Gonorrhea



Gonorrhea is a bacterial infection that usually spreads from person to person during sexual contact, making it a sexually transmitted disease (STD). It also can be transmitted from an infected mother to a baby during childbirth. If untreated, gonorrhea may result in infertility in women, among other problems.

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Antibiotics

Antibiotic resistance

Infection

Sexually transmitted diseases

Venereal diseases

Gonorrhea is an infection caused by Neisseria gonorrhoeae (ni-SEE-ree-a gon-o-REE-i) bacteria, which grow rapidly in the warm, moist tissues of the body's genital areas. Gonorrhea infection may cause pain during urination and a pus-like discharge from the genitals. Sometimes women have such mild symptoms that they ignore them. If left untreated, however, gonorrhea may lead to pelvic inflammatory disease (PID), infection of babies during childbirth, or infertility.

Who Is at Risk for Gonorrhea?

Anyone who has sexual relations with an infected person is at risk. The risk increases when people do not use condoms, or when people have multiple sexual partners. Gonorrhea may be spread by genital, anal, or oralgenital sex. In the United States, the highest rates of gonorrhea infection occur among teenagers and adults in their twenties. People who have chlamydial (kla-MID-e-al) infections, or other sexually transmitted diseases, are more likely to have gonorrhea as well. Public health officials recommend that all sexually active young women and young men be tested regularly for both gonorrhea and chlamydia.

History:
Ancient and Modern

Gonorrhea has been known since ancient times. Its name is from the Greek words for "flow of seed," apparently a reference to the genital discharge that is a major symptom.

It was not until the nineteenth century, however, that researchers understood the difference between syphilis, caused by Treponema pallidum, and gonorrhea. The gonorrhea bacterium Neisseria gonorrhoeae was identified in 1879 by the German biologist Albert Neisser, for whom it was named.

During the 1930s and 1940s, antibiotics were found to treat syphilis and gonorrhea effectively. With treatment, fewer people spread the diseases, and the number of cases fell sharply in the United States. But then the numbers began to rise again. Some researchers believe that a change in attitude toward sex during the 1960s and 1970s contributed to this increase, as people became sexually active earlier and with more partners than before.

When AIDS became a problem during the 1980s, people began to practice what has come to be known as "safer sex." That meant, among other things, using condoms and trying harder to have monogamous relationships, in which two people have sex only with each other. Greater efforts also were made to teach people about the health and social benefits of abstaining from sex and of not becoming sexually active at a young age. Since the early 1980s, rates of gonorrhea and syphilis in the United States mostly have fallen.

What Are the Symptoms of Gonorrhea?

Many women, and some men, have no symptoms or have such mild symptoms that they go unnoticed. Some women, however, have especially severe symptoms. For both men and women, symptoms may include:

  • a burning sensation when urinating
  • frequent urination
  • pus-like discharge from the vagina or penis
  • tenderness or pain in the genital area or abdomen
  • for women, bleeding between menstrual cycles

If a rectal infection occurs, there may be rectal pain and discharge. If a throat infection occurs (from oralgenital sex), there may be a sore throat as well. If the Neisseria gonorrhoeae bacteria get into the bloodstream, they may travel throughout the body and cause a mild fever, joint pains, and a rash, particularly on the palms of the hands. This condition is called disseminated gonococcal infection. Or one or two joints may be swollen, tender, and extremely painful, a condition known as gonococcal arthritis.

How Is Gonorrhea Diagnosed and Treated?

Diagnosis

Three tests are available to diagnose gonorrhea:

  • Gram stain test: A smear from the genital discharge is stained with a dye and examined under a microscope to see if Neisseria gonorrhoeae bacteria are present. This test, which gives immediate results, is reliable mostly for men.
  • Bacterial gene detection: This test uses high-tech means to look for evidence of bacterial DNA (genetic material) in a sample of urine or in a smear of fluid from the cervix (the bottom of the uterus or womb). It is reliable for both sexes and gives instant results, but not all laboratories perform it.
  • Culture: A sample of discharge is placed in a dish of culture medium, which is a jelly-like material containing nutrients that support the growth of the bacteria. If Neisseria gonorrhoeae bacteria are present, they will multiply in one or two days and can then be identified. This test is also very reliable for both sexes, but it does not give instant results.

Treatment

Gonorrhea can be treated with one or more antibiotics. Doctors usually prescribe an antibiotic that can be taken by mouth or by injection, which may cure the disease within a week or two. When people with gonorrhea have chlamydial infections, the doctor may prescribe a combination of antibiotics that treats both infections at the same time.

How Is Gonorrhea Prevented?

Because it is almost impossible to know if a sexual partner has gonorrhea, not having sexual relations (abstinence) provides the best protection. Using latex condoms can lead to safer sex when they are used correctly, and when worn every single time a person has sexual relations. Having fewer sexual partners or only one partner may reduce the risk, but some risk remains unless a person is certain that his or her partner is uninfected. This is very difficult, since many people with gonorrhea infection have no symptoms and don't know they are infected.

How Do Antibiotics Work?

There are two ways antibiotics attack bacteria. Some medications (like penicillins) destroy the bacterium's wall, causing it to disintegrate. Other antibiotics block the production of proteins inside the bacterium, which prevents it from reproducing.

What Is the Future of Gonorrhea Treatment?

Bacterial resistance

Penicillin once was routinely prescribed to cure gonorrhea, but bacteria grew resistant to it, and some could survive treatment. At first, larger doses of penicillin worked, but by the 1980s those treatments began to fail. Doctors then switched to newer and more expensive antibiotics, but some strains of gonorrhea bacteria already show signs of becoming resistant to the most commonly used of the newer drugs (ceftriaxone). Although many other antibiotics exist, public health officials around the world are now monitoring bacterial resistance.

Vaccination

In another approach, the U.S. National Institute of Allergy and Infectious Diseases is sponsoring research to investigate the possibility of developing a vaccine to prevent gonorrhea infection.

See also
Chlamydial Infections
Infertility
Pelvic Inflammatory Disease
Pregnancy, Complications of
Sexually Transmitted Diseases
Syphilis

Resources

Brodman, Michael, M.D., JohnThacker, and Rachel Kranz. Straight Talk about Sexually Transmitted Diseases. New York: Facts on File, 1998.

The U.S. Centers for Disease Control and Prevention (CDC), located in Atlanta, Georgia, posts information about gonorrhea at its website.
http://cdc.gov/ncidod/dastlr/gcdir/gono.htm

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