Gonorrhea – Symptoms, Risks, Causes, Diagnosis, Treatment

Gonorrhea

Gonorrhea

Gonorrhea is a s*xually transmitted disease that can infect both men and women. Caused by the Neisseria gonorrhea bacterium, gonorrhea can cause infections in the genitals, rectum, and throat. You can get gonorrhea through vaginal, oral or anal s*x. A mother can also pass it to her baby during childbirth. Although treatable, drug-resistant forms of gonorrhea are increasing

Gonorrhea, s*xually transmitted disease characterized principally by inflammation of the mucous membranes of the genital tract and urethra. It is caused by the gonococcus, Neisseria gonorrhoeae a bacterium with a predilection for the type of mucous membranes found in the genitourinary tract and adjacent areas.

All gonococcal infections except eye infections in newborn infants (ophthalmia neonatorum), some instances of vulvovaginitis of young girls living in institutions, and occasional accidental eye infections in adults are transmitted by direct s*xual contact.

The Centers for Disease Control and Prevention (CDC) estimates that approximately 820,000 new gonococcal infections occur in the United States each year.

Gonorrhea has progressively developed resistance to nearly every drug used to treat it and has been labeled an urgent public health threat by the CDC.

In Illinois, the incidence of gonorrhea has declined significantly since 1975, when 59,000 cases were reported. Yet, almost 17,000 cases of the disease were reported in the state in 2011. It is estimated that another nearly 17,000 cases, mostly among teenagers and young adults, go unreported each year. The approximate annual cost of gonorrhea and its complications in Illinois is more than $3 million.

United States Centers for DC estimates that, annually, more than 700,000 people in the United States get new gonorrhea infections and less than half of these infections are reported to CDC. In 2010, nearly 322,000 cases of gonorrhea were reported to CDC.

Gonorrhea is a ubiquitous, worldwide s*xually transmitted disease (STD) that is most common in developing nations and it disproportionately afflicts under­-privileged and urban populations. It is also widely acknowledged that gonorrhea is underreported, and its true incidence is probably much greater than the official numbers.

While about 90% of men typically display symptoms within a few days of infection, in women symptoms are more nonspecific and at least 30–50% (possibly more) of infected women are asymptomatic or go unrecognized (Hook and Hands field, 1999).

Moreover, women bear the brunt of morbidity as untreated cervicitis can progress to upper tract infection and pelvic inflammatory disease (PID), leading to subsequent tubal scarring, infertility, and risk for ectopic pregnancy. Eye infections can be acquired by babies born to infected women, or in adults by the direct transfer of infected material, in both cases leading to corneal scarring and blindness.

Though an infrequent complication of genital infection disseminated gonococcal infection is a systemic bacteremia condition most often involving the skin or joints, leading to septic dermatitis, arthritis, or other manifestations. Untreated gonorrhea is a risk factor for the acquisition of HIV, although the mechanisms underlying this are incompletely understood.

Since the beginning of the antibiotic era, the gonococcus (Neisseria gonorrhoeae) has regularly developed resistance to antibiotics used for treatment, including penicillin, tetracycline, and most recently the fluoroquinolone, ciprofloxacin. Although anecdotal evidence suggests that some cases of uncomplicated gonorrhea may be self-limiting and clear spontaneously after a few months, it can also persist for years.

Furthermore, it does not leave a state of effective specific immunity but can be acquired repeatedly with no apparent diminution in probability, severity, or duration. This has led to the speculation that N. gonorrhoeae interacts with the human immune system in a manner that is little understood, but that results in failure to generate an adaptive immune response.

Gonorrhea therefore represents a challenging problem in infectious disease, both from the public health and clinical standpoint, and scientifically. Great strides have been made in comprehending the molecular biology of N. gonorrhoeae (its genome has been completely sequenced), and in elucidating its pathogenic mechanisms and colonization of the human male and female genital tracts (Edwards and Apicella, 2004). Comprehension of the immune response against the gonococcus and how this can be manipulated to generate protective immunity to gonorrhea are, however, limited, and efforts over many years to develop an effective vaccine have not yet been successful.

What is gonorrhea?

Gonorrhea is an infection spread through s*xual contact. In men, it most often infects the urethra. In women, it usually infects the urethra, cervix, or both. It also can infect the rectum, anus, throat, and pelvic organs. In rare cases, it can infect the eyes.

Gonorrhea doesn’t cause problems if you treat it right away. But if you don’t treat it, it can lead to serious problems.

For a woman, untreated gonorrhea can move into the uterus, fallopian tubes, and ovaries. This can cause painful scar tissue and inflammation, known as pelvic inflammatory disease (PID). PID can cause infertility or ectopic pregnancy.

Sometimes gonorrhea is called the clap, drip, or GC.

Causes

Gonorrhea is passed through vaginal, oral, and anal s*xual contact.  This includes both penetrative s*x and s*xual activities where there is an exchange of body fluids.  You can also get gonorrhea by sharing s*x toys.  Once you have this infection, you can pass it to others even if you don’t have symptoms.

It is spread during vaginal, anal, or oral s*x. A pregnant woman may also pass the infection to her baby during delivery.

