Gonorrhea

Gonorrhea is a bacterial infection transmitted during sexual contact.

Gonorrhea is a sexually transmitted disease (STD) caused by the bacteria Neisseria gonorrhoeae. It is only transmitted by unprotected sexual contact, with either oral, vaginal, or anal intercourse.

Chlamydia is another type of STD that can occur as a co-infection with gonorrhea.

• Women with gonorrhea have about a 40% chance of also having chlamydia
• Men with gonorrhea have about a 25% chance of also having chlamydia
• Young adults with gonorrhea have about a 50% chance of also having chlamydia

Gonorrhea can only be transmitted by unprotected oral, vaginal, or anal sex.

• The gonorrhea bacteria can only survive for a few seconds outside of the body and it cannot live on the skin, arms, hands, or legs. Gonorrhea cannot be transmitted from toilet seats, countertops, or sinks.

Symptoms of gonorrhea are related to where the infection occurs; the throat, the urethra (the tube that drains the bladder when you urinate), the anus, and the vagina.

It is important to know that many people who are infected with gonorrhea have no symptoms at all and may not know that they have an infection.

The following are some of the symptoms that may occur based on the location of the infection.

Genital gonorrhea symptoms

• Urethritis (inflammation of the urethra)
  • In males, there is often a pus discharge from the urethra or it may be more watery. There may also be burning with urination and increased urge to urinate. The penis may also swell.
  • Women are more likely to have no symptoms, but occasionally may have burning with urination and increased urge to urinate.
• Cervicitis (inflammation of the cervix)
  • The cervix is the most common site of infection in women, but about 70% have no symptoms.
  • Most common symptoms include vaginal discharge and vaginal itching.
  • Less common symptoms include atypical vaginal bleeding between menstrual periods or heavier menses.
• Pelvic Inflammatory Disease (PID)
  • Because women may be initially asymptomatic, the gonorrhea infection may spread from the cervix to the uterus, tubes, and ovaries. This may cause lower abdominal pain, heavy menses, and painful intercourse. A fever may also be present.
• Lymphadenitis
  • Symptoms include swelling and tenderness of the lymph in the groin in both males and females.
• Bartholinitis
  • In women, Bartholin’s glands sit just beneath the labia majora at the opening of the vagina and help lubricate it. Inflammation of these glands may cause swelling and pain of the glands and the labia of the vagina, and may include associated discharge.
• Epididymitis
  • Males can develop infection and inflammation of the epididymis, a tightly coiled structure on the testicles where sperm are stored. This inflammation can cause swelling, redness, and pain of the scrotum.

Gonorrhea of the throat

• Gonorrhea infections of the throat usually have no symptoms.
• Symptoms may include sore throat, pus in the back of the throat, and swollen glands.

Gonorrhea of the anus

• In males, infection of the anus and rectum usually occurs in those who have sexual intercourse with other males.
• In women, because of the short distance between the vagina and anus, gonorrhea infection can occur even without anal intercourse.
• Usually, anal gonorrhea has no symptoms.
• When proctitis (inflammation of the rectum) occurs, symptoms may include pain, rectal fullness, the urge to have a bowel movement, rectal bleeding, and rectal discharge.

Symptoms of gonorrhea can be present from 2 to 14 days after exposure, but most often will occur within a week.

Please remember that many people with gonorrhea are asymptomatic and do not know that they are infected.

The diagnosis of gonorrhea is made in the laboratory.

Swabs from the throat, cervix, rectum, or urethra are tested for the Neisseria gonorrhoeae bacteria using polymerase chain reaction (PCR). PCR is a type of nucleic acid amplification test (NAAT) that detects the genes of the bacteria.

Swabs may be taken by medical personnel in a clinic or hospital, but can also be collected at home by the patient and brought to the lab.

First voided urine in the morning can be tested for the presence of gonorrhea.

Often, treatment is started before the results have returned.

Testing for other STDs is often appropriate, since they are often found co-infecting the patient. These include chlamydia, syphilis, and HIV.

Historically, cultures were used to make the diagnosis of gonorrhea, where the bacteria were grown from the swab in the microbiology lab. There are limited uses for cultures as compared to PCR/NAAT. Cultures are considered if treatment has failed and whether antibiotic resistance has occurred.

