Gonorrhea
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Gonorrhea is a curable sexually transmitted infection (STI) caused by a bacterium
called
Neisseria gonorrhoeae. These bacteria can infect the genital tract,
the mouth, and the rectum. In women, the opening to the uterus, the cervix,
is the first place of infection.
The disease however can spread into the uterus and fallopian tubes,
resulting in pelvic inflammatory disease (PID). PID affects more than 1
million women in this country every year and can cause infertility in as
many as 10 percent of infected women and tubal (ectopic) pregnancy.
In 2000, 358,995 cases of gonorrhea were reported to the U.S. Centers
for Disease Control and Prevention (CDC). In the United States,
approximately 75 percent of all reported cases of gonorrhea is found in
younger persons aged 15 to 29 years. The highest rates of infection are
usually found in 15- to 19-year old women and 20- to 24-year-old men.
Health economists estimate that the annual cost of gonorrhea and its
complications is close to $1.1 billion.
Gonorrhea is spread during sexual intercourse. Infected women also can
pass gonorrhea to their newborn infants during delivery, causing eye
infections in their babies. This complication is rare because newborn
babies receive eye medicine to prevent infection. When the infection
occurs in the genital tract, mouth, or rectum of a child, it is due most
commonly to sexual abuse.
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The early symptoms of gonorrhea often are mild. Symptoms usually appear within
2 to 10 days after sexual contact with an infected partner. A small number of
people may be infected for several months without showing symptoms.
When women have symptoms, the first ones may include
- Bleeding associated with vaginal intercourse
- Painful or burning sensations when urinating
- Vaginal discharge that is yellow or bloody
More advanced symptoms, which may indicate development of PID, include
cramps and pain, bleeding between menstrual periods, vomiting, or
fever.
Men have symptoms more often than women, including
- Pus from the penis and pain
- Burning sensations during urination that may be severe
Symptoms of rectal infection include discharge, anal itching, and
occasional painful bowel movements with fresh blood on the feces.
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Doctors or other health care workers usually use three laboratory techniques
to diagnose gonorrhea: staining samples directly for the bacterium, detection
of bacterial genes or DNA in urine, and growing the bacteria in laboratory cultures.
Many doctors prefer to use more than one test to increase the chance of an accurate
diagnosis.
The staining test involves placing a smear of the discharge from the
penis or the cervix on a slide and staining the smear with a dye. Then the
doctor uses a microscope to look for bacteria on the slide. You usually
can get the test results while in the office or clinic. This test is quite
accurate for men but is not good in women. Only one in two women with
gonorrhea have a positive stain.
More often, doctors use urine or cervical swabs for a new test that
detects the genes of the bacteria. These tests are as accurate or more so
than culturing the bacteria, and many doctors use them.
The culture test involves placing a sample of the discharge onto a
culture plate and incubating it up to 2 days to allow the bacteria to
grow. The sensitivity of this test depends on the site from which the
sample is taken. Cultures of cervical samples detect infection
approximately 90 percent of the time. The doctor also can take a culture
to detect gonorrhea in the throat. Culture allows testing for
drug-resistant bacteria.
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Doctors usually prescribe a single dose of one of the following antibiotics
to treat gonorrhea:
- Cefixime
- Ceftriaxone
- Ciprofloxacin
- Ofloxacin
- Levofloxacin
If you have gonorrhea and are pregnant or are younger than 18 years
old, you should not take ciprofloxacin or ofloxacin. Your doctor can
prescribe the best and safest antibiotic for you.
Gonorrhea and chlamydial infection, another common STI, often infect
people at the same time. Therefore, doctors usually prescribe a
combination of antibiotics, such as ceftriaxone and doxycycline or
azithromycin, 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 of
infection.
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In untreated gonorrhea infections, the bacteria can spread up into the reproductive
tract, or more rarely, can spread through the blood stream and infect the joints,
heart valves, or the brain.
The most common result of untreated gonorrhea is PID, a serious
infection of the female reproductive tract. 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.
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 (HIV, human immunodeficiency virus, causes AIDS). 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.
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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 doctor can prevent infection
of your baby's eyes by applying silver nitrate or other medications to the eyes
immediately after birth. Because of the risks from gonococcal infection to both
you and your baby, doctors recommend that pregnant women have at least one test
for gonorrhea during pregnancy.
By using latex condoms correctly and consistently during vaginal or rectal sexual
activity, you can reduce your risk of getting gonorrhea and its complications.
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The National Institute of Allergy and Infectious Diseases (NIAID) continues
to support a comprehensive, multidisciplinary program of research on
N. gonorrhoeae
(gonoccoci). Researchers are trying to understand how gonoccoci infect cells
while evading human immune defenses (immune response). Studies are ongoing to
determine
- How this bacterium attaches to host cells
- How it gets inside them
- Gonococcal surface structures and how they can change
- Human response to infection by gonococci
All of these efforts, together, will eventually lead to development of
an effective vaccine against gonorrhea. They also have led to, and will
lead to further, improvements in diagnosis and treatment of gonorrhea.
Another important area of gonorrhea research concerns antibiotic
resistance. This is particularly important because strains of N.
gonorrhoeae that are resistant to recommended antibiotic therapies
have spread from Southeast Asia to Hawaii and are now starting to appear
on the West Coast. These events add urgency to NIAID efforts to develop
effective microbicides (antimicrobial preparations that can be applied
inside the vagina) to prevent infections.
Recently, scientists have determined the sequence of the N.
gonorrhoeae genome. They are using this information to find promising
new leads to help us better understand how the organism causes disease and
becomes resistant to antibiotics.
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National Institute of Allergy
and Infectious Diseases
National Library of Medicine
American Social Health
Association
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