Anyone who has gonorrhea can pass it on, even without symptoms. Treatment is the only way to get rid of the infection.

Having a gonorrhea infection once doesn’t protect you from getting another infection in the future. New exposure to gonorrhea will cause reinfection. This can happen even if you were treated and cured before.

This STD comes from bacteria called Neisseria gonorrhoeae. It’s spread through s*x, but a man doesn’t have to ejaculate in order to pass it on to their partner.

You can get gonorrhea from any kind of s*xual contact, including:

  • Anal intercourse
  • Oral intercourse (both giving and receiving)
  • Vaginal intercourse

As with other germs, you can get the bacteria that cause gonorrhea just from touching an infected area on another person. If you come into contact with the penis, vagina, mouth, or anus of someone with gonorrhea, you could get it.

Gonorrhea is almost always s*xually transmitted and is most easily passed on during unprotected s*x. Genital s*x with an infected person will cause gonorrhea of the genitals. Likewise, anal s*x with an infected person can transmit gonorrhea to the rectum and oral s*x can cause gonorrhea of the throat. Gonorrheal eye infections are usually found in infants who have picked it up in the birth canal, but adults may get eye infections if they touch the infected area and then rub their eyes.

Special cases/additional information: conjunctivitis and HIV

Gonorrhea, like chlamydia, can also be transmitted from mother to child during the delivery. Babies born to mothers with untreated gonorrhea infections may develop gonorrheal conjunctivitis (infection in the eye), though this is not very common. For this reason, gonorrhea testing should be routine during pregnancy.

Having an STI, like gonorrhea, can also increase your chances of contracting HIV if you are exposed to it, or spreading HIV if you are already infected. If you think you have gonorrhea or any STI, it is important for you to seek help immediately from your healthcare provider or an STI clinic. Many clinics provide free or low-cost STI testing. This will all help keep you, your s*xual partners, and your community healthy.

Women who have gonorrhea can pass it to their baby during vaginal delivery. Babies born by C-section can’t get it from their mother.

These germs can’t live very long outside the body, so you can’t get gonorrhea by touching objects like toilet seats or clothes.

Gonorrhea is a s*xually transmitted infection (STI) caused by infection with the bacterium Neisseria gonorrhea. Gonorrhea can result in infertility. Commonly known as “the clap”, gonorrhea is transmitted through oral, genital, or anal s*x with someone who has the infection. It can also be spread from mother to child during birth.

This bacterial infection is on the rise in Canada and is becoming increasingly resistant to antibiotics. Of more concern, in recent years there have been two cases of drug-resistant gonorrhea in Canada related to travel to Southeast Asia. Being aware of the risks of STI during travel (to any location) as well as using safer s*x measures while traveling are important factors in preventing additional cases of drug-resistant gonorrhea in Canada.

In females, untreated gonorrhea can lead to pelvic inflammatory disease (PID). PID health risks include abdominal pain, fever, internal abscesses, long-lasting pelvic pain, and scarring of the fallopian tubes, which can cause infertility and increase the chance of ectopic and/or tubal pregnancies.

Men can develop epididymitis, a painful inflammation in the tubes attached to the testicles. If left untreated, it can on rare occasions lead to infertility.

If untreated, you and your partner are at risk of the infection spreading through the bloodstream and infecting other parts of the body, including joints. This condition can be life-threatening.

If a person has gonorrhea and is pregnant, the infection can be passed to the baby in the birth canal during delivery, causing blindness, joint infection, or a life-threatening blood infection.

For couples where one has HIV infection and the other doesn’t (i.e., serodiscordant), the risk of contracting and transmitting HIV is increased if you or your partner already have another STI.

Risk factors for contracting gonorrhea and other STIs include:

  • Having condomless vaginal, oral, or anal s*x
  • Being younger (15-29 years old)
  • Having multiple s*xual partners

Risks

Gonorrhea is a s*xually transmitted infection (STI) caused by infection with the bacterium Neisseria gonorrhea. Gonorrhea can result in infertility. Commonly known as “the clap”, gonorrhea is transmitted through oral, genital, or anal s*x with someone who has the infection. It can also be spread from mother to child during birth.

This bacterial infection is on the rise in Canada and is becoming increasingly resistant to antibiotics. Of more concern, in recent years there have been two cases of drug-resistant gonorrhea in Canada related to travel to Southeast Asia. Being aware of the risks of STI during travel (to any location) as well as using safer s*x measures while travelling are important factors in preventing additional cases of drug resistant gonorrhea in Canada.

In females, untreated gonorrhea can lead to pelvic inflammatory disease (PID). PID health risks include abdominal pain, fever, internal abscesses, long-lasting pelvic pain, and scarring of the fallopian tubes, which can cause infertility and increase the chance of ectopic and/or tubal pregnancies.

Men can develop epididymitis, a painful inflammation in the tubes attached to the testicles. If left untreated, it can on rare occasions lead to infertility.

If untreated, you and your partner are at risk of the infection spreading through the bloodstream and infecting other parts of the body, including joints. This condition can be life-threatening.

If a person has gonorrhea and is pregnant, the infection can be passed to the baby in the birth canal during delivery, causing blindness, joint infection, or a life-threatening blood infection.