Gonorrhea is a curable sexually transmitted disease, but requires treatment with antibiotics.

The following are the recommended antibiotic treatments:

Uncomplicated gonorrhea

• Ceftriaxone as a single intramuscular injection.
• If the patient has a severe allergy to penicillin or ceftriaxone, alternative treatments include a single dose of cefixime by mouth, or a single dose of azithromycin by mouth and a single IM injection of gentamicin. These alternatives have significant failure rates.
• In addition to treating for gonorrhea, it is recommended that patients also be treated for chlamydia infections with doxycycline by mouth for seven days.
• It is also recommended that sex partners be treated. Cefixime can be sent home with the patient to provide the antibiotic to their sex partner(s). If the male patient has a male sex partner, it is recommended that the partner seek medical care for evaluation.
• Pregnant patients are treated with the same antibiotic (Ceftriaxone IM) and should be closely monitored and retested in the third trimester before delivery due to risk of infecting the fetus.

Disseminated gonorrhea

Patients with an infected joint with pus in it require surgery to drain the joint. This is followed by 1-2 weeks of intravenous antibiotics.

Patients with tenosynovitis, dermatitis and/or polyarthralgia (multiple sore joints without pus) are treated with intravenous or intramuscular antibiotics for at least one week and continue until symptoms have resolved.

Does gonorrhea go away on its own?

Unfortunately, the body cannot heal itself of the Neisseria gonorrhoeae bacteria on its own. Antibiotics are the only way to rid the body of the infection.

In women, untreated gonorrhea may result in pelvic inflammatory disease. This may result in tubo-ovarian abscesses, fallopian tube scarring, infertility, and the risk of ectopic pregnancy.

An uncommon complication is Fitz-Hugh-Curtis syndrome or perihepatitis, where the capsule of the liver becomes inflamed.

Complications of pregnancy and risk to the fetus and newborn are possible.

Pregnancy complications

• If the pregnant mother has a vaginal gonorrhea infection, there is a significant risk of infection of the amniotic fluid, premature rupture of membranes, early labor, low birth weight, and spontaneous miscarriage.
• Neonates can also get conjunctivitis or inflammation of the clear covering of the eye (ophthalmia neonatorum). If untreated, it can lead to corneal ulcers and blindness.
• Neonates are also at risk for pharyngitis (sore throat), joint infections, and blood infections with the Neisseria gonorrhoaea bacteria.

Both men and women can develop disseminated gonorrhea.

Disseminated gonorrhea

• This describes illnesses where the infection extends beyond the areas where the infection initially occurs (throat, vagina, urethra, or anus).
• Joint infections, tendon inflammation, skin inflammation, and eye infections are possible.
• Pelvic inflammatory disease (PID)
  • Infection and inflammation of the tubes, ovaries, and uterus can cause significant illness, with fever, abdominal pain and tenderness, vaginal bleeding and pain with vaginal intercourse.
  • PID may also be caused by bacteria that are not gonorrhea.
  • Complications of PID include abscess formation in the tubes and/or ovary, scarring of the fallopian tubes leading to ectopic pregnancy or infertility.

Men can develop epididymitis and there is an increased risk of prostate cancer.

Gonorrhea is a curable infection, but it requires that patients seek care. STD screening should be done routinely.

Uncomplicated gonorrhea is treated effectively with a single intramuscular infection and symptoms resolve within a few days. No retesting is required for gonorrhea except for oral pharyngeal gonorrhea. Because of how antibiotics circulate, sometimes there are treatment failures for oral infections. It is recommended that the patient be retested in 7 days.

Disseminated gonorrhea may require longer treatment, but the prognosis is excellent if the patient completes treatment.

Gonorrhea is a sexually transmitted disease. Prevention includes using barrier methods like condoms during oral, vaginal, and anal sex.

Post exposure prophylaxis (PEP) for sexually transmitted disease has been shown to decrease the risk of contracting gonorrhea, chlamydia, and syphilis. Doxycycline 200mg taken by mouth within 24-48 hours has been shown to be effective.

Monogamous sexual relationships will not allow for gonorrhea infections. Ideally, both partners will be tested for STDs beforehand.