Gonorrhea

• Alternative Names

  Clap; The drip

• Causes, incidence, and risk factors

  Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. Anyone who has any type of sex can catch gonorrhea. The infection can be spread by contact with the mouth, vagina, penis, or anus.

  The bacteria grow in warm, moist areas of the body, including the tube that carries urine out of the body (urethra). In women, the bacteria may be found in the reproductive tract (which includes the fallopian tubes, uterus, and cervix). The bacteria can even grow in the eyes.

  Health care providers in every state in the U.S. are required by law to tell their State Board of Health about anyone diagnosed with gonorrhea. The goal of this law is make sure the patient gets proper follow-up care and that their sexual partners are found and tested.

  More than 700,000 persons in the United States get gonorrhea every year, according to the Centers for Disease Control and Prevention (CDC).

  Gonorrhea is more common in large cities, inner-city areas, populations with lower overall levels of education and people with lower socioeconomic status.

  You are more likely to develop this infection if you:

  • Have multiple sexual partners
  • Have a partner with a past history of any sexually transmitted disease
  • Do not use a condom during sex
  • Are a man who has sexual contact with another man
  • Have a drug addiction
• Symptoms

  Symptoms of gonorrhea usually appear 2 - 5 days after infection, however, in men, symptoms may take up to a month to appear. Some people do not have symptoms. They may be completely unaware that they have caught the disease, and therefore do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person.

  Symptoms in men include:

  • Burning and pain while urinating
  • Increased urinary frequency or urgency
  • Discharge from the penis (white, yellow, or green in color)
  • Red or swollen opening of penis (urethra)
  • Tender or swollen testicles
  • Sore throat (gonococcal pharyngitis)

  Symptoms in women can be very mild or nonspecific, and may be mistaken for another type of infection. They include:

  • Vaginal discharge
  • Burning and pain while urinating
  • Increased urination
  • Sore throat
  • Painful sexual intercourse
  • Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area)
  • Fever (if the infection spreads to the fallopian tubes and stomach area)

  If the infection spreads to the bloodstream, fever, rash, and arthritis-like symptoms may occur. See: Disseminated gonococcemia

• Signs and tests

  Gonorrhea can be quickly identified by staining a sample of tissue or discharge and then looking at it under a microscope. This is called a gram stain. Although this method is fast, it is not the most certain.

  Gram stain tests used to diagnose gonorrhea include:

  • Cervical gram stain in women
  • Gram stain of urethral discharge in men
  • Joint fluid gram stain

  Cultures (cells that grow in a lab dish) provide absolute proof of infection. Generally, samples for a culture are taken from the cervix, vagina, urethra, anus, or throat. Cultures can provide a preliminary diagnosis often within 24 hours and a confirmed diagnosis within 72 hours.

  Cultures used to diagnose gonorrhea include:

  • Endocervical culture in women
  • Urethral discharge culture in men
  • Throat swab culture in both men and women
  • Rectal culture in both men and women
  • Culture of joint fluid
  • Blood cultures

  DNA tests are especially useful as a screening test. They included the ligase chain reaction (LCR) test. DNA tests are quicker than cultures. Such tests can be performed on urine samples, which are a lot easier to collect than samples from the genital area.

• Treatment

  There are two goals in treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first is to cure the infection in the patient. The second is to locate and test all of the other people the person had sexual contact with and treat them to prevent further spread of the disease.

  Never treat yourself without being seen by your doctor first. Your health care provider will determine the best and most up-to-date treatment. The U.S. Centers for Disease Control and Prevention (CDC) recommends the following treatments for uncomplicated gonorrhea.

  • A single shot of ceftriaxone (Rocephin) 125 mg or a single dose of cefixime 400 mg taken by mouth are currently the recommended antibiotic treatment
  • Azithromycin (Zithromax) 2g in a single dose may be used for people who have severe allergic reactions to ceftriaxone, cefixime, or penicillin.

