Gonorrhea
The Clap: Sexually Transmitted Disease

Gonorrhea

Contents

• What Is Gonorrhea?
• How Do I Catch It?
• What Are The Symptoms?
• How Is It Diagnosed?
• How Is It Treated?
• How Is It Treated In Pregnancy?
• Who Is Most Likely To Develop Gonorrhea?
• How Can It Be Prevented?

Gonorrhea is a sexually transmitted disease (STD) caused by the bacterium Neisseria gonorrhoeae, also known as gonococcus. Although about 300,000 cases are reported to the CDC every year, the actual occurrence is probably closer to 1 or 2 million a year. As gonorrhea often produces no symptoms in women it is less likely to be diagnosed and treated than in men, and can cause some serious health issues. Despite the fact it can easily be cured with antibiotics, gonorrhea is still one of the major causes of pelvic inflammatory disease (PID) in women which can result in infertility and ectopic pregnancy. Health care providers in every American state are required by law to inform their State Board of Health about anyone diagnosed with gonorrhea. The aim of this law is ensure patients get the correct treatment and that their sexual partners are informed and tested. Additionally, it ensures national statistics can be gathered to monitor the numbers of infections so authorities can judge the effectiveness of public awareness campaigns.

How Do I Catch It?

Gonorrhea spreads from one person to another through sexual contact - oral, vaginal and anal sex. Because gonococcus can only survive a few seconds outside of the body, it is extremely unlikely to be transmitted any other way. It thrives in warm moist areas like the cervix, womb and fallopian tubes in women and in the urine canal (urethra) in men (and women). It can also grow in the eyes, throat and anus. It can spread to the eyes if infected genitals are touched and then the eyes are touched. It causes inflammation of the eyelids (gonococcal conjunctivitis), which can lead to blindness if untreated. Occasionally the bacterium gets into the bloodstream at which point it is clinically described as a disseminated gonococcal infection. Depending on which part of the body it infects it can cause skin lesions, arthritis, heart valve disorders and meningitis. Women appear to be more prone to disseminated infections than men.

What Are The Symptoms?

Symptoms In Women
As nearly 80 percent of infected women display no symptoms, they may only begin to suspect a problem if the man develops symptoms. If symptoms do occur in women, they are likely to start within 10 days of exposure and include:

• Thick vaginal discharge.
• Abnormal vaginal bleeding or spotting.
• Pelvic pain.
• Burning sensation when urinating.
• Painful intercourse.

Mostly, symptoms, if they do occur, are mild and may be mistaken for a urinary tract infection and ignored.

Less Common Signs
• Severe pain in lower tummy area (if it spreads to the fallopian tubes and stomach area).
• Fever (if it spreads to the fallopian tubes and stomach area).
• If the infection spreads to the bloodstream: fever, rash (often found near the joints of the hands and feet) and arthritic pain (especially in the elbows, knees, ankles and wrists).
• Fitz-Hugh-Curtis Syndrome: Pain in the upper abdomen area with fever and nausea may be a sign of Fitz-Hugh-Syndrome or perihepatitis, signalling inflammation of the liver.

Rectal Infection
About 30 to 50 percent of women with gonorrhea have a rectal infection as well - usually from infected vaginal secretions although occasionally via anal intercourse. Most rectal infections have no symptoms, but it can cause constipation, pain and bleeding of the anus and anal discharge.

Symptoms In Men
Symptoms are much more likely to occur in men (but 1 in 5 don't show signs), although they can take longer to materialize - up to 2 weeks after exposure. Signs include:

• Burning and pain while urinating.
• Increased urinary frequency or urgency.
• White, yellow or green discharge from the penis.
• Red or swollen opening at the tip of the penis (urethra).
• Tender or swollen testicles.

Throat Gonorrhea

If gonorrhea grows in the throat (mostly 'caught' by performing oral sex) it usually causes no symptoms. There may be a mild to moderate sore throat which can be mistaken for strep throat. While the sore throat will clear without treatment within 3 months it should be treated with an antibiotic or the throat will become a reservoir of infection.

How Is It Diagnosed?

A simple urine or blood test will NOT identify a gonorrhea infection - even if it has spread to the bloodstream. For an accurate diagnosis a sample of pus, mucus or other potentially infected material or discharge from the body must be extracted and examined under a microscope.
Gram Stain Test: In women a swab of material is taken from the cervix, although it could be taken from the throat, rectum or urethra depending on her symptoms. The sample is then spread on a slide, stained and looked at under a microscope. While a fast and cheap method of analysis, a gram test is more reliable at diagnosing men but misses up to 60 percent of gonorrhea cases in women.
Culture Test: A more accurate method of diagnosing gonorrhea in women is the culture test. This involves growing (culturing) the sample of tissue in a special type of nutrient jelly. It takes up to 2 days but can identify 90 percent of all infections.
DNA Tests: Newer, faster techniques using DNA amplification have largely replaced the culture test. They can be performed on a urine sample.
Note: Health screenings for women: List of all recommended screenings.

How Is It Treated?

In the past anyone suspected of having gonorrhea was dosed with penicillin, but this practice has been abandoned because the bacterium became resistant to it. Penicillin-resistant gonococci accounts for at least 25 percent of gonorrhea cases and penicillin is not good for treating chlamydia (nearly 50 percent of women who have gonorrhea also have chlamydia). For this reason, the CDC periodically changes treatment guidelines to reflect patterns of antibiotic resistance. Currently most infected people are treated with cephalosporin antibiotics (Suprax or Rocephin for example) or fluoroquinolones (Noroxin or Cipro), in addition to antibiotics to treat chlamydia. The advantage of Rocephin (given by injection) is that it can also help get rid of any possible syphilis bacterium. You should not resume sexual activity until you are given the all-clear by your doctor.

How Is It Treated In Pregnancy?

Gonorrhea can spread to a newborn baby during a vaginal birth if the mother is infected. In the past it was a major cause of blindness in babies who became infected and developed conjunctivitis. Today blindness is a rare occurrence because all babies with conjunctivitis are treated with antibiotic eye drops, whether or not the mother has an STD. If you are diagnosed with gonorrhea in pregnancy, treatment needs to be given as soon as possible. During pregnancy Rocephin is considered the safest regimen, in addition to amoxicillin or erythromycin to treat any possible chlamydia infection.

Who Is Most Likely To Develop Gonorrhea?

You are more likely to develop it if you:
• Are aged under 25. More than 50 percent of those infected are under 25.
• Have a history of infection.
• Your sexual partner recently had a urethral discharge.
• You did not use a condom or female condom when you had sex.

Additionally:
Women who perform oral sex on an infected man are more likely to get gonorrhea of the throat than men who perform oral sex on an infected women.

How Can It Be Prevented?

All women who are sexually active and not in a mutually monogamous relationship should:
1. Undergo annual STD testing at an STD clinic or doctor's office.
2. Follow STD prevention advice in regards to safer sex practice.
3. Stop sexual activity if they suspect they are infected until they have been checked out.
4. Be aware of the most common symptoms of STDs: including genital herpes and chlamydia.

For more reproductive advice, see the following:

• Birth Control Methods: Barrier methods to prevent STDs.
• Pubic lice and scabies: Know the signs.
• Reproductive System Disorders: List of gyno problems.

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WOMENS HEALTH ADVICE: ABOUT SEXUALLY TRANSMITTED DISEASES
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