Sexually Transmitted Diseases: Gonorrhea


Gonorrhea is a curable sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae. It infects approximately 750,000 people in the United States each year, although another 750,000 unreported cases are also believed to occur each year. According to the CDC, the rate of reported gonorrhea infections was 132.2 per 100,000 persons in 1999.

Any sexually active person can be infected with gonorrhea, yet nearly 75 percent of all reported gonorrhea is found in individuals 15 to 29 years old.

The most common symptoms of gonorrhea are a discharge from the vagina or penis and painful or difficult urination. It can infect the genital tract, the mouth, and the rectum. In women, the cervix and uterus can be the first place of infection, with the disease later spreading to the uterus and fallopian tubes, resulting in pelvic inflammatory disease (PID). PID affects more than one million women in the U.S. each year and can cause ectopic pregnancies and infertility in as many as 10 percent of infected women.

Antigen Alert

The highest rates of infection are found in 15- to 19-year-old women and 20- to 24-year-old men, with a disproportionate number of cases (77 percent of the total number) reported among African Americans.

Burning, Pain, and Swelling

In men, symptoms include a burning sensation when urinating and a yellowish white discharge from the penis. Some men experience painful or swollen testicles.

In women, the early symptoms of gonorrhea are often mild, with few, if any, symptoms of infection. Like other STDs, gonorrhea can be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating and a vaginal discharge that is yellow or occasionally bloody. If gonorrhea is not treated, the bacteria can spread to the bloodstream and infect the joints, heart valves, or the brain. Untreated gonorrhea in women can develop into pelvic inflammatory disease (PID). Rectal infection in men and women includes discharge, anal itching, soreness, bleeding, and sometimes painful bowel movements.

Doctors test for gonorrhea by sending a sample consisting of a vaginal or penile discharge, or fluid from the infected mucous membrane (cervix, urethra, rectum, or throat) to a lab for analysis. Infections present in the male or female genital tract can be diagnosed from a urine specimen. The bacteria can also be identified using a microscope. More advanced testing involving the detection of bacterial genes or nucleic acid (DNA) in urine, and growing the bacteria in laboratory cultures are the most accurate.

Treatment and Drug-Resistance

Gonorrhea can be effectively treated with antibiotics. Historically, penicillin has been used to treat gonorrhea, but ampicillin and amoxicillin are also prescribed. Unfortunately, strains of penicillin-resistant gonorrhea are increasing, and newer antibiotics or combinations of drugs must be used to treat these resistant strains.

Gonorrhea and chlamydia infection often infect people at the same time; therefore, some physicians prefer a combination of antibiotics such as ceftriaxone and doxycycline or azithromycin, which will treat both diseases.

Precautions and Prevention

People diagnosed with gonorrhea need to tell all of their sexual partners, so they can get tested and then treated if infected, whether or not they have symptoms of infection. If a woman has gonorrhea when she gives birth, the infection can be passed to the newborn and cause eye damage.

Infectious Knowledge

There is no effective vaccine against gonorrhea largely because it is a complex organism that infects only humans, and it has a remarkable ability to protect itself by changing or mutating.

People with gonorrhea can also more easily contract HIV. The best prevention is to practice sexual abstinence. Sexually active individuals should engage in safe sex practices in-cluding the use of barrier protection methods, like condoms. However, condoms do not provide complete protection from all STDs. Sores and lesions of other STDs on infected men and women may be present in areas not covered by the condom, resulting in transmission of infection to another person. Limit the number of sex partners, and do not go back and forth between partners. If you think you are infected, avoid sexual contact and see a health-care provider immediately.

Sexually transmitted diseases are clearly a major problem, and they are often under-diagnosed. It is important to try to practice safe sex and to see a doctor if any symptoms appear. Although many of these diseases aren't life-threatening, if left untreated they can cause fertility problems and have other unpleasant long-term effects.

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Excerpted from The Complete Idiot's Guide to Dangerous Diseases and Epidemics © 2002 by David Perlin, Ph.D., and Ann Cohen. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.