For couples where one has HIV infection and the other doesn’t (i.e., serodiscordant), the risk of contracting and transmitting HIV is increased if you or your partner already have another STI.

Risk factors for contracting gonorrhea and other STIs include:

  • Having condom less vaginal, oral, or anal s*x
  • Being younger (15-29 years old)
  • Having multiple s*xual partners

Gonorrhea is most common among s*xually young adults. Other factors that increase your chances of getting gonorrhea include:

  • Being s*xually active
  • Multiple s*x partners
  • Having s*x without a condom
  • History of STDs

Any s*xually active person can be infected with gonorrhea. In the United States, approximately 75% of all reported 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. In 1999, 77% of the total number of cases of gonorrhea reported to the CDC occurred among African Americans.

Who is at risk?

Gonorrhea is the second most common notifiable STI in Canada. A notifiable disease must be reported to public health authorities when an infection is confirmed by a clinic, doctor or laboratory. All people who are s*xually active, including people who experience s*xual violence, may be at risk for gonorrhea. The majority of reported cases of gonorrhea occur in people under the age of 30.

Anyone who is s*xually active can get gonorrhea. It is more common among s*xually active teens and young adults ages 15-24.

Some individuals are at increased risk of gonorrhea infection:

  • people who have had s*xual contact with a person with a confirmed or suspected case of gonorrhea
  • people who have had condoles s*x with a resident of an area with high gonorrhea burden and/or high risk of antibiotic resistance
  • people with a history of STI infections
  • people living with HIV
  • People who have had condom less s*x with multiple partners.

There are higher rates of gonorrhea among gay men and other men who have s*x with men (MSM), s*x workers and their s*xual partners, Aboriginal people, s*xually active youth under 25, street-involved youth, and other homeless populations.

Symptoms

The initial symptoms in the female are, in most instances, so mild as to go unnoticed. Slight vaginal discharge with burning may occur. The disease is not usually suspected by either patient or physician until complications arise or a s*xual partner is infected. Abscess of a vulvovaginal (Bartholin) gland occurs rarely as an early complication.

Many women recover spontaneously from gonorrheal infections that extend no farther than the uterine cervix (mouth of the uterus). In many cases, however, the infection extends through the uterus to the fallopian tubes and ovaries condition known as a pelvic inflammatory disease. Fever usually accompanies this extension, and lower abdominal pain is a prominent symptom. Pelvic abscess or peritonitis may result.

The symptoms can be confused with those of appendicitis. Healing occurs without resort to surgery in most cases, often with some physical disability and sterility. In immature girls the infection is usually confined to the vagina.

  1. gonorrhea can sometimes enter the bloodstream, causing disseminated gonococcal infection (DGI) in virtually any organ system.

In both male and female, arthritis is the most common manifestation of DGI. The process usually settles in one or two joints and may result in permanent disability in the absence of treatment. Involvement of the tendon sheaths in the region of the affected joint or joints is not uncommon. Other, very rare, complications of gonorrhea are iritis (inflammation of the iris), endocarditis, meningitis, and skin lesions.

If you have gonorrhea, it is common to not notice any symptoms.  If you do get symptoms, they will most likely show up between 2 to 7 days.  Your symptoms will depend on where the infection is located, but occur most often in the penis/external genitals.

Gonorrhea may not cause symptoms until the infection has spread to other areas of the body.

The most common symptoms include:

  • Penis/external genitals:  You may notice abnormal discharge and an unusual, painful, or itchy sensation.  You may also have pain or trouble when urinating.  If you have testicles you may experience pain and sometimes a little swelling in the area.
  • Vagina/internal genitals:  You may notice abnormal discharge and bleeding.  Other symptoms may include lower abdominal pain and sometimes pain during s*x.
  • Anus:  You may notice abnormal discharge.  You can also have generalized pain in the area.
  • Throat:  It is rare to have symptoms, but you might experience a sore throat.
  • Eye: You may notice swelling or abnormal discharge.

You can spread gonorrhea even if you don’t have symptoms. You are contagious until you have been treated.

It’s common for gonorrhea to cause no symptoms, especially in women. The incubation period—the time from exposure to the bacteria until symptoms develop—is usually 2 to 5 days. But sometimes symptoms may not develop for up to 30 days.

Symptoms in women

In women, the early symptoms are sometimes so mild that they are mistaken for a bladder infection or vaginal infection. Symptoms may include:

  • Painful or frequent urination.
  • Anal itching, discomfort, bleeding, or discharge.
  • Abnormal vaginal discharge.
  • Abnormal vaginal bleeding during or after s*x or between periods.
  • Genital itching.
  • Irregular menstrual bleeding.
  • Pain in the lower belly.
  • Fever and general tiredness.
  • Swollen and painful glands at the opening of the vagina (Bartholin glands).
  • Painful s*xual intercourse.
  • Sore throat. (This symptom is rare.)
  • Pinkeye (conjunctivitis). (This symptom is rare.)

