the presence of genes from the gonorrhea bacteria.Culture test
Requires swabs of sample tissue from the cervix, urethra, rectum or throat. The sample is placed in a culture media and allowed to grow for at least 48 hours. Culture tests are more accurate than some other tests, but take more time.Enzyme linked immunoabsorbent assay test (ELISA test)
This test uses a discharge sample from the infected area. It detects antibodies (substances that fight the infection) to the bacteria. It is more sensitive in women than the gram stain test but not as accurate as the culture test.DNA probe test
Uses a discharge sample from the infected area and tests for genetic material of the gonorrhea bacteria. It is less accurate for samples collected from the throat. The DNA probe test may also identify chlamydia, a sexually transmitted disease (STD) that frequently occurs with gonorrhea.How is Gonorrhea treated?
Gonorrhea is treated with antibiotics, usually given in the form of a pill or injection. In recent years, some strains of the gonorrhea bacteria have become resistant to certain antibiotics. A culture of the gonorrhea infection may indicate if it is a drug-resistant strain. Because of the increase in resistant strains, physicians may treat all gonorrhea cases as if they were drug-resistant strains and use nonresistant antibiotics.
Most antibiotics can be administered in a single dose or as a week's worth of pills. The patient should refrain from sexual activity for seven days (for either form of medication) to give the medication time to work. Patients should also wait before resuming sexual activity with their previous sexual partners until their partners have been both tested and seven days after being treated for gonorrhea. Patients should have a follow-up physician visit after a week of medication to recheck symptoms and possibly repeat cultures and verify that the gonorrhea infection has been cured. They should be certain to complete any oral medication or the infection may not be completely eradicated. Patients treated for gonorrhea can be reinfected with the disease if they have sexual contact with another infected person.
Pregnant women with gonorrhea have additional treatment considerations. They cannot take certain antibiotics because the drugs may affect fetal development. For example, tetracycline antibiotics may discolor the developing baby's teeth. Gonorrhea also makes women more likely to have a miscarriage or a premature birth. In addition to treatment with antibiotics, pregnant women may be treated with other drugs to avoid preterm labor.
People infected with gonorrhea are frequently infected with chlamydia, another sexually transmitted disease with few symptoms. When gonorrhea is diagnosed, physicians may prescribe a combination of antibiotics in order to treat the patient for chlamydia as well. This is because the antibiotics used to treat chlamydia are usually less expensive than the test used to diagnose it.
Medications
- Antibiotics to fight the infection.
- You may take non-prescription drugs, such as acetaminophen or aspirin, to reduce discomfort but not in place of antibiotics. Home remedies or folk-medicine treatments are ineffective.
What might complicate it?
In men, urethral gonorrhea infections can result in acute or chronic prostate gland inflammation or testicular infection. Women may have pelvic inflammatory disease, ectopic pregnancy, or sterility. In pregnant women, infection can lead to spontaneous abortion, premature rupture of the membranes, premature delivery, and stillbirths.
Gonorrhea can occasionally spread through the blood stream to infect other areas of the body including the skin, joints (producing an acute arthritis with pus formation inside the joint), or rarely, the heart or meninges.
Predicted outcome
The prognosis for gonorrhea infections is good, with effective antibiotic treatment and follow-up. The infections usually clear in two to four weeks. With an impaired immune system, infections may last for months and become more severe.
Alternatives
Genital infections of bacterial, viral, fungal and chlamydial origins can result in similar symptoms. If the bacterium cannot be isolated, the diagnosis can be difficult. Meningococcemia can resemble a systemic gonorrhea infection.
Appropriate specialists
Infectious disease specialist, urologist and gynecologist.
Seek Medical Attention
- You or a family member has symptoms of gonorrhea.
- Chills, fever, abdominal pain, genital sores or joint pain occur either before or during treatment.
Last updated 2 July 2015