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Overview

Gonorrhea is one of the most commonly occurring STDs. It affects the mucous membranes of the urethra, cervix, rectum, mouth, throat, and eyes. Both men and women may carry the disease without experiencing symptoms. Gonorrhea frequently occurs with chlamydia/nongonoccal urethritis (NGU).

Incidence and Prevalence
According to the Centers for Disease Control and Prevention (CDC), approximately 650,000 people in the United States are infected with gonorrhea each year. This rate indicates about 50% of annual infections because as many as one-half of cases are unreported.

Incidence of gonorrhea in the United States declined from 1985 to 1996 and increased 9% from 1997 to 1999. In 1999, the incidence was about 132 per 100,000 people.

About 75% of cases occur in people between the ages of 15 and 29. The highest incidence is among women aged 15–19 and men aged 20–24. Depressed socioeconomic areas typically have the highest incidence, particularly where illicit drug use and prostitution are common. Gonorrhea occurs more frequently in men who have sex with men than in heterosexual men.

Causes and Risk Factors

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which enters the body and multiplies rapidly. It is usually transmitted by direct contact with an infected person during vaginal, anal, or oral sex, or during birth. Oral sex is probably the least common mode of transmission. Infected pregnant women can pass the disease to newborns (called vertical transmission), where it can cause conjunctivitis and blindness due to corneal scarring.

Signs and Symptoms

Symptoms may appear within 5 to 21 days, usually earlier in men than in women. In men, inflammation of the urethra (urethritis), yellow or green discharge with pus, painful urination, and burning and itching are common symptoms. The opening at end of penis (meatus) may become reddened and inflamed. As infection travels up the urethra, frequency and urgency of urination develops.

In women, symptoms may be mild at first and often go unnoticed until sudden and severe onset. Inflammation and reddening of the cervix is common and bleeding between menstrual periods may occur. Urethritis causes painful, frequent urination and thick, yellow discharge. In later stages, the ducts and glands in the genital region and the rectum are affected.

In children who contract gonorrhea through vertical transmission, genital irritation and inflammation occurs and may be accompanied by a discharge.

Complications
Untreated gonorrhea may cause abdominal pain, vomiting, fever, sore throat (pharyngitis), arthritis, skin lesions, and discharge from the eyes. Anal and rectal itching, anal discharge, painful bowel movements, and painful anal sex may occur. Gonorrhea can affect the prostate and testicles in men. In women, gonorrhea can cause pelvic inflammatory disease (PID), which may lead to infertility, and tubal (ectopic) pregnancy.

Longstanding untreated infections can enter the bloodstream (bacteriuria) and affect the joints (gonococcal arthritis), heart, and brain, though this is rare. A hallmark of gonorrhea is the recurrence of infection.

Diagnosis

Gonorrhea is diagnosed by observing symptoms and by taking a thorough history of sexual activity. In men, a sample of the discharge is cultured and examined microscopically to confirm the presence of the bacteria (gonococci); infection can usually be diagnosed immediately. In women, a sample of the discharge is usually taken from the cervix, and the culture may require incubation for 2 days before an accurate diagnosis can be made.

Treatment

Gonorrhea is resistant to penicillin, ampicillin, and amoxicillin. In some countries, gonorrhea is resistant to the antibiotics that cure strains found in the United States.

Medications that effectively treat uncomplicated gonorrhea include cefixime, ceftriaxone, spectinomycin, and ofloxacin. Ceftriaxone is usually injected intramuscularly in a single dose. Side effects include nausea, rash headache, itching, and pain and redness at the injection site.

Because NGU or chlamydia occurs simultaneously with gonorrhea in up to one-half of infected patients, ceftriaxone is often given and oral tetracycline, doxycycline, minocycline, or erythromycin prescribed. These oral medications are typically taken for 7 to 10 days. Side effects include nausea, mild abdominal pain, and diarrhea. Pregnant women should consult their physician before taking these drugs. A follow-up examination is recommended 3 to 5 days after completing treatment.

Infants are routinely given an antibacterial antibiotic immediately after birth to treat possible infection and thus prevent blindness.

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