Gonorrhea

Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It can infect the genitals, rectum, and throat, and is one of the most common bacterial STIs worldwide.

Overview

Gonorrhea is a highly contagious bacterial infection that has been documented for centuries, with references dating back to ancient times. Despite being easily treatable with antibiotics, it remains a significant public health concern, with the World Health Organization estimating over 80 million new cases globally each year. The infection is particularly common among sexually active teenagers and young adults aged 15-24.

The causative bacterium, Neisseria gonorrhoeae, is a gram-negative diplococcus that exclusively infects humans. It thrives in warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in both women and men. The bacteria can also infect the mucous membranes of the mouth, throat, eyes, and rectum.

One of the most concerning aspects of gonorrhea is that many infected individuals, particularly women, may have no symptoms at all. This asymptomatic nature allows the infection to spread unknowingly and can lead to serious complications if left untreated. Additionally, the emergence of antibiotic-resistant strains of gonorrhea has become a growing concern, making prevention and proper treatment more critical than ever.

Symptoms

The symptoms of gonorrhea vary depending on the site of infection and the individual's sex. Many people with gonorrhea have no symptoms at all, which is why regular testing is important for sexually active individuals. When symptoms do occur, they typically appear within 2-14 days after exposure.

Symptoms in Men

  • Penile discharge - white, yellow, or green discharge from the penis
  • Burning sensation when urinating
  • Painful or swollen testicles (less common)
  • Anal itching, soreness, bleeding, or discharge (with rectal infection)
  • Sore throat (with throat infection)

Symptoms in Women

Other Sites of Infection

  • Rectal gonorrhea: Discharge, anal itching, soreness, bleeding, painful bowel movements
  • Throat gonorrhea: Usually asymptomatic, but may cause sore throat
  • Eye gonorrhea: Eye pain, sensitivity to light, pus-like discharge
  • Disseminated infection: Problems with movement, joint pain, skin rash, fever

Complications if Untreated

Without treatment, gonorrhea can lead to serious health problems:

  • Pelvic inflammatory disease (PID) in women
  • Epididymitis in men
  • Infertility in both men and women
  • Increased risk of HIV transmission
  • Disseminated gonococcal infection (DGI)
  • Pregnancy complications and transmission to newborns

Causes

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which is transmitted through sexual contact with an infected person. Understanding how the infection spreads is crucial for prevention.

Transmission Methods

  • Sexual contact: Vaginal, anal, or oral sex with an infected partner
  • Genital contact: Can spread even without penetration or ejaculation
  • Mother to child: During childbirth through the birth canal
  • Contaminated objects: Rarely, through shared sex toys

How Gonorrhea Does NOT Spread

It's important to understand that gonorrhea cannot be transmitted through:

  • Casual contact such as hugging or holding hands
  • Sharing toilets or bathroom facilities
  • Sharing cups, plates, or eating utensils
  • Swimming pools or hot tubs
  • Doorknobs or other surfaces
  • Coughing or sneezing

Bacterial Characteristics

  • Gram-negative diplococcus bacteria
  • Requires warm, moist environment to survive
  • Cannot survive long outside the human body
  • Targets mucous membranes
  • Can develop antibiotic resistance

Risk Factors

Several factors increase the risk of contracting gonorrhea:

  • Age: Highest rates in people aged 15-24 years
  • Sexual activity:
    • Having multiple sexual partners
    • Having a new sexual partner
    • Having a partner with concurrent partners
  • Unprotected sex: Not using condoms or dental dams
  • Previous STI: History of gonorrhea or other STIs
  • Substance use: Alcohol or drug use that impairs judgment
  • Commercial sex work: Both workers and clients
  • Men who have sex with men: Higher prevalence in this population
  • Socioeconomic factors: Limited access to healthcare and STI prevention
  • Geographic location: Higher rates in certain urban areas

Reinfection Risk

Important points about reinfection:

  • Having gonorrhea once doesn't provide immunity
  • Can be reinfected multiple times
  • Partners must be treated simultaneously
  • Reinfection rates are high without partner treatment

Diagnosis

Accurate diagnosis of gonorrhea is essential for proper treatment and preventing complications. Several testing methods are available, and healthcare providers will choose the most appropriate based on symptoms and exposure history.

Testing Methods

  • Nucleic Acid Amplification Tests (NAATs):
    • Most sensitive and specific tests
    • Can use urine samples or swabs
    • Preferred method for diagnosis
    • Can test for multiple STIs simultaneously
  • Culture:
    • Growing bacteria from samples
    • Allows antibiotic susceptibility testing
    • Less sensitive than NAATs
    • Important for resistant cases
  • Gram stain:
    • Rapid microscopic examination
    • More useful in symptomatic men
    • Less reliable for other sites

Sample Collection Sites

  • Men: Urine sample or urethral swab
  • Women: Vaginal or cervical swab, urine sample
  • Other sites: Rectal swab, throat swab, eye discharge

When to Get Tested

  • If you have symptoms of gonorrhea
  • If a sexual partner has been diagnosed with gonorrhea
  • If you've had unprotected sex with a new partner
  • Annual screening for sexually active women under 25
  • Annual screening for men who have sex with men
  • During pregnancy (first prenatal visit)
  • If diagnosed with another STI

Test Results

  • Results typically available in 1-3 days
  • Some rapid tests available with same-day results
  • Positive results require immediate treatment
  • Partner notification is important
  • Retesting recommended 3 months after treatment

Treatment Options

Gonorrhea is curable with the right antibiotic treatment. However, the emergence of drug-resistant strains has led to evolving treatment guidelines. It's crucial to complete the full course of treatment and follow up as recommended.