Symptoms in men

In men, symptoms are usually more obvious. Most men get treated before other problems occur. But some men have mild or no symptoms. This means that they can infect their s*x partners and not know it. Symptoms may include:

  • Abnormal discharge from the penis. At first, the discharge is clear or milky. Then it can become yellow, creamy, or a little bloody.
  • Painful or frequent urination or urethritis.
  • Anal itching, discomfort, bleeding, or discharge.
  • Sore throat. (This symptom is rare.)
  • Pinkeye (conjunctivitis). (This symptom is rare.)

Other symptoms

Disseminated gonococcal infection (DGI) occurs when the gonorrhea infection spreads to other parts of the body. This includes the joints, skin, heart, or blood. Symptoms of DGI include:

  • A rash.
  • Joint pain or arthritis.
  • Inflamed tendons.

How is gonorrhea spread?

You can get gonorrhea by having vaginal, anal, or oral s*x with someone who has gonorrhea. A pregnant woman with gonorrhea can give the infection to her baby during childbirth.

People get gonorrhea by having s*x (anal, vaginal or oral) with someone who has the disease. Gonorrhea can still be transmitted via fluids even if a man does not ejaculate. Gonorrhea can be spread from an untreated mother to her baby during childbirth.

People who have had gonorrhea and have been treated may get infected again if they have s*xual contact with a person infected with gonorrhea. When the infection occurs in children, it is most commonly due to child abuse.

Gonorrhea is spread through s*x oral, anal, and vaginal. Women are more likely to catch gonorrhea from men than men are from women. Although it is less likely, women can also acquire gonorrhea from female s*xual partners. Gonorrhea is highly contagious between male s*xual partners. Gonorrhea can also be passed to the eye by a hand or other body part carrying infected fluids.

If left untreated, gonorrhea can spread from the original site of infection and infect and damage the joints, skin, and other organs. Indications of this can include fever, skin rashes, sores, and joint pain and swelling.

In advanced cases, gonorrhea may cause a general feeling of tiredness similar to other infections. It is also possible for an individual to have an allergic reaction to the bacteria, in which case any appearing symptoms will be greatly intensified. Very rarely it may settle in the heart, causing endocarditis, or in the spinal column, causing meningitis. Both are more likely among individuals with suppressed immune systems, however.

Diagnosis

Diagnosis is established by culture of a sample of urine or discharge. Treatment is with antibiotics. In the past, infection was treated with either penicillin or tetracycline, and one injection usually was sufficient to cure uncomplicated gonorrhea. In the 1970s, however, strains of gonococci resistant to penicillin or tetracycline emerged.

Thus, fluoroquinolones such as ciprofloxacin, the aminocyclitol antibiotic spectinomycin, and cephalosporins such as cefoxitin became increasingly used as alternatives for eliminating N. gonorrhoeae. Some strains of the bacteria, however, later developed resistance to fluoroquinolones, and eventually multidrug-resistant strains appeared. In the early 2000s, evidence of cephalosporin-resistant N. gonorrhoeae emerged.

In many places, the recommended approach to treating gonorrhea centres on dual drug therapy. Which drugs are used in dual therapy is determined in part by which drug-resistant strains are prevalent in the geographical region where infection was acquired and in some cases by whether there exists a likelihood of coinfection (such as with Chlamydia trachomatis, a bacterium that causes nongonococcal urethritis).

An example of a dual therapy that is used in the United States is the administration of a cephalosporin, such as cefixime or ceftriaxone, in combination with azithromycin (a macrolide antibiotic) or doxycycline (a tetracycline antibiotic). This approach is used regardless of whether coinfection has been ruled out. Isolates of N. gonorrhoeae are routinely collected from patients and tested for antibiotic susceptibility, thereby facilitating the detection of new drug-resistant strains.

Your doctor will ask you questions about your symptoms and may perform a physical exam. Your doctor will send either a urine sample, or a sample of the discharge from the infected site to a laboratory. The samples will be tested to see if they contain the bacteria that cause gonorrhea. Your doctor may also recommend that you be tested for other s*xually transmitted infections, since people who have a s*xually transmitted infection often have more than one.

All s*xual partners in the last 60 days, regardless of signs and symptoms, should be tested and treated for gonorrhea. If there has been no partner over the last 60 days, the most recent partner should be tested and treated. If you are uncomfortable contacting your previous s*xual partners, your health care provider will.

The administration of small doses of antibiotics sufficient to cure gonorrhea may mask the early manifestations of coexisting syphilis and delay its diagnosis. An integral part of the treatment of gonorrhea, therefore, is the so-called serological follow-up a blood test for syphilis at least once a month for four months.

Diagnosis of gonorrhea includes a medical history and a physical exam. Your doctor may ask you the following questions.

  • Do you think you have been exposed to any s*xually transmitted infections (STIs)? How do you know? Did your partner tell you?
  • What are your symptoms?
    • Do you have any discharge? What color is it? Does it smell?
    • Do you have sores in your genital area or anywhere else on your body?
    • Do you have any urinary symptoms? These symptoms include frequent urination, burning or stinging with urination, and urinating in small amounts.
    • Do you have any unusual belly or pelvic pain?
  • What kind of birth control do you use?
  • Do you or your partner engage in certain s*xual behaviors that may put you at risk? These include having multiple s*x partners or having s*x without a condom.
  • Have you had an STI in the past? How was it treated?

