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May 2002 GonorrheaWHAT 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
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
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 complications.RESEARCHThe 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
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. MORE INFORMATIONNational Institute of Allergy and Infectious DiseasesNational Institutes of Health 31 Center Drive, MSC 2520 Bethesda, MD 20892-2520 http://www.niaid.nih.gov National Library of Medicine National STD and AIDS Hotline American Social Health Association
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