Gonorrhea

Gonorrhea is a bacterial infection transmitted during sexual contact.

Gonorrhea is a bacterial infection caused by the organism Neisseria gonorrhoeae that is transmitted during unprotected sex. It is one of the oldest known sexually transmitted diseases. Among individuals who are infected with gonorrhea, 50% to 70% also will be infected with chlamydia, another type of bacteria that causes another STD.

Gonorrhea is only transmitted by unprotected oral, vaginal and anal sex.

• Gonorrhea cannot be transmitted from toilet seats or door handles.
• The bacterium that causes gonorrhea requires very specific conditions for growth and reproduction. It cannot live outside the body for more than a few seconds or minutes, nor can it live on the skin of the hands, arms, or legs.

Most infected women have no symptoms, especially in the early stages of the infection. Men are more likely to have symptoms, but many may not.

Gonorrhea symptoms and signs include:

• Burning
• Frequent, and/or painful urination
• Yellowish vaginal discharge
• Redness and swelling of the genitals
• Burning or itching of the vaginal area
• Sore throat

Untreated gonorrhea can lead to a severe pelvic infection with inflammation of the Fallopian tubes and ovaries. Gonorrheal infection of the Fallopian tubes can lead to a serious, painful infection of the pelvis known as pelvic inflammatory disease or PID. PID occurs in many women with gonorrheal infections of the uterine cervix. Symptoms of pelvic infection include fever, pelvic cramping, pelvic pain, or pain with intercourse.

Pelvic infection can lead to difficulty in becoming pregnant or even infertility because of tubal damage or obstruction. Occasionally, if the infection is severe enough, a localized area of infection and pus-like discharge (an abscess) form (tubo-ovarian abscess) that can be life-threatening, and major surgery may be necessary.

Testing for gonorrhea is done by swabbing the infected site (throat, cervix, urethra, rectum) or by urine testing and identifying the bacteria in the laboratory either through culturing of the material from the swab (growing the bacteria) or identification of the genetic material from the bacteria.

Newer tests to diagnose gonorrhea involve the use of DNA probes or amplification techniques (for example, polymerase chain reaction, or PCR) to identify the genetic material of the bacteria. These tests are more expensive than cultures but typically yield more rapid results.

Unfortunately, there are new strains of gonorrhea that have become resistant to various antibiotics, including penicillins, and are therefore more difficult to treat. Fortunately, gonorrhea can still be treated by other injectable or oral medications.

Uncomplicated gonococcal infections of the cervix, urethra, and rectum, are usually treated by a single injection of ceftriaxone intramuscularly or by cefixime (Suprax) in a single oral dose. For uncomplicated gonococcal infections of the pharynx, the recommended treatment is ceftriaxone in a single IM dose.

Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, and rectum is spectinomycin in nonpregnant women (not available in the United States) in a single IM dose or single doses of cephalosporins (ceftizoxime or cefoxitin, administered with probenecid (Benemid), or cefotaxime).

Treatment should always include medication that will treat chlamydia, for example, azithromycin (Zithromax, Zmax) or doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others), as well as gonorrhea because both diseases frequently exist together in the same person. The sexual partners of women who have had either gonorrhea or chlamydia must receive treatment for both infections since their sex partners may be infected as well. Treating the sex partners also prevents reinfection of the woman.

Women suffering from PID require more aggressive treatment that is effective against the bacteria that cause gonorrhea as well as against other organisms. These women often require hospitalization and intravenous administration of antibiotics.

It is important to note that doxycycline, one of the recommended drugs for the treatment of PID, is not recommended for use in pregnant women.

You can prevent transmission by using barrier methods during oral, vaginal and anal sex. These include latex condoms, dental dams and internal condoms.

Another option is having a mutually monogamous relationship with a partner who has been tested or treated.