Your doctor will ask you questions about your medical history. Then:

  • Women may have a pelvic exam.
  • Men may have a genital exam. The doctor will look for signs of urethritis and epididymitis.
  • You may have a urine test.

Several tests can be used to confirm an infection. Your doctor will collect a sample of fluid or urine to be tested. Most tests give results in a few days.

Along with gonorrhea, you may have other s*xually transmitted infections. Your doctor may recommend testing for:

  • Chlamydia.
  • Syphilis.
  • Hepatitis B.
  • Human immunodeficiency virus (HIV).

In the United States, your doctor must report to the state health department that you have gonorrhea.

Your doctor will ask you questions about your past health and your s*xual history, such as how many partners you have. Your doctor may also do a physical exam to look for signs of infection.

Urine or fluid from the infected area will be tested for gonorrhea. You may also be tested for other s*xually transmitted infections (STIs) at the same time. Testing can be done with a Pap test.

As soon as you find out you have gonorrhea, be sure to let your s*x partners know. Experts recommend that you notify everyone you’ve had s*x with in the past 60 days. If you have not had s*x in the past 60 days, contact the last person you had s*x with.

Treatment

Many of the gonorrhea strains circulating today, both in Canada and around the world have become resistant to previously recommended treatments. Along with the increasing number of gonorrhea cases in Canada in recent years, we are also seeing an increase in antimicrobial resistance.

If you are diagnosed with gonorrhea, be sure to follow your healthcare professional’s treatment and follow-up recommendations. Both you and your s*xual partner(s) will require treatment. To avoid re-infection after treatment it is important to avoid unprotected s*xual activities with your s*xual partner(s) until you and your partner(s) have completed your treatment and have been informed that the infection is cured. Remember condoms are your best protection against STIs.

Gonorrhea is treated with prescription antibiotics.  It is important to take all your medications as directed.  If you miss any doses, the infection may not be cured.  See your health care provider if this happens or if you still have symptoms after you finish your treatment.

It is important to not have s*x (even with a condom) for 7 days after the start of your treatment.  If you do have s*x during this time, you could pass gonorrhea to your s*xual partners or get it again.  If this happens, talk to your health care provider.

The medications used to treat gonorrhea are available for free in BC.  Talk to your health care provider to see if they have them in stock.

A variety of treatments are available for gonorrhea. In uncomplicated cases, the usual treatment is a single dose of a medication such as ceftriaxone* injected into the muscle, or cefixime, a pill, plus a dose of oral azithromycin. People with gonorrhea often have chlamydia, and this treatment treats chlamydia as well. Ask your doctor how long you should wait before beginning s*xual contact again after the treatment.

Antibiotics

Antibiotics are used to treat gonorrhea infections. As of 2016, both ceftriaxone by injection and azithromycin by mouth are most effective. However, due to increasing rates of antibiotic resistance, local susceptibility patterns must be taken into account when deciding on treatment.

Adults may have eyes infected with gonorrhea and require proper personal hygiene and medications. The addition of topical antibiotics has not been shown to improve cure rates compared to oral antibiotics alone in the treatment of eye infected gonorrhea. For newborns, erythromycin ointment is recommended as a preventative measure for gonococcal infant conjunctivitis. Among persons in the United States between 14 and 39 years of age, 46% of people with gonorrheal infection also have a chlamydial infection.

Infections of the throat can be especially problematic, as antibiotics have difficulty becoming sufficiently concentrated there to destroy the bacteria. This is amplified by the fact that pharyngeal gonorrhoea is mostly asymptomatic, and gonococci and commensal Neisseria species can coexist for long time periods in the pharynx and share anti-microbial resistance genes. Accordingly, an enhanced focus on early detection (i.e., screening of high-risk populations, such as men who have s*x with men, PCR testing should be considered) and appropriate treatment of pharyngeal gonorrhea is important.

S*xual partners

It is recommended that s*xual partners be tested and potentially treated. One option for treating s*xual partners of people infected is patient-delivered partner therapy (PDPT), which involves providing prescriptions or medications to the person to take to his/her partner without the health care provider’s first examining him/her.

The United States’ Centers for Disease Control and Prevention (CDC) currently recommend that individuals who have been diagnosed and treated for gonorrhea avoid s*xual contact with others until at least one week past the final day of treatment in order to prevent the spread of the bacterium.

Antibiotic resistance

Many antibiotics that were once effective including penicillin, tetracycline, and fluoroquinolones are no longer recommended because of high rates of resistance. Resistance to cefixime has reached a level such that it is no longer recommended as a first-line agent in the United States, and if it is used a person should be tested again after a week to determine whether the infection still persists. Public health officials are concerned that an emerging pattern of resistance may predict a global epidemic.

The UK’s Health Protection Agency reported that 2011 saw a slight drop in gonorrhea antibiotic resistance, the first in five years. In 2016, the WHO published new guidelines for treatment, stating “There is an urgent need to update treatment recommendations for gonococcal infections to respond to changing antimicrobial resistance (AMR) patterns of N. gonorrhoeae.

