Gonorrhea

In Illinois, the incidence of gonorrhea has declined significantly since 1975, when 64,560 cases were reported. Yet, more than 20,000 cases of the disease were reported in the state in 2005. It is estimated that another nearly 20,000 cases, mostly among teenagers and young adults, go unreported each year. The approximate annual cost of gonorrhea and its complications in Illinois is over $3 million.

What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) caused by a bacterium, Neisseria gonorrhoeae (gonococcus), that grows and multiplies in moist, warm areas of the body such as the cervix, urethra, throat or rectum. In women, the cervix is the most common site of infection. However, the disease can spread to the uterus and fallopian tubes, resulting in pelvic inflammatory disease. This, in turn, can cause infertility and ectopic pregnancy.

How is gonorrhea spread?

Gonorrhea is most commonly spread during genital contact, but it can also be passed from the genitals of one partner to the throat of the other during oral sex. Gonorrhea of the rectum can occur in people who practice anal intercourse and may also occur in women due to the spread of the infection from the vaginal area.

Gonorrhea can be passed from an infected woman to her newborn infant during delivery. When the infection occurs in children, it is most commonly due to child abuse.

What are the symptoms of gonorrhea?

The early symptoms of gonorrhea often are mild, and most women who are infected have no symptoms. If symptoms do develop, they usually appear within two to 10 days after sexual contact with an infected partner, although a small percentage of patients may be infected for several months without showing symptoms.

The initial symptoms in women include a painful or burning sensation when urinating or an abnormal vaginal discharge. More advanced symptoms, which indicate progression to pelvic inflammatory disease, include abdominal pain, bleeding between menstrual periods, vomiting or fever.

Many men with gonorrhea may have not symptoms at all. Some men have a discharge from the penis and a burning sensation during urination that may be severe. These symptoms appear within three to five days after sexual contact.

Symptoms of rectal infection in men and women include discharge, anal itching and sometimes painful bowel movements. Symptoms of gonorrhea in the throat may vary from a mild to a severe sore throat.

How is gonorrhea diagnosed?

Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample. A quick laboratory test for gonorrhea that can be done in some clinics or doctor’s offices is a Gram Stain. A Gram stain of a sample from a urethra or a cervix allows the doctor to see the gonorrhea bacterium under a microscope. This test works better for men than for women.

How is gonorrhea treated?

Because penicillin-resistant gonorrhea is widespread, non-penicillin antibiotics, such as ceftriaxone, is used to treat most gonococcal infections.

Gonorrhea often occurs together with chlamydial infection, another common STD. Therefore, physicians usually prescribe a combination of antibiotics, such as ceftriaxone and doxycycline, to treat both diseases. Women who are pregnant should not take doxycycline and are usually given an alternative antibiotic, such as erythromycin.

Regardless of what drug is prescribed, it is important that the patient take the full course of medication. Although medications will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea.

All sex partners of a person with gonorrhea should be tested and treated appropriately even if they do not have symptoms of infection.

Does gonorrhea have any complications?

Untreated gonorrhea can cause serious and permanent health problems in both women and men. The bacteria can spread to the bloodstream and infect the joints, heart valves or the brain. The most common consequence of gonorrhea, however, is pelvic inflammatory disease (PID), a serious infection of the female reproductive organs that occurs in an estimated 1 million American women each year. PID can scar or damage cells lining the fallopian tubes, resulting in infertility in as many as 10 percent of women affected. In others, the damage prevents the proper passage of the fertilized egg into the uterus. If this happens, the egg may implant in the tube; this is called an ectopic or tubal pregnancy and is life-threatening to the woman if not detected early.

In men, gonorrhea can cause epididymitis, a painful condition of the testicles that can lead to infertility if left untreated.

An infected woman who is pregnant may give the infection to her infant as the baby passes through the birth canal during delivery. Most states require that the eyes of newborns be treated with silver nitrate or other medication immediately after birth to prevent gonococcal infection of the eyes, which can lead to blindness. Because of the risk of gonococcal infection to both mother and child, doctors recommend that a pregnant woman have at least one test for gonorrhea during her pregnancy.

Because of the symptoms associated with gonorrhea, infected individuals have a three- to five-fold increase in the risk of acquiring HIV (the virus that causes AIDS) if exposed to the virus during sexual intercourse.

How is gonorrhea prevented?

Not having sex is the best protection against acquiring gonorrhea and other STDs. Having sex with only one uninfected partner who only has sex with you is also safe.

Condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea. Because gonorrhea is highly contagious and yet may cause no symptoms, all men and women who have sexual contact with more than one partner should be tested regularly for the disease. Constant awareness and precautions are necessary because a person who has once contracted the disease does not become immune. Many people acquire gonorrhea more than once.