Gonorrhea

Gonorrhea is one of the most common sexually transmitted diseases in the United States, where more than 800,000 gonorrhea infections are estimated to occur each year. Although some men and women may have symptoms (such as discharge or burning when urinating), most people infected with gonorrhea do not. As a result, many infections go undetected and untreated. Left untreated, gonorrhea can cause serious health problems, particularly for women, including chronic pelvic pain, life-threatening ectopic pregnancy and infertility. Gonorrhea infection also increases a person’s risk of contracting and transmitting HIV.

Cause

Gonorrhea is caused by bacteria called Neisseria gonorrhoeae. These bacteria can infect the genital tract, mouth, and rectum of both men and women. In women the opening to the uterus (cervix) is the first place of infection.

Transmission

You can get gonorrhea during vaginal, oral, or anal sex with an infected partner.

If you are pregnant and have gonorrhea, you may give the infection to your baby as it passes through your birth canal during delivery.

Symptoms

The bacteria that cause gonorrhea are carried in semen and vaginal fluids and cause a discharge in men and women. A small number of people may be infected for several months without showing symptoms.

For women, the early symptoms of gonorrhea often are mild. Symptoms usually appear within 2 to 10 days after sexual contact with an infected partner. When women have symptoms, the first ones may include:

• Bleeding associated with vaginal intercourse
• Painful or burning sensations when urinating
• Yellow or bloody vaginal discharge

More advanced symptoms, which may indicate development of pelvic inflammatory disease (PID), include cramps and pain, bleeding between menstrual periods, vomiting, or fever.

Men have symptoms more often than women, including:

• White, yellow, or green pus from the penis with pain
• Burning sensations during urination that may be severe
• Swollen or painful testicles

If left untreated, men could experience prostate complications and epididymitis (inflammation of the testicles).

Symptoms of rectal infection include discharge, anal itching, and occasional painful bowel movements with fresh blood in the feces. Symptoms typically appear 2 to 5 days after infection but could appear as long as 30 days later.

Diagnosis

Healthcare providers usually use three laboratory tests to diagnose gonorrhea.

• Staining samples directly for the bacteria
• Detecting bacterial genes or DNA in urine
• Growing the bacteria in laboratory cultures

Many providers prefer to use more than one test to increase the chance of an accurate diagnosis.

You usually can get the staining test results while in the office or clinic. This test is more accurate in men than in women.

More often, healthcare providers use urine or cervical swabs for a new test that detects the genes of the bacteria. These tests are more accurate than culturing the bacteria.

The laboratory culture test involves placing a sample of the discharge onto a culture plate. A healthcare provider also can take a culture to detect gonorrhea in the throat. Culture also allows testing for bacteria that are resistant to the antibiotics used to treat gonorrhea.

Treatment

Treating gonorrhea is becoming more difficult because drug-resistant strains of gonorrhea are increasing around the world.

If you are pregnant, or are younger than 18 years old, you shouldn't be treated with certain types of antibiotics. Your healthcare provider can prescribe the best and safest antibiotic for you. Gonorrhea and chlamydia often infect people at the same time. Therefore, healthcare providers usually prescribe a combination of antibiotics, which will treat both diseases.

If you have gonorrhea, all of your sexual partners should get tested and then treated if infected, whether or not they have symptoms. Health experts also recommend that you not have sex until your infected partners have been treated.

Prevention

The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact or be in a long-term, mutually monogamous relationship with a partner who has been tested and is not infected.

By using latex condoms correctly and consistently during vaginal or rectal sexual activity, you can reduce your risk of getting gonorrhea and developing complications.

Complications

In untreated gonorrhea infections, the bacteria can spread up into the reproductive tract, or more rarely, can spread into the blood stream and infect the joints, heart valves, or the brain.

The most common result of untreated gonorrhea is pelvic inflammatory disease (PID). Gonococcal PID often appears immediately after the menstrual period. PID causes scar tissue to form in the fallopian tubes. If the tube is partially scarred, the fertilized egg may not be able to pass into the uterus. If this happens, the embryo may implant in the tube causing a tubal (ectopic) pregnancy. This serious complication may result in a miscarriage and can cause death of the mother.

In men, gonorrhea causes epididymitis, a painful condition of the testicles that can lead to infertility if left untreated. Also, gonorrhea affects the prostate gland and may cause scarring in the urine canal.

Rarely, untreated gonorrhea can spread through the blood to the joints. This can cause an inflammation of the joints, which is very serious.

If you are infected with gonorrhea, your risk of getting HIV infection increases. Therefore, it is extremely important for you to either prevent yourself from getting gonorrhea or get treated early if you already are infected with it.

Complications in newborns and children

If you are pregnant and have gonorrhea, you may give the infection to your baby as it passes through the birth canal during delivery. A healthcare provider can prevent infection of your baby's eyes by applying silver nitrate or other medicine to the eyes immediately after birth. Because of the risks from gonococcal infection to both you and your baby, health experts recommend that pregnant women have at least one test for gonorrhea during prenatal care.

When gonorrhea occurs in the genital tract, mouth, or rectum of a child, it is due most commonly to sexual abuse.

Reference: National Institute of Allergy and Infectious Diseases. http://www.niaid.nih.gov/topics/gonorrhea/understanding/Pages/complications.aspx