High-level resistance to previously recommended quinolones is widespread and decreased susceptibility to the extended-spectrum (third-generation) cephalosporins, another recommended first-line treatment in the 2003 guidelines, is increasing and several countries have reported treatment failures.

Fluoroquinolones, penicillins, or tetracyclines used to be effective therapies, but many of the strains today have developed resistance to these antibiotics. It is very important to take medications exactly as prescribed, and some people will require a follow-up test after finishing treatment. All people treated for gonorrhea will need to follow up with their doctor in 6 months.

Gonorrhea is treated with antibiotics. Treatment is recommended for:

  • A person who has a positive gonorrhea test.
  • Anyone who has had s*xual contact in the past 60 days with a person who’s been diagnosed with gonorrhea. Treatment is recommended even if you used condoms or if the other person doesn’t have symptoms.
  • A newborn whose mother has gonorrhea at the time of delivery.

If you are prescribed more than one dose, be sure to take your antibiotic exactly as directed. If you miss doses or don’t take all of the medicine, the infection may not go away.

Do not have s*xual contact with anyone:

  • While you are being treated.
  • Until both you and your partner(s) have been tested and treated. If you are treated for gonorrhea and your s*x partner is not, you will probably get infected again.

If your treatment is just one dose of medicine, wait at least 7 days after you take it before having any s*xual contact.

Always use a condom when you have s*x. This helps protect you from s*xually transmitted infections.

Some people who have gonorrhea also have chlamydia. The U.S. Centers for Disease Control and Prevention (CDC) recommends that treatment for gonorrhea include antibiotics that also treat chlamydia.

Treatment if the condition doesn’t get better

If your symptoms don’t go away, you may have another gonorrhea infection.

Certain strains of the gonorrhea bacteria have become resistant to some medicines. When bacteria become resistant to an antibiotic, they no longer can be killed by that medicine.

If you’ve been treated for gonorrhea and don’t get better, you may be retested to see if there is resistance to the antibiotic you took. In this case, you may need another antibiotic.

S*xual Partners

Your s*xual partners within the last two months should be tested and treated for gonorrhea. If you haven’t had s*x in the last two months your last partner should be tested and treated.

There are a few ways to tell partners. You can tell partners yourself or anonymously. Talk to your health care provider about what is right for you.

When to Get Tested?

For women, yearly testing is recommended if you are s*xually active and younger than age 25, or 25 or older and at increased risk for gonorrhea; if you fall into one of these groups and are pregnant or considering pregnancy.

For men, yearly testing is recommended if you are a man who has s*x with men.

When you have symptoms of gonorrhea, such as pain while urinating, vaginal discharge or vaginal bleeding between menstrual periods (for women), or unusual discharge from the penis, pain while urinating or painful, swollen testicles (for men)

Who should be tested for gonorrhea?

Any s*xually active person can be infected with gonorrhea. Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should stop having s*x and see a health care provider immediately.

Also, anyone with an oral, anal or vaginal s*x partner who has been recently diagnosed with an STD should see a health care provider for evaluation.

Some people should be tested for gonorrhea even if they do not have symptoms or know of a s*x partner who has gonorrhea. Anyone who is s*xually active should discuss his or her risk factors with a health care provider and ask whether he or she should be tested for gonorrhea or other STDs.

People who have gonorrhea should be tested for other STDs.

Test Preparation Needed?

What is being tested?

Gonorrhea is a common bacterial s*xually transmitted disease (STD) that can cause serious complications if not diagnosed and treated. Gonorrhea testing identifies if the bacteria Neisseria gonorrhoeae is the cause of your infection.

The recommended method for gonorrhea testing is the nucleic acid amplification test (NAAT) that detects the genetic material (DNA) of Neisseria gonorrhoeae. It is generally more sensitive and specific than other gonorrhea tests and can be performed on a vaginal swab on women or urine from both men and women, which eliminates the need for a pelvic exam in women.

Besides NAAT, another test to detect gonorrhea is a gonorrhea culture, which grows the bacteria. In men, a quick method that may be used in a clinic or healthcare provider’s office is the gram stain, which allows the healthcare practitioner to look at a sample from your urethra for the presence of the bacteria using a microscope. While this method can diagnose gonorrhea, it is not sufficient to rule out an infection in asymptomatic men. This method is not reliable for samples from women since other bacteria normally found in your genital tract will look the same under the microscope.

Screening for, diagnosing, and treating gonorrhea is very important in preventing long-term complications and the spread of the infection to others. The Centers for Disease Control and Prevention (CDC) estimates that about 1.14 million people in the U.S. get new gonorrheal infections each year. In the U.S., the highest reported rates of infection are among s*xually active teenagers, young adults, and African Americans.

Gonorrhea is generally spread through s*xual contact (oral, vaginal, or anal) with an infected partner. Risk factors include having multiple s*x partners, infection with another STD at the same time or previous STD infection, and not using a condom correctly and consistently.

While some men with gonorrhea will notice symptoms, many women do not. Women may mistake gonorrhea symptoms for a bladder infection or other vaginal infection. For men, symptoms usually appear within 2 to 5 days after infection but can take up to 30 days. Women who experience symptoms usually do so within 10 days of infection. Signs and symptoms of gonorrhea are similar to and can be confused with those caused by another STD, chlamydia, so tests for these infections are often done at the same time.

