Alternate Names: The Clap
Causes and Risks: Gonorrhea is one of the most common infectious bacterial diseases and is most frequently transmitted during sexual intercourse, including both oral and anal sex. Gonorrhea is a reportable disease and all state governments require that cases of diagnosed gonorrhea be reported to the health authorities (State Board of Health). This allows for adequate follow-up and testing of sexual contacts.
There are almost 400,000 cases of gonorrhea reported to the CDC (Centers for Disease control) each year in the United States. There are probably many cases that are treated but not reported (the total number of cases is thought to approach 1,000,000 and if unreported cases are included and some estimates reach 2,000,000). However, a rate of 400,000 cases per year means that 1 out of every 687 Americans has gonorrhea (a rate of two million means that 1 in every 130 Americans are infected).
It has higher prevalence in large metropolitan areas, inner city areas, populations with lower overall levels of education, and people with lower socioeconomic status. Gonorrhea is most prevalent in people 15 to 29 years old. Risk factors include having multiple sexual partners, a partner with a past history of any STD, and unprotected sex (sex without the use of a condom).
Gonorrhea can be contracted during oral, vaginal, or anal sex and is very easily transmitted. The causative organism can infect the throat, producing a severe sore throat (gonococcal pharyngitis); the vagina, producing an irritated vagina with drainage (vaginitis); and the anus and rectum, producing a condition called proctitis. In addition, the organisms may spread up the female reproductive tract, through the cervix and uterus, into the Fallopian tubes (the tubes that carry the egg from the ovaries to the uterus).
In the Fallopian tubes, the infection is called PID or pelvic inflammatory disease (this occurs in 10 to 15% of the women with untreated gonorrhea). If the bacteria spreads beyond the Fallopian tubes into the peritoneum, it can produced a generalized infection in the abdomen called peritonitis. The bacteria can also spread to the blood stream causing gonococcemia and may settle in a joint causing gonococcal arthritis.
On rare occasions non-sexual transmission of gonorrhea can occur. An infected woman may transmit the infection to her newborn during childbirth. Infection of the newborn’s eyes is called ophthalmia neonatorum (gonococcal conjunctivitis). Young girls who contract gonorrhea either from sexual abuse or intimate contact with recently contaminated objects (such as a damp towel), develop a severe infection called vulvovaginitis.
Approximately 50% of women with gonorrhea have no symptoms (asymptomatic). They may be completely unaware that they have contracted the disease, and subsequently do not seek treatment. This increases the risk of complications and of passing the disease on to other individuals.
Gonorrhea has a short incubation period and symptoms appear 2 to 5 days following sexual activity. When the individual is symptomatic, the most frequently observed symptoms include vaginal discharge, increased urinary frequency, and urinary discomfort (dysuria). Spread of the organism to the Fallopian tubes and abdomen may cause lower abdominal pain, guarding, rebound tenderness, fever, and generalized symptoms of bacterial infection.
Ultimately gonorrhea may result in scarring of the Fallopian tubes and permanent sterility (inability to become pregnant). Scar tissue formation around the uterus and tubes may result in painful intercourse (dyspareunia) and chronic pelvic pain.
Gonorrhea is often associated with the presence of other sexually-transmitted diseases. About half of the women with gonorrhea are also infected with Chlamydia trachomatis, another very common STD that can result in sterility. Women who have contracted gonorrhea should request testing for other sexually-transmitted diseases including AIDS.
Prevention: Abstinence is the only absolute method of preventing gonorrhea. A monogamous sexual relationship with an individual known to be free of any STD is advisable. The use of condoms, both male and female types, markedly decrease the likelihood of contracting a sexually-transmitted disease but MUST BE USED PROPERLY. The condom should be in place from the beginning to end of sexual activity and should be used EVERY time the person engages in sexual activity with a non-monogamous partner or other suspect partner. Condoms are inexpensive considering the consequences of contracting a sexually-transmitted disease.
Treatment of all sexual partners is essential to prevent reinfection, and is a primary reason that the government has implemented mandatory reporting. Gonorrhea is still relatively easily cured and total eradication of the disease is, in theory, at least possible as the gonorrhea organism appears to exist only on the mucous membranes of humans.
Symptoms:
Signs and Tests:
An immediate preliminary diagnosis of gonorrhea can be made at the time of examination. A cervical smear is taken, stained, and examined under the microscope. Neisseria gonorrhea organisms appear as two-at-a-time side by side (diplococci) red (Gram negative) spheres within the cells scraped from the cervix. The appearance of these Gram negative diplococci is sufficient for a presumptive diagnosis of gonorrhea.
Cultures provide absolute proof of infection. Neisseria gonorrhea organisms may grow in any tissue of the body. They can be easily cultured from most areas using standard culture techniques. In suspected cases of gonorrhea, cultures should be taken from the cervix, vagina, anus, urethra, or the throat (pharynx). Laboratories can give a preliminary diagnosis often within 24 hours and a confirmed diagnosis within 72 hours.
Treatment: There are two aspects of treating a sexually-transmitted disease, especially one as easily spread as gonorrhea. The first aspect is to cure the affected person. The second is to locate and test all of the other sexual contacts and to treat them to prevent further spread of the disease. That is why mandatory reporting has been instituted and has, until recently, held the number of cases of gonorrhea at a low level. However, the incidence is once again rising.
Beginning about the time of the Viet Nam war, the United States encountered penicillin- and tetracycline-resistant strains of gonorrhea. These resistant strains have been increasing over the last few years. Because of this, a new standardized treatment regimen has now been recommended by the Centers for Disease control (CDC). Instead of the standard penicillin treatment, gonorrhea is now treated by a large number of new and very potent antibiotics.
Common prescriptions are one of the following:
- ceftriaxone 125 mg (milligrams) injected into a muscle, one time
- cefixime 400 mg by mouth, one time
- ciprofloxacin - oral 500 mg by mouth, one time
- ofloxacin - oral 400 mg by mouth, one time
- Spectinomycin 2 grams injected into a muscle, one time
- cefuroxime Axotal 1 gram by mouth, one time
- cefpodoxime proxetil 200 mg by mouth, one time
- enoxacin 400 mg given by mouth, one time
- erythromycins - oral 500 mg by mouth, four times a day for one week
A follow-up visit 7 days after treatment to recheck cultures and confirm the cure of infection is important, especially for women who may not have symptoms associated with the infection.
Prognosis: When gonorrhea is treated immediately upon onset, the outcome is likely to be good, meaning that no permanent scarring will have taken place and fertility will be maintained. When treatment is delayed there is a greater likelihood of complication and a high probability of sterility.
Complications: Untreated gonorrhea may spread to other parts of the body causing disseminated infection. The following is a list of possible complications:
If you have symptoms suggestive of gonorrhea, you should call your health care provider immediately. If you are short of funds or uninsured, state sponsored Sexually Transmitted Disease Clinics will diagnose and treat STDs without charge. Using a state sponsored clinic allows the state to keep accurate statistics on the number of cases and to treat other infected contacts who would otherwise spread the disease.
Women who have engaged in high risk sexual practices (multiple partners, unknown partners, and so on) should be periodically examined to detect the presence of asymptomatic disease.