  Penicillin used to be the standard treatment, but it is not used any longer because it does not cure gonorrhea all the time. The CDC also recommendeds against using a class of antibiotics called fluoroquinolones (ciprofloxacin, ofloxacin, or levofloxacin).

  Persons with gonorrhea often also have a chlamydia infection. If a chlamydia culture was not done to rule out this infection, a single dose of azithromycin (1g by mouth) or doxycycline 100 mg twice a day, by mouth for 7 days should also be given.

  A follow-up visit 7 days after treatment is important if joint pain, skin rash, or more severe pelvic or belly pain is present. Tests will be done to make sure the infection is gone.

  All sexual contacts of the person with gonorrhea should be contacted and tested. This helps prevent further spread of the disease. In some places you may be able to take counseling information and medicines to your sexual partner yourself. In other places, the health department will contact your partner.

• Expectations (prognosis)

  Immediately treating a gonorrhea infection helps prevent permanent scarring and infertility. When treatment is delayed there is a greater chance of complications and sterility.

  About half of the women with gonorrhea are also infected with chlamydia, another very common sexually transmitted disease that can result in sterility. Chlamydia is treated at the same time as a gonorrhea infection.

  If you have gonorrhea, you should ask to be tested for other sexually transmitted diseases, including chlamydia, syphilis, and HIV. You should also receive the hepatitis B vaccine.

• Complications

  Complications in women may include:

  • Salpingitis (scarring of the fallopian tubes), which can lead to problems getting pregnant or ectopic pregnancy
  • Pelvic inflammatory disease
  • Sterility (inability to become pregnant)
  • Painful intercourse (dyspareunia)
  • Pregnant women with severe gonorrhea may pass the disease to their baby while in the womb or during delivery

  Complications in men may include:

  • Scarring or narrowing of the urethra, the tube that carries urine out of the body (See: Urethral stricture)
  • Abscess (collection of pus around the urethra)
  • Urination problems
  • Urinary tract infection
  • Kidney failure

  Complications in both men and women may include:

  • Disseminated infection, which can be very serious
  • Long-term joint pain, if the infection is left untreated
  • Heart valve infection
  • Meningitis
• Calling your health care provider

  If you have symptoms suggestive of gonorrhea, you should call your health care provider immediately. Most state-sponsored clinics will diagnose and treat STDs without charge.

• Prevention

  Not having sexual intercourse (abstinence) is the only absolute method of preventing gonorrhea. A monogamous sexual relationship with an individual known to be free of any STD can reduce risk. Monogamous means you and your partner do not have sex with any other persons.

  You can greatly lower your risk of catching an STD by using a condom every time you have sex. Condoms are available for both men and women, but are most commonly worn by the man. A condom must be used properly every time. (For instructions on how to use a condom, see safe sex.)

  To further prevent the spread of infection, treatment of all sexual partners is important.

• References

  Centers for Disease Control and Prevention (CDC). Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006: Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections. MMWR. 2007; 56(14);332-336.

  U.S. Preventive Services Task Force. Screening for Gonorrhea: Recommendation Statement. Am Fam Physician. Nov. 1, 2005; 72(9); 1783-1786.

  Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2007. Atlanta, GA: U.S. Department of Health and Human Service, December 2008.

  U.S. Preventive Services Task Force. Screening for Gonorrhea: Recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality. May 2005. Accessed April 5, 2009.

  Bamberger DM. Gonorrhea. In: Rakel P, Bope ET, eds. Conn’s Current Therapy 2008. 60th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 184.

  Bauer HM, Wohlfeiler D, Klausner JD, Guerry S, Gunn RA, Bolan G. California Guidelines for Expedited Partner Therapy for Chlamydia trachomatis and Neisseria gonorrhoeae. Sexually Transmitted Diseases. 2008 Mar;35(3):314-319.

Review Date: 5/30/2009

Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.