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1. Gonorrhea

What is gonorrhea?

Gonorrhea is a bacterial infection caused by the organism Neisseria gonorrheae (also known as gonococcus bacteriae) that is transmitted by sexual contact. Gonorrhea is one of the oldest known sexually transmitted diseases. It is estimated that over one million women are currently infected with gonorrhea. Among women who are infected, a significant percentage also will be infected with chlamydia, another type of bacteria that causes another STD. (Chlamydia infection is discussed later in this article.)

Contrary to popular belief, 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 longer than a few minutes, nor can it live on the skin of the hands, arms, or legs. It survives only on moist surfaces within the body and is found most commonly in the vagina, and, more commonly, the cervix. (The cervix is the end of the uterus that protrudes into the vagina.) It can also live in the tube (urethra) through which urine drains from the bladder. Gonorrhea can also exist in the back of the throat (from oral-genital contact) and in the rectum.

Gonorrhea symptoms

A majority of infected women have no symptoms, especially in the early stages of the infection. When women do experience signs and symptoms gonorrhea they include

  • burning during urination,
  • frequent urination,
  • a yellowish vaginal discharge,
  • redness and swelling of the genitals, and
  • vaginal itching or burning.

If untreated, gonorrhea can lead to a severe pelvic infection with inflammation of the Fallopian tubes and ovaries. Gonorrhea can also spread through the body to infect joints to cause gonococcal arthritis. 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 a significant portion of women with gonorrheal infection of the uterine cervix. Symptoms of pelvic infection include fever, pelvic cramping, abdominal pain, or pain with intercourse. Pelvic infection can lead to difficulty in becoming pregnant or even sterility. Occasionally, if the infection is severe enough, a localized area of infection and pus (an abscess) forms, and major surgery may be necessary and even lifesaving. Gonorrhea infection in people with conditions causing serious abnormal immune function, such as AIDS,, can also be more serious.

Testing and diagnosis of gonorrhea

Testing for gonorrhea is done by swabbing the infected site (rectum, throat, cervix) 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. Sometimes the tests do not show bacteria because of sampling errors (the sampled area does not contain bacteria) or other technical difficulties, even when the woman has an infection. 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.

Treatment of gonorrhea

In the past, the treatment of uncomplicated gonorrhea was fairly simple. A single injection of penicillin cured almost every infected person. 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 or by oral cefixime (Suprax). 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 include spectinomycin in nonpregnant women (not available in the United States) or single doses of other cephalosporins such as ceftizoxime or cefoxitin, administered with probenecid (Benemid), 1 g orally; or cefotaxime.

Treatment for gonorrhea 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 gonorrhea and chlamydia 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 partners may be infected as well. Treating the partners also prevents reinfection of the woman. Women suffering from PID or gonococcal arthritis require more aggressive treatment that is effective against the bacteria that cause gonorrhea as well as against other organisms. These women often require intravenous administration of antibiotics.

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

Gonorrhea is one of the easier STDs to prevent because the bacterium that causes the infection can survive only under certain conditions. The use of condoms protects against gonorrhea infection. Since the organism can live in the throat, condoms should be used during oral-genital contact as well.

Return to Sexually Transmitted Diseases in Women (STD)

See what others are saying

Comment from: Chancroid Sufferer, 45-54 Female (Patient) Published: February 17

I suspect that I contracted chancroid in the fall of 2000. I experienced the 1st sore from it on my genitals very soon after I had the sexual contact I contracted the infection through. At the time I thought it was herpes and that I had a herpes infection because of the sore. It was very large and very painful. It was throbbing with pain. I also started experiencing very severe fatigue at this time which I did not know at the time was chronic fatigue syndrome. I got a syphilis blood test in November of 2002 which was negative and a herpes blood test in December of 2002 which was negative, so I assumed I had chancroid and that chancroid was responsible for that sore and the other genital sores I had after that as well as the fatigue. I went to an infectious disease specialist in January of 2003 and told about this and he told me that I didn't have to worry about whether I had chancroid because according to him chancroid wasn't a very serious infection. He told me that I didn't need treatment for it since I hadn't had a sore from it since summer of 2002, and my immune system was successfully fighting the chancroid off on its own. He didn't say anything about whether I was infectious and claimed that fatigue wasn't a symptom. The chronic fatigue syndrome that I started experiencing when I contracted the infection is very severe and very debilitating. It is still going on. I wonder if it is possible that they just don't know enough about chancroid that they can know that it doesn't cause chronic fatigue syndrome. I have sent e-mails to the CDC about this and they have told me that no STD can cause chronic fatigue syndrome. The chronic fatigue syndrome started when I got the first sore. I don't think that this could be a coincidence.

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Comment from: mimi, 25-34 Female (Patient) Published: November 29

I contacted staph 8 years ago. I have been treating it since then but it won't go away. The lab results keep saying it is a mild growth of staph. Now I am married and we can't conceive. Since I got married I got more observant with my body system and I noticed I have sensitive movements in my body, like worm. Also I get bowel pains (like a rush or sharp pain in my rectum and it is painful to sit sometimes. I get cramps, bloating, white discharge, and this happens when I am ovulating or a day after ovulation. Also sometimes my urine has a very foul odor. I have been to the hospital here in my country but the doctor seems not to understand what am saying, they always send me for lab or scan and it will still be mild growth of staph and insignificant uterine fibroid. Please doctors help me, I don't know what is wrong with me and am very scared that is STD.

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Comment from: blue purple, 25-34 Male (Patient) Published: October 08

Two days ago I noticed a creamy discharge from my penis and it later turned yellow. I started feeling a mild irritation and burning when urinating and today felt a growing lump in my groin with a minor pain and swelling. This is scary.

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