Gonorrhea can usually be treated with a course of antibiotics. If not diagnosed and treated, gonorrhea can cause serious complications.

In women, untreated gonorrhea infections may lead to pelvic inflammatory disease (PID), which can develop from several days to several months after infection and cause complications such as:

  • Long-term (chronic) pelvic pain
  • An increased risk of tubal (ectopic) pregnancy, which can be fatal
  • Infertility

If you are infected while pregnant, you have an increased risk of miscarriage, premature rupture of the membranes, and your baby may be born early (premature) or with low birth weight. You may pass the infection to your baby during childbirth. Untreated infants can develop eye infections.

In men, untreated gonorrhea can cause complications such as:

  • Inflammation of your prostate gland
  • Scarring of your urethra, possible narrowing or closing of the urethra
  • Infertility

Untreated gonorrhea may also spread to your blood (septicemia) or joints, progressing to a serious condition called disseminated gonococcal infection (DGI). DGI symptoms include fever, multiple skin lesions, painful swelling of joints (gonococcal arthritis), infection of the inner lining of the heart, and inflammation of the membrane covering the brain and spinal cord (meningitis).

Symptoms of DGI in infants born to infected mothers include those associated with arthritis, meningitis and sepsis, a severe, life-threatening condition.

DGI can be successfully treated using antibiotics similar to those used for treating uncomplicated gonorrhea. However, antibiotic-resistant gonorrhea is a growing threat. (Read Antibiotic Resistance in Bacteria.)

CDC guidelines currently recommend therapy with two antibiotics to treat all uncomplicated gonococcal infections among adults and adolescents in the United States. If your symptoms do not resolve after treatment, a healthcare practitioner may need to order a repeat gonorrhea test to determine whether antibiotic treatment cured your infection. If it did not, the practitioner may order susceptibility testing to help determine the likelihood that a different antibiotic(s) will cure your infection.

There are choices for how you test for gonorrhea.  A health care provider will recommend certain tests depending on the types of s*x that you’re having. Testing is usually done with a urine sample or a swab of the throat, rectum or vagina.

It is best to get tested for gonorrhea if you:

  • have symptoms
  • have a s*xual partner who has tested positive for gonorrhea
  • are doing routine screening for STIs
  • are pregnant
  • are going to have an IUD inserted, a surgical abortion, or a gynecological procedure

Window Period (how long to wait before testing):  Most test results are accurate 7 days after you come in contact with gonorrhea. In British Columbia, most test results should be ready in 10 days.

Currently, there is no reliable technology that can determine antibiotic susceptibility without first culturing Neisseria gonorrhoeae. However, the widespread use of the more sensitive nucleic acid amplification test (NAAT) for gonorrhea has replaced routine culture in most laboratories. Culture and susceptibility testing are only performed in large reference laboratories or public health laboratories that are monitoring antimicrobial resistance.

Complications

Untreated gonorrhea infection of the cervix can spread to the uterus and fallopian tubes and cause pelvic inflammatory disease (PID). This can result in chronic abdominal pain, infertility, and an increased risk of ectopic pregnancy (a potentially serious complication of pregnancy where the embryo implants outside the uterus).

Untreated gonorrhea in the urethra can result in inflammation of the epididymis (called epididymitis). The epididymis is a tube in the testicle that stores and carries sperm. Epididymitis can result in infertility; however, this is a relatively rare occurrence.

Gonorrhea can be passed to a newborn during birth. Severe complications from an infection acquired during birth can include blindness, arthritis, meningitis (inflammation of the protective membrane that surrounds the brain and spinal cord), and sepsis (infection of the bloodstream).

An untreated eye infection (conjunctivitis) caused by gonorrhea can cause scarring of the cornea.

If left untreated, gonorrhea infection can enter the bloodstream and spread through the body (disseminated gonorrhea). This can lead to arthritis, skin lesions, and tenosynovitis, which is an inflammation of the sheath surrounding the tendons (the tissues that connect muscle to bone). In rare cases, disseminated gonorrhea may lead to meningitis as well as inflammation of the heart or liver.

If you treat gonorrhea early, there are usually no other health problems. If left untreated, it can lead to serious complications including:

  • higher chance of getting and passing HIV
  • pelvic inflammatory disease
  • epididymitis
  • infertility
  • ectopic pregnancy
  • chronic pelvic pain
  • reactive arthritis
  • disseminated gonococcal infection

Complications in men include:

  • Epididymitis — A painful swelling and inflammation of the testicles, which may lead to infertility.
  • Urethritis — The inside of the urethra may become inflamed, which causes burning when passing urine. If scarring occurs, it may cause difficulty with passing urine, or block urine flow completely.
  • Prostatitis — An inflammation of the prostate gland. Symptoms include pain in and around the groin and pelvis, or discomfort when urinating. It may also create flu-like symptoms, such as fever, chills, body aches, or fatigue.

Complications in women include:

  • Pelvic inflammatory disease (PID) — A serious infection that can lead to infertility, even in women who never have symptoms. If symptoms do occur, they may include pelvic pain and pain with intercourse. PID causes scar tissue or may cause an abscess to form, in the fallopian tubes.
  • Infection in a newborn infant if you are infected during pregnancy.

