Increasing numbers of infected adolescent girls may be asymptomatic for gonorrhea.

Gonorrhea infects more than 700,000 individuals in the United States each year and has the potential risk for severe complications, such as infertility and pelvic inflammation. However, very little is known about the natural history of the infection.1 Additionally, the actual onset of natural infection is difficult to identify because prospective experimental studies that may elucidate this, are unethical.

To uncover the history and progression of gonorrhea infection, a longitudinal cohort study was carried out recently, using weekly vaginal samples and daily diaries to document occurrence of gonorrhea infection among adolescent women. The study sample included 387 women aged 14 to 17 years. Participants’ vaginal samples were obtained weekly and screened for STIs in a 12-week period biannually for 8 years.2,3 Participants kept daily diaries to report partner-specific sexual behaviors along with vaginal and pelvic symptoms. In this study, 16 women became infected with gonorrhea as identified during the weekly sampling period. These infected women were examined for organism load and evident changes or symptoms after initial infection.

The results of the study offer an insight into the asymptomatic and infectious nature of gonorrhea. Data collected from participants’ diaries show that the majority of gonorrhea-infected patients did not report symptoms. In fact, the rate of women with gonorrhea reporting no symptoms exceeded prior reports in which 80% of women with gonorrhea are asymptomatic.4
The results also concluded that there is no linear relationship between organism load and the duration of gonorrhea infection. On the other hand, higher gonorrhea organism loads were observed in women who were concurrently infected with chlamydia compared to women infected only with gonorrhea. Infection in human participants with previous gonorrhea infection had similar organism loads, both initially and during the early course of infection, as participants who had no previous gonorrhea infection.3 Hence, prior gonorrhea infection does not provide immunity to later infections as in some other infections.4

There were some limitations to the study. At the outset, the sample size was very limited — only a small number of women who had gonorrhea infections provided data. Additionally, young women acquired infections at different points during the period.. However, because the study followed naturally occurring infections, the data proved to be highly relevant.

In conclusion, chlamydia co-infection is associated with high gonorrhea organism loads whereas symptoms are not associated with organism loads.3 The lack of apparent symptoms in patients with gonorrhea suggests that routine screening is crucial, especially among at-risk adolescents in populations where disease is prevalent. Routine screening can help detect cases for early treatment. The treatment of gonorrhea has become even more complicated because of the emergence of resistant strains to the available medications used in the treatment.5
As always, prevention is better than a cure for any infection, and especially for one as common as gonorrhea. It is important that young women are educated on the risks of sexually transmitted infections such as gonorrhea.

Risk avoidance is key to preventing infections such as gonorrhea and complications associated with the disease and its treatment. By encouraging the screening of sexually active individuals and promoting risk avoidance until one is in a lifelong relationship with an uninfected partner, health advocates can hope to improve the sexual health of young individuals.


1. CDC. Gonorrhea – CDC Fact Sheet. Available at Accessed August 18, 2011.

2. Tu W, Batteiger BE, Wiehe S, et al. Time for first intercourse to first sexually transmitted infection diagnosis among adolescent women. Arch Pediatr Adolesc Med 2009; 163:1106-1111.

3. Stupiansky NW, Van Der Pol B, et al. The natural history of incident gonococcal infection in adolescent women. Sex Trans Dis 2011; 38: 750-754.

4. Hook EW, Handsfield HH. Gonococcal infections in the adult. In: Holmes KK, Sparling PF, Stamm WE et al, eds. Sexually Transmitted Diseases, 4th ed. New York, NY: McGraw-Hill, 2008.

5. CDC. Cephalosporin Susceptibility Among Neisseria gonorrhoeae Isolates – United States, 2000-2010. MMWR 2011; 60(26):873-877.

Reviewed: September 2011