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Gonorrhea

Gonorrhea is a common sexually transmitted infection (STI).

Causes

Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. Any type of sex can spread gonorrhea. You can get it through contact with the mouth, vagina, penis, or anus.

Gonorrhea is the second most commonly reported communicable disease. Approximately 330,000 cases occur in the US each year.

The bacteria grow in warm, moist areas of the body. This can include the tube that carries urine out of the body (urethra). In women, the bacteria may be found in the reproductive tract (which includes the fallopian tubes, uterus, and cervix). The bacteria can also grow in the eyes.

Health care providers are required by law to tell the State Board of Health about all cases of gonorrhea. The goal of this law is make sure the person gets proper follow-up care. Sexual partners also need to be found and tested.

You are more likely to develop this infection if:

  • You have many sex partners.
  • You have a partner with a past history of any STI.
  • You do not use a condom during sex.
  • You abuse alcohol or illegal substances.

Symptoms

Symptoms of gonorrhea most often appear 2 to 5 days after infection. However, it may take up to a month for symptoms to appear in men.

Some people do not have symptoms. They may not know that they have caught the infection, so do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person.

Symptoms in men include:

  • Burning and pain while urinating
  • Need to urinate urgently or more often
  • Discharge from the penis (white, yellow, or green in color)
  • Red or swollen opening of penis (urethra)
  • Tender or swollen testicles
  • Sore throat (gonococcal pharyngitis)

Symptoms in women can be very mild. They can be mistaken for another type of infection. They include:

  • Burning and pain while urinating
  • Sore throat
  • Painful sexual intercourse
  • Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area)
  • Fever (if the infection spreads to the fallopian tubes and stomach area)

If the infection spreads to the bloodstream, symptoms include:

  • Fever
  • Rash
  • Arthritis-like symptoms
  • Abnormal vaginal discharge with greenish, yellow or foul smelling discharge

Exams and Tests

Gonorrhea can be quickly detected by looking at a sample of discharge or tissue under the microscope. This is called a gram stain. This method is fast, but it is not the most certain.

Gonorrhea is most accurately detected with DNA tests. DNA tests are useful for screening. The ligase chain reaction (LCR) test is one of the tests. DNA tests are quicker than cultures. These tests can be performed on urine samples, which are easier to collect than samples from the genital area.

Prior to DNA tests, cultures (cells that grow in a lab dish) were used to provide proof of gonorrhea, but are less commonly used now.

Samples for a culture are most often taken from the cervix, vagina, urethra, anus, or throat.

  • Rarely they are taken from joint fluid or blood
  • Cultures can often provide an early diagnosis within 24 hours. A confirmed diagnosis is available within 72 hours.

If you have gonorrhea, you should ask to be tested for other sexually transmitted infections, including chlamydia, syphilis, and HIV herpes and hepatitis.

Treatment

A number of different antibiotics may be used for treating this type of infection.

  • You may receive one large dose of oral antibiotics or take a smaller dose for seven days.
  • You may be given an antibiotic injection or shot, and then perhaps be sent home with antibiotic pills.
  • More severe cases of PID (pelvic inflammatory disease) may require you to stay in the hospital. Antibiotics are first given by IV.
  • Never treat yourself without being seen by your doctor first. Your health care provider will determine the best treatment.

About half of the women with gonorrhea are also infected with chlamydia. Chlamydia is treated at the same time as a gonorrhea infection.

You will need a follow-up visit 7 days after if your symptoms include joint pain, skin rash, or more severe pelvic or belly pain. Tests will be done to make sure the infection is gone.

Sexual partners must be tested and treated to prevent passing the infection back and forth. You and your partner must finish all of the antibiotics. Use condoms until you both have finished taking your antibiotics.

All sexual contacts of the person with gonorrhea should be contacted and tested. This helps prevent further spread of the infection.

  • In some places you may be able to take information and medicines to your sexual partner yourself.
  • In other places, the health department will contact your partner.

Outlook (Prognosis)

A gonorrhea infection that has not spread can almost always be cured with antibiotics. Gonorrhea that has spread is a more serious infection. Most of the time, it gets better with treatment.

Possible Complications

Complications in women may include:

  • Infections that spread to the fallopian tubes can cause scarring. This can cause problems getting pregnant at a later time. It can also lead to chronic pelvic pain, PID, infertility, and ectopic pregnancy.
  • Pregnant women with severe gonorrhea may pass the disease to their baby while in the womb or during delivery.
  • It can also cause complications in pregnancy such as infection and preterm delivery.

Complications in men may include:

  • Scarring or narrowing of the urethra (tube that carries urine out of the body)
  • Abscess (collection of pus around the urethra)
  • Complications in both men and women may include:
  • Joint infections
  • Heart valve infection
  • Infection around the brain (meningitis)

When to Contact a Medical Professional

Call your health care provider right away if you have symptoms of gonorrhea. Most state-sponsored clinics will diagnose and treat STIs without charge.

Prevention

Avoiding sexual contact is the only sure way to prevent gonorrhea. If you and your partner do not have sex with any other people, this can greatly reduce your chance also.

Safe sex means taking steps before and during sex that can prevent you from getting an infection, or from giving one to your partner. Safe sex practices include screening for STIs in all sexual partners, using condoms consistently, having fewer sexual contacts.

Ask your provider if you should receive the hepatitis B vaccine-link and the HPV vaccine-link. You may also want to consider the HPV vaccine.

Alternative Names

Clap; The drip

References

Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2013. U.S. Department of health and Human Services; 2014. Updated March 30, 2015. www.cdc.gov/std/stats13. Accessed July 15, 2015.

Final Recommendation Statement: Chlamydia and Gonorrhea: Screening. U.S. Preventive Services Task Force. December 2014. www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening. Accessed July 15, 2015.

Marrazzo JM, Apicell MA. Neisseria gonorrhoeae (Gonorrhea). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 214.

Workowski KA, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(3):1-137.

Update Date 5/9/2015

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