Current Treatment Guidelines

Uncomplicated gonorrhea (CDC 2021 recommendations):

  • Preferred regimen: Ceftriaxone 500mg intramuscular injection (single dose)
  • Alternative if ceftriaxone unavailable: Gentamicin 240mg IM plus azithromycin 2g orally
  • For pharyngeal gonorrhea: Same as above, as ceftriaxone is highly effective

Special Considerations

  • Pregnancy: Same treatment; avoid doxycycline
  • Allergies: Consultation with specialist for severe penicillin/cephalosporin allergy
  • Coinfections: Often treated presumptively for chlamydia
  • HIV patients: Same treatment recommendations
  • Children: Weight-based dosing with specialist consultation

Treatment of Complicated Gonorrhea

  • Disseminated gonococcal infection: Ceftriaxone 1g IV/IM daily for 7 days
  • Meningitis: Ceftriaxone 1-2g IV every 12-24 hours for 10-14 days
  • Endocarditis: Ceftriaxone 1-2g IV every 12-24 hours for at least 4 weeks
  • Epididymitis: Ceftriaxone plus doxycycline for 10 days

Post-Treatment Care

  • Abstain from sexual activity for 7 days after treatment
  • Ensure all partners are treated before resuming sexual activity
  • No test of cure needed for uncomplicated infections if symptoms resolve
  • Retest after 3 months due to high reinfection rates
  • Report persistent symptoms to healthcare provider immediately

Antibiotic Resistance

Growing concern about resistant gonorrhea:

  • Resistance to penicillin, tetracycline, and fluoroquinolones is widespread
  • Emerging resistance to azithromycin and ceftriaxone
  • Importance of appropriate antibiotic use
  • Need for new treatment options being researched
  • Culture and sensitivity testing for treatment failures

Prevention

Preventing gonorrhea involves reducing exposure risk and practicing safer sex. Since many people with gonorrhea have no symptoms, prevention is particularly important.

Primary Prevention Methods

  • Condom use: Consistent and correct use of latex or polyurethane condoms
  • Dental dams: For oral-genital or oral-anal contact
  • Mutual monogamy: Being in a long-term relationship with an uninfected partner
  • Regular testing: Know your status and your partner's status
  • Communication: Open discussion with partners about STI history
  • Limiting partners: Reducing number of sexual partners

Screening Recommendations

  • Sexually active women under 25: Annual screening
  • Women 25 and older: If at increased risk
  • Pregnant women: At first prenatal visit; retest if at risk
  • Men who have sex with men: Annual or more frequent screening
  • People with HIV: At least annual screening
  • Anyone with symptoms or exposure: Immediate testing

Risk Reduction Strategies

  • Avoid sexual contact if you or partner have symptoms
  • Don't share sex toys, or clean them between uses
  • Avoid douching, which can increase infection risk
  • Strengthen immune system through healthy lifestyle
  • Limit alcohol and drug use that may impair judgment
  • Consider pre-exposure prophylaxis discussions with provider

When to See a Doctor

Seek medical attention promptly if you experience:

  • Any unusual discharge from penis, vagina, or rectum
  • Burning sensation during urination
  • Pelvic or abdominal pain
  • Painful or swollen testicles
  • Unusual vaginal bleeding
  • Anal itching, discharge, soreness, or bleeding
  • Persistent sore throat after oral sex
  • If a sexual partner has been diagnosed with gonorrhea or any STI

Seek immediate emergency care if you experience:

  • High fever with pelvic pain
  • Severe abdominal pain
  • Joint pain and swelling with fever
  • Skin rash with fever and joint pain
  • Signs of pregnancy complications with gonorrhea

Remember, many people with gonorrhea have no symptoms. Regular screening is important if you're sexually active, especially with multiple partners or new partners.

Frequently Asked Questions

Can gonorrhea be cured?

Yes, gonorrhea can be completely cured with appropriate antibiotic treatment. However, damage already done to the body cannot be reversed, and you can get reinfected if exposed again.

How soon after exposure do symptoms appear?

Symptoms typically appear 2-14 days after exposure, but many people never develop noticeable symptoms. Men are more likely to have symptoms than women.

Can I get gonorrhea from oral sex?

Yes, gonorrhea can be transmitted through oral, vaginal, or anal sex. It can infect the throat, genitals, and rectum.

Do I need to tell my partners?

Yes, it's crucial to notify all recent sexual partners (typically from the past 60 days) so they can get tested and treated. Many health departments offer anonymous partner notification services.

Can gonorrhea affect pregnancy?

Yes, untreated gonorrhea during pregnancy can cause miscarriage, premature birth, low birth weight, and can be transmitted to the baby during delivery, potentially causing eye infections.

References

  1. Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187.
  2. World Health Organization. WHO Guidelines for the Treatment of Neisseria gonorrhoeae. Geneva: WHO; 2023.
  3. Unemo M, et al. Gonorrhoea. Nat Rev Dis Primers. 2019;5(1):79.
  4. St. Cyr S, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR. 2020;69(50):1911-1916.
  5. Kirkcaldy RD, et al. Neisseria gonorrhoeae Antimicrobial Susceptibility Surveillance. Clin Infect Dis. 2023.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.