Gonorrhea

What is gonorrhea?
Gonorrhea infection is a sexually transmitted infection (STI) caused by the bacteria
Neiserria gonorrhoeae.

How common is gonorrhea?
Gonorrhea infection is the second most commonly reported bacterial STI, after Chlamydia. In 2009, the rate of gonorrhea in the U.S. was the lowest since records were kept. However, from 2009 – 2012, the rate increased slightly each year. In 2013, the rate decreased slightly and there was a shift in the populations that are most effected. For the first time since 2000, the rate was higher among men than women. Men in the age group of 20 – 24 had the highest rate. The CDC estimates there are currently over 333, 000 cases of gonorrhea in the U.S.1
How is gonorrhea spread?
Gonorrhea infection can be spread through vaginal, anal, or oral sex. It can also be spread from an infected mother to her baby at delivery.

Does gonorrhea cause symptoms?
Most of the time, a gonorrhea infection does not cause symptoms in women. In fact, 95% of women infected with gonorrhea in their vagina have no symptoms. In contrast, most men with urethral gonorrhea (90%) do have pain with urination or a discharge from the penis. If gonorrhea occurs in the rectum, 50% of both men and women report symptoms. Most cases of gonorrhea of the throat do not cause symptoms, with 90% of infected men and women being asymptomatic. Since many infected people do not have symptoms of the infection, they do not know that they have an STI and do not go to the doctor to be treated. Without symptoms, infected people can spread the gonorrhea infection to their sexual partners without knowing it.2
Because this infection does not usually cause symptoms in women, the U.S. Preventive Services
Task Force recommends that all sexually active females aged 24 and younger undergo screening for gonorrhea infection.3

What are the symptoms of gonorrhea?
Many people do not have symptoms when they have a gonorrhea infection; but when symptoms do occur, they include painful urination and discharge from the penis or vagina. If the gonorrhea infection involves the anus and rectum, pain with bowel movements and bleeding of the rectum may occur. If gonorrhea infection involves the mouth and throat, the only symptom of infection may be a sore throat.

Are there any treatments available for gonorrhea?
Gonorrhea infection is usually curable with antibiotics. However, there are strains of the bacteria that have become resistant to the antibiotics commonly used for treatment. In 2012 the CDC recommended new treatments that include a combination of antibiotics.4Many infections go unrecognized for long periods of time, because the infected person does not have symptoms. If a gonorrhea infection causes damage to a person’s body before antibiotic treatment is started, that damage may be permanent.

What complications can result from gonorrhea?
One potential complication of gonorrhea infection in a female is pelvic inflammatory disease (PID). If the gonorrhea infection spreads from the cervix up into the uterus and fallopian tubes, PID can develop. This occurs in about 10-19% of the gonorrhea infections.5 PID may cause permanent damage in the fallopian tubes and scarring in the pelvis. This damage to the fallopian tubes and scarring in the pelvis increases the chances that a woman will experience infertility, ectopic pregnancy, and chronic pelvic pain.
Another possible complication of a gonorrhea infection is the spread of the infection from a mother to her baby. If a mother has an active gonorrhea infection at the time of delivery, the infant is at risk of developing an eye infection that can lead to blindness.
In both males and females, gonorrhea infections can spread to the bloodstream and cause disease in the heart, brain, and joints.

Does gonorrhea affect the spread of HIV?
When a person has an active gonorrhea infection, they are more likely to acquire HIV from a sexual partner. Among men who have sex with men, repeated chlamydia or gonorrhea infections increase the risk of HIV by about 8 times.6

Can gonorrhea be prevented?
Yes; sexual transmission of gonorrhea can be prevented by refraining from sexual activity until a person is in a lifelong, mutually monogamous relationship with an uninfected partner. Mothers should be screened for gonorrhea infection during pregnancy to prevent the spread of gonorrhea infection to babies.

 

Note the pus coming from the tip of the penis on the right side of the image.

References:
1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance,2013. Atlanta, GA: U.S. Department of Health and Human Services. 2014. Available at: http://www.cdc.gov/std/stats13/toc.htm. Accessed April 2015
2. Mayor MT, et al, “Diagnosis and Management of Gonococcal Infections,” American Family Physician, http://www.aafp.org/afp/2012/1115/p931.html Accessed April 2015
3. U.S. Preventive Services Task Force. “Screening for gonorrhea: recommendation
Statement,” http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/chlamydia-and-gonorrhea-screening. Accessed April 2015
4. Centers for Disease Control and Prevention. Update to CDC’s sexually transmitted diseases treatment guidelines, 2010; Oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal Wkly Rep.2012; 61(31):590-594
5. Paavonen J, Westrom L, Eschenbach D. Pelvic inflammatory disease. In: Holmes K, Sparling FP, Stamm W, Wasserheit J, eds. Sexually Transmitted Diseases. 4th edn. New York: McGraw Hill, 2008:1017–1050.
6. Bernstein KT, Marcus JL, Nieri G, Philip SS, Klausner JD. Rectal gonorrhea and chlamydia re-infection is associated with increased risk of HIV seroconversion. J Acquir Immune Defic Syndr 2010; 53:537–54

Updated: May 2015