WHAT IS GONORRHEA?
Gonorrhea is a curable sexually transmitted infection (STI) caused by
a bacterium called Neisseria gonorrhoeae. These bacteria can infect
the genital tract, the mouth, and the rectum. In women, the opening to
the uterus, the cervix, is the first place of infection.
The disease however can spread into the uterus and fallopian tubes,
resulting in pelvic inflammatory disease (PID). PID affects more than
1 million women in this country every year and can cause infertility
in as many as 10 percent of infected women and tubal (ectopic) pregnancy.
In 2000, 358,995 cases of gonorrhea were reported to the U.S. Centers
for Disease Control and Prevention (CDC). In the United States, approximately
75 percent of all reported cases of gonorrhea is found in younger persons
aged 15 to 29 years. The highest rates of infection are usually found
in 15- to 19-year old women and 20- to 24-year-old men. Health economists
estimate that the annual cost of gonorrhea and its complications is
close to $1.1 billion.
Gonorrhea is spread during sexual intercourse. Infected women also
can pass gonorrhea to their newborn infants during delivery, causing
eye infections in their babies. This complication is rare because newborn
babies receive eye medicine to prevent infection. When the infection
occurs in the genital tract, mouth, or rectum of a child, it is due
most commonly to sexual abuse.
WHAT ARE THE SYMPTOMS OF GONORRHEA?
The early symptoms of gonorrhea often are mild. Symptoms usually appear
within 2 to 10 days after sexual contact with an infected partner. A small
number of people may be infected for several months without showing symptoms.
When women have symptoms, the first ones may include
- Bleeding associated with vaginal intercourse
- Painful or burning sensations when urinating
- Vaginal discharge that is yellow or bloody
More advanced symptoms, which may indicate development of PID, include
cramps and pain, bleeding between menstrual periods, vomiting, or fever.
Men have symptoms more often than women, including
- Pus from the penis and pain
- Burning sensations during urination that may be severe
Symptoms of rectal infection include discharge, anal itching, and occasional
painful bowel movements with fresh blood on the feces.
HOW IS GONORRHEA DIAGNOSED?
Doctors or other health care workers usually use three laboratory techniques
to diagnose gonorrhea: staining samples directly for the bacterium, detection
of bacterial genes or DNA in urine, and growing the bacteria in laboratory
cultures. Many doctors prefer to use more than one test to increase the
chance of an accurate diagnosis.
The staining test involves placing a smear of the discharge from the
penis or the cervix on a slide and staining the smear with a dye. Then
the doctor uses a microscope to look for bacteria on the slide. You
usually can get the test results while in the office or clinic. This
test is quite accurate for men but is not good in women. Only one in
two women with gonorrhea have a positive stain.
More often, doctors use urine or cervical swabs for a new test that
detects the genes of the bacteria. These tests are as accurate or more
so than culturing the bacteria, and many doctors use them.
The culture test involves placing a sample of the discharge onto a
culture plate and incubating it up to 2 days to allow the bacteria to
grow. The sensitivity of this test depends on the site from which the
sample is taken. Cultures of cervical samples detect infection approximately
90 percent of the time. The doctor also can take a culture to detect
gonorrhea in the throat. Culture allows testing for drug-resistant bacteria.
HOW IS GONORRHEA TREATED?
Doctors usually prescribe a single dose of one of the following antibiotics
to treat gonorrhea:
If you have gonorrhea and are pregnant or are younger than 18 years
old, you should not take ciprofloxacin or ofloxacin. Your doctor can
prescribe the best and safest antibiotic for you.
Gonorrhea and chlamydial infection, another common STI, often infect
people at the same time. Therefore, doctors usually prescribe a combination
of antibiotics, such as ceftriaxone and doxycycline or azithromycin,
which will treat both diseases.
If you have gonorrhea, all of your sexual partners should get tested
and then treated if infected, whether or not they have symptoms of infection.
WHAT CAN HAPPEN IF GONORRHEA IS NOT TREATED?
In untreated gonorrhea infections, the bacteria can spread up into the
reproductive tract, or more rarely, can spread through the blood stream
and infect the joints, heart valves, or the brain.
The most common result of untreated gonorrhea is PID, a serious infection
of the female reproductive tract. Gonococcal PID often appears immediately
after the menstrual period. PID causes scar tissue to form in the fallopian
tubes. If the tube is partially scarred, the fertilized egg may not
be able to pass into the uterus. If this happens, the embryo may implant
in the tube causing a tubal (ectopic) pregnancy. This serious complication
may result in a miscarriage and can cause death of the mother.
Rarely, untreated gonorrhea can spread through the blood to the joints.
This can cause an inflammation of the joints which is very serious.
If you are infected with gonorrhea, your risk of getting HIV infection
increases (HIV, human immunodeficiency virus, causes AIDS). Therefore,
it is extremely important for you to either prevent yourself from getting
gonorrhea or get treated early if you already are infected with it.
CAN GONORRHEA AFFECT A NEWBORN BABY?
If you are pregnant and have gonorrhea, you may give the infection to
your baby as it passes through the birth canal during delivery. A doctor
can prevent infection of your baby’s eyes by applying silver nitrate or
other medications to the eyes immediately after birth. Because of the
risks from gonococcal infection to both you and your baby, doctors recommend
that pregnant women have at least one test for gonorrhea during pregnancy.
HOW CAN I PREVENT GETTING INFECTED WITH GONORRHEA?
By using latex condoms correctly and consistently during vaginal or rectal
sexual activity, you can reduce your risk of getting gonorrhea and its
The National Institute of Allergy and Infectious Diseases (NIAID) continues
to support a comprehensive, multidisciplinary program of research on N.
gonorrhoeae (gonoccoci). Researchers are trying to understand how
gonoccoci infect cells while evading human immune defenses (immune response).
Studies are ongoing to determine
- How this bacterium attaches to host cells
- How it gets inside them
- Gonococcal surface structures and how they can change
- Human response to infection by gonococci
All of these efforts, together, will eventually lead to development
of an effective vaccine against gonorrhea. They also have led to, and
will lead to further, improvements in diagnosis and treatment of gonorrhea.
Another important area of gonorrhea research concerns antibiotic resistance.
This is particularly important because strains of N. gonorrhoeae
that are resistant to recommended antibiotic therapies have spread from
Southeast Asia to Hawaii and are now starting to appear on the West
Coast. These events add urgency to NIAID efforts to develop effective
microbicides (antimicrobial preparations that can be applied inside
the vagina) to prevent infections.
Recently, scientists have determined the sequence of the N. gonorrhoeae
genome. They are using this information to find promising new leads
to help us better understand how the organism causes disease and becomes
resistant to antibiotics.
National Institute of Allergy and Infectious Diseases
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American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709-9940
NIAID is a component of the National Institutes of Health
(NIH), which is an agency of the Department of Health and Human Services.
NIAID supports basic and applied research to prevent, diagnose, and
treat infectious and immune-mediated illnesses, including HIV/AIDS
and other sexually transmitted diseases, illness from potential agents
of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma
News releases, fact sheets and other NIAID-related
materials are available on the NIAID Web site at http://www.niaid.nih.gov.
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892
Last Updated November 21, 2003 (alt)