Pregnancy: If you are pregnant you should be screened for gonorrhea.  You can pass gonorrhea to your child during birth.

I’m pregnant. How does gonorrhea affect my baby?

If you are pregnant and have gonorrhea, you can give the infection to your baby during delivery. This can cause serious health problems for your baby. If you are pregnant, it is important that you talk to your health care provider so that you get the correct examination, testing, and treatment, as necessary. Treating gonorrhea as soon as possible will make health complications for your baby less likely.

How do I know if I have gonorrhea?

Some men with gonorrhea may have no symptoms at all. However, men who do have symptoms may have:

  • A burning sensation when urinating;
  • A white, yellow, or green discharge from the penis;
  • Painful or swollen testicles (although this is less common).

Most women with gonorrhea do not have any symptoms. Even when a woman has symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Women with gonorrhea are at risk of developing serious complications from the infection, even if they don’t have any symptoms. Symptoms in women can include:

  • Painful or burning sensation when urinating;
  • Increased vaginal discharge;
  • Vaginal bleeding between periods.

Rectal infections may either cause no symptoms or cause symptoms in both men and women that may include:

  • Discharge;
  • Anal itching;
  • Soreness;
  • Bleeding;
  • Painful bowel movements.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or bleeding between periods.

Prevention

It is a good idea to be tested regularly for STIs, especially if you have new  s*xual partners or open relationships.  Talking with partners about safer s*x makes sure everyone knows what to expect.  Condoms are great if they work for you – the correct use of condoms reduces your chances of getting and passing gonorrhea.

Tell the healthcare practitioner about any use of antibiotics or, if you are a woman, douches or vaginal creams. You may be asked to avoid using these within 24 hours before testing vaginal samples since they may affect test results. Menstruation will not affect results. You may be instructed to wait for one to two hours after you last urinated before collecting the urine sample. Follow any instructions you are given.

Correct and consistent use of condoms reduces the risk of transmitting gonorrhea. There are two types of condoms available. The external condom (sometimes called the “male” condom) is a sheath made from polyurethane, latex or polyisoprene that covers the penis during s*x. The internal condom (sometimes called the insertive or “female” condom) is a pouch made of polyurethane or a synthetic latex material called nitrile that can be inserted into the vagina or rectum.

Some transgender men may cut a condom or oral dam to fit their genitals.

The use of oral dams or other barriers can reduce the risk of gonorrhea during oral s*x or rimming.

Using a new condom for s*x toys with each partner can reduce the risk of gonorrhea transmission by preventing the exchange of bodily fluids.

Someone who is diagnosed with gonorrhea should avoid having s*x until they have been treated and all symptoms have gone. The notification, testing, and treatment of all s*xual partners of an individual with gonorrhea all help to prevent the spread of further infections

Following these suggestions can help you avoid contracting and transmitting gonorrhea:

  • Learn about safer s*x methods and practice them.
  • Make informed decisions. Talk to your partner(s) about their STI status.
  • Correctly and consistently use a condom and oral/dental dams during s*x.
  • Get tested for gonorrhea, and other STIs, if you are s*xually active, and encourage your s*xual partner(s) to get tested.
  • It is important that you or someone from your public health department notify any s*xual partners who may have been put at risk of infection. They will also need to be tested and possibly treated.

Take these steps to protect yourself from gonorrhea:

Use condoms. They help keep you from getting STDs. They act as a barrier and keep bacteria from infecting you. Spermicide won’t prevent you from getting gonorrhea.

How can you protect yourself from getting gonorrhea?

The only method that is 100% effective in preventing STDs is abstinence, but if you’re s*xually active, the best way to avoid gonorrhea is to be mutually monogamous with someone who has tested negative for gonorrhea.

If you test positive for gonorrhea, get tested again three (3) months later to make sure you don’t have it again. Condoms do decrease your chances of getting gonorrhea during vaginal s*x or during oral s*x with a male, but it’s important for both partners to get tested because it’s easy to get re-infected if one partner still has it.

To decrease your chances of getting gonorrhea during oral s*x on a female, you can use a dental dam as a barrier between the mouth and vulva. A dental dam is a thin square of latex that is placed over a woman’s vulva before her partner performs oral s*x on her and acts as a barrier between the vulva and the mouth. They are sold in some stores, but you can make your own dental dam using a latex glove or a male condom. To decrease your chances of getting gonorrhea during any type of anal s*x (rimming, penetration, etc.), you can use a female condom.

If you’re s*xually active and under 25, you should get tested for gonorrhea every year – better safe than sorry.

What’s the worst that could happen?

For women, a gonorrhea infection can lead to pelvic inflammatory disease (PID), an infection of parts of the reproductive system, like the uterus, ovaries, and fallopian tubes. That means if you have gonorrhea and you don’t get it treated, you might not be able to have babies if and when you want to. If a woman has gonorrhea while she is pregnant, gonorrhea could harm the baby’s eyes during birth.

Rarely, a man with untreated gonorrhea could get a bad infection that causes scarring of the tubes that carry sperm. If this happens, he might not be able to have children.

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