Gonorrhea

Gonorrhea is caused by the bacterium gonococcus, which cannot survive outside the body and is transmitted only by sexual intercourse, and never (as is sometimes imagined) on toilet seats or towels.

What is gonorrhea?

Gonorrhea, also known as "the clap," is a curable infection caused by the bacteria Neisseria gonorrhoea.

The bacteria targets the cells of the mucous membranes including:

• the surfaces of the urethra,vagina, cervix and endometrium 
• the fallopian tubes
• the anus and rectum
• the lining of the eyelid
• and the throat.

How can I get gonorrhea?

• Gonorrhea is passed during oral, anal or vaginal sex. It can be passed when the mucous membrane, the soft skin covering all the openings of the body, comes into contact with the mucous membrane secretions or semen of an infected person.
• During oral sex, it is possible for gonorrhea to be transmitted from mouth-to-penis and penis-to-mouth contact, and though less so, from vagina-to-mouth or anus-to-mouth contact. Transmission is not known to occur from mouth-to-vagina and mouth to anus contact.
• Gonorrhea can be passed even if the penis or tongue does not go all the way into the vagina or anus. If the vagina, cervix, anus, penis or mouth come in contact with infected secretions or fluids; then transmission is possible. 
• Even a woman who has not had anal sex can get gonorrhea in the anus or rectum if bacteria are spread from the vaginal area, such as when wiping with toilet paper.
• Eye infections in adults may result when discharge caries the disease into the eye during sex or hand-to-eye contact.
• Gonorrhea is not passed through things like shaking hands or toilet seats.
• Even if a person with gonorrhea is treated and cured, they can be reinfected if they are exposed to gonorrhea again.
• It can also be passed from mother to newborn as the baby passes through the infected birth canal. This can result in eye infections, pneumonia or other complications.
• In children, gonorrhea may be a possible sign of sexual abuse. 

What are the symptoms of gonorrhea?

• Most men exhibit symptoms within two days to five days after exposure, with a possible range of one to 30 days.
• Although most women infected will remain asymptomatic (without symptoms), women who develop symptoms will do so within 10 days of infection.

Men may be asymptomatic (without symptoms) but might experience:

• Yellowish-white discharge from the penis
• Burning or pain during urination (peeing)
• Urinating more often than usual
• Pain or swelling of the testicles

Women are usually asymptomatic (without symptoms) but might experience:

• Abnormal discharge from the vagina that is yellow and sometimes bloody.
• Burning or pain during urination (peeing)
• When the infection spreads to the fallopian tubes, some women still have no signs or symptoms. Others may experience one or more of the following symptoms, which can be an indication that the infection has progressed to PID:
• Lower abdominal pain
• Lower back pain
• Pain during intercourse
• Bleeding between menstrual periods
• Nausea
• Fever
• The symptoms of gonorrhea are similar to the symptoms of chlamydia.
• Both men and women might have rectal or anal infection. Symptoms are usually not present in about 90% of cases. When present, symptoms include anal or rectal itching, discharge, and pain during defecation.
• Gonorrhea infections of the mouth and throat are usually without symptoms. If present, symptoms include soreness and redness in the mouth or throat. A culture test is used to determine if gonorrhea is causing these symptoms.
• If gonorrhea infects the eye, men and women might experience conjunctivitis (inflammation of the eyelid lining). Symptoms of conjunctivitis include redness, itching, and discharge from the eye.
• The most common symptoms in newborns include conjunctivitis and pneumonia, which usually develop 5 to 12 days after birth.

How can I find out if I have gonorrhea?

There are several different testing options for gonorrhea. It may be helpful to speak to your health care provider about what testing options they have available. 

Nucleic Acid Amplification Test

• These tests may be called by any of the following names: PCR, LCR, SDA or TMA tests.
• They detect the bacteria that cause gonorrhea by identifying a strand of the bacterial DNA. 
• Nucleic acid amplification tests can be done on urine or a sample of secretions from the potentially infected area (the urethra or cervix). They are not currently approved for use on secretions from the rectum or throat. 
• These tests is highly sensitive and specific, which means it is unlikely to give back a false-negative or false-positive result.
• These tests can detect both chlamydia and gonorrhea from just one patient sample.
• Although nucleic acid amplification tests are FDA-approved, they may not be available in all clinics.

Gram Stain Test

• This test involves placing a smear of the secretions from the urethra or cervix on a slide and staining the smear with dye. The HCP then uses a microscope to look for bacteria on the slide.
• Test results are usually available during the office or clinic visit.
• This test has been found to be reliable for men.
• The gram stain test has been found to be unreliable for women. Centers for Disease Control does not recommend that this test be used to diagnose women.

Culture Test

• A culture test is performed by inserting a swab into the cervix or urethra, and sometimes the rectum or throat, to take a sample. The sample is then placed on a culture plate and incubated for 24 to 72 hours to allow bacteria to grow.
• Although the culture test is more reliable than the Gram stain test, it takes longer to get results. 
• The culture test is a highly specific test, meaning that the risk of having a false positive on this test is very low.

People infected with gonorrhea are often co-infected with chlamydia; therefore, in patients with gonorrhea treatment is often prescribed for chlamydia as well, since the cost of the treatment is less than the cost of testing for Chlamydia trachomatis.
According to the 2002 CDC STI Treatment Guidelines, health care providers do not need to consider re-testing patients after treatment unless the patient still has symptoms or if reinfection is suspected.

What is the treatment for gonorrhea?

• Cephalosporin (sef-ah-low-SPORE-in) class:
• Cefixime (suh-FIX-I-me), taken orally in a single dose
• Ceftriaxone (sef-TRY-ux-own), a single dose injection
• Quinolone class (Please see information about Antimicrobial Resistance below):
• Ciprofloxacin (sip-row-FLOX-uh-sin), taken orally in a single dose
• Ofloxacin (oh-FLOX-uh-sin), taken orally in a single dose
• Levofloxacin (lee-voh-FLOX-uh-sin), taken orally in a single dose

Patients with gonorrhea should also be treated for chlamydia (unless testing has ruled out chlamydia infection). Along with one of the above recommended treatments for gonorrhea, CDC recommends that one of the following medications be used to treat chlamydia:

• Doxycycline (dox-ih-SIGH-clean), taken orally twice a day for 7 days
• Azithromycin (uh-zith-row-MICE-in), taken orally in a single dose
• Doxycycline and quinolone treatments are not advised for pregnant women. Instead, pregnant women should be treated with cephalosporin.
• Pregnant women who cannot tolerate cephalosporin can be administered spectinomycin.

Alternative Treatment:

• Spectinomycin (spec-tin-oh-MICE-in), a single dose injection
• Quinolones other than those listed above, such as ceftizoxime (sef-tiz-OX-uh-me), cefotaxime (sef-oh-TAX-uh-me), cefotetan (sef-oh-TEE-ton), or cefoxitin (sef-OX-uh-tin)

Antimicrobial Resistance:

• Some strains of N. gonorrhoea have been found to be resistant to treatment with quinolone. Antimicrobial resistant strains of gonorrhea are most common in Asian countries. In the US, quinolone-resistant strains have been found in Hawaii and on the West Coast.
• In Hawaii and California, quinolone should not be used to treat gonorrhea. Instead, ceftriaxone or cefixime should be used. If a person cannot tolerate ceftriaxone or cefixime, then spectinomycin can be used. 
• People diagnosed with gonorrhea should tell their health care provider if they or their sex partners have recently traveled to any of these areas to ensure proper treatment

Follow-up:

• Take all medications as directed.
• All partners should be examined and treated.
• Do not have sex until you and your partner(s) have been treated and cured.
• Persons with symptoms after treatment should be tested again by culture.
• Infections detected after treatment with one of the recommended treatments more commonly occur because of reinfection rather than treatment failure.

What can I do to reduce my risk of getting gonorrhea?

• Abstinence (not having sex)
• Mutual monogamy (having sex with only one uninfected partner)
• Water-based spermicides are not recommended for the prevention of gonorrhea. Recent studies have shown that nonoxynol-9 (N-9), which is found in most water-based spermicides, is not effective in preventing gonorrhea.
• Latex condoms for vaginal and anal sex.
• Since gonorrhea can be transmitted even if the penis or tongue does not completely enter the vagina, mouth or rectum, using latex condoms at the beginning of sexual contact until there is no longer skin contact is the best form of prevention.
• Several barrier methods can be used to reduce the risk of transmission of gonorrhea during oral sex. A non-lubricated condom can be used for mouth-to-penis contact. Household plastic wrap, a dental dam, or a latex condom cut-up and opened flat can reduce the risk of transmission during mouth-to-vulva/vagina or oral-anal (rimming) contact.

Why worry about gonorrhea?
If untreated, gonorrhea can cause complications in men, women and infants.

Untreated gonorrhea infections in men may lead to:

• Prostatitis: inflammation of the prostate gland
• Urethral scarring, which can cause a narrowing or closing of the urethra
• Infertility
• Epididymitis: inflammation of the epididymis, the elongated, sperm-carrying, cord-like structure along the posterior border of the testes

Untreated gonorrhea infections in women may lead to:

• Pelvic Inflammatory Disease (PID): PID can develop from several days to several months after infection with gonorrhea. Left untreated, PID can cause infertility.
• Chronic menstrual difficulties
• Postpartum endometritis: inflammation of the lining of the uterus after childbirth
• Miscarriage
• Cystitis: inflammation of the urinary bladder
• Mucopurulent cervicitis: characterized by a yellow discharge from the cervix.

Untreated gonorrhea infections in men and women may lead to:

• About 1% of men or women with gonorrhea may develop Disseminated Gonococcal Infection (DGI), which is sometimes called gonococcal arthritis.
• DGI occurs when gonorrhea infection spreads to sites other than genitals, such as the blood, skin, heart, or joints.
• Symptoms of DGI include fever, multiple skin lesions, painful swelling of joints (arthritis), infection of the inner lining of the heart, and inflammation of the membrane covering the brain and spinal cord (meningitis).
• DGI can be successfully treated using antibiotic regimens similar to those recommended for treating uncomplicated gonorrhea.

Gonorrhea can be passed from mother to newborn as the baby passes through the infected birth canal. Complications in infants include:

• blindness, from untreated eye infections
• DGI. Symptoms of DGI in infants include arthritis, meningitis and sepsis, a bacterial infection of the blood.

Do I need to talk to my partner about gonorrhea?

Yes. Telling a partner can be hard, but keep in mind that most people with an STI don't know they have it. It's important that you talk to your partner as soon as possible so she or he can get treatment. It is possible to pass gonorrhea back and forth, so if you get treated and your partner doesn't, you may get infected again.

Should I talk to my health care provider about gonorrhea?

Yes. If you are having unprotected sex or discover that your partner is having unprotected sex with another person, you may want to ask your doctor about being tested.