In 1995, 392,848 cases of gonorrhea
in the United States were reported to the U.S. Centers for
Disease Control and Prevention (CDC). The Institute of Medicine,
however, estimates that 800,000 cases of gonorrhea occur annually
in the United States. The annual cost of gonorrhea and its
complications is estimated at close to $1.1 billion.
Gonorrhea is caused by a bacterium,
Neisseria gonorrhoeae, that grows and multiplies
quickly in moist, warm areas of the body including the reproductive
tract, the oral cavity, and the rectum. Although in women
the cervix usually is the initial site of infection, the disease
can spread to and infect the uterus (womb) and fallopian tubes,
resulting in pelvic inflammatory disease (PID). This can cause
infertility and ectopic (tubal) pregnancy.
The disease is most commonly spread
during sexual intercourse – vaginal, oral, and anal. Gonorrhea
of the rectum can occur in people who practice anal intercourse
and also may occur in women due to spread of the infection
from the vaginal area.
Gonorrhea can be passed from an infected
woman to her newborn infant during delivery, causing eye infections
in the baby. When the infection occurs in the genital tract,
mouth, or rectum of a child, it is due most commonly to sexual
abuse.
Symptoms
The early symptoms of gonorrhea
often are mild, and many women who are infected have no
symptoms of the disease. If symptoms of gonorrhea develop,
they usually appear within two to 10 days after sexual contact
with an infected partner, although a small percentage of
patients may be infected for several months without showing
symptoms. The initial symptoms in women include a painful
or burning sensation when urinating and/or vaginal discharge
that is yellow or bloody. More advanced symptoms, which
indicate progression to PID, include abdominal pain, bleeding
between menstrual periods, vomiting, or fever. Men are more
often symptomatic than women. They usually have a discharge
from the penis and a burning sensation during urination
that may be severe. Symptoms of rectal infection include
discharge, anal itching, and sometimes painful bowel movements.
Diagnosis
Three techniques, gram stain, detection
of bacterial genes or nucleic acid (DNA), and culture, are
generally used to diagnose gonorrhea. Many doctors prefer
to use more than one test to increase the chance of an accurate
diagnosis. The gram stain is quite accurate for men but
is not very sensitive for women. Only one in two women with
gonorrhea have a positive gram stain. The test involves
placing a smear of the discharge from the penis or the cervix
(the opening to the uterus) on a slide and staining the
smear with a dye. The slide is examined under a microscope
for the presence of the bacteria. A doctor usually can give
test results to the patient at the time of an office or
clinic visit. More often, urine or cervical swabs are used
for a new test that detects the genes of the bacteria. These
tests are as accurate as culture and are used widely.
The culture test involves placing
a sample of the discharge onto a culture plate and incubating
it up to two days to allow the bacteria to multiply. The
sensitivity of this test depends on the site from which
the sample is taken. Cervical samples detect infection approximately
90 percent of the time. The doctor also can take a throat
culture to detect pharyngeal gonorrhea.
Treatment
Because penicillin-resistant cases
of gonorrhea are common, other antibiotics are used to treat
most patients with gonococcal infections. One of the most
effective medicines to treat patients is ceftriaxone, which
the doctor can inject in a single dose. Other effective
antibiotics that a patient can take by mouth include a single
dose of cefixime, ciprofloxacin, or ofloxacin. Pregnant
women and patients younger than 18 years old should not
take ciprofloxacin or ofloxacin.
Gonorrhea can occur together with
chlamydial infection, another common sexually transmitted
disease (STD). Therefore, doctors usually prescribe a combination
of antibiotics, such as ceftriaxone and doxycycline or azithromycin.
Single-dose oral therapy is available. All sexual partners
of a person with gonorrhea should be tested and treated
if infected whether or not they have symptoms of infection.
Complications
The most common consequence of
untreated gonorrhea is PID, a serious infection of the female
reproductive organs that occurs in an estimated 1 million
American women each year. Gonococcal PID often appears immediately
after the menstrual period. PID can scar or damage cells
lining the fallopian tubes, resulting in infertility in
as many as 10 percent of women affected. If the tube is
only partially scarred, proper passage of the fertilized
egg into the uterus is prevented. If this happens, the egg
may implant in the tube; this is called ectopic or tubal
pregnancy and is life-threatening if not detected early.
Rarely, untreated gonorrhea can spread to the blood or the
joints.
An infected pregnant woman may
give the infection to her infant as the baby passes through
the birth canal during delivery. A doctor can prevent infection
of the eye, called ophthalmia neonatorum, by applying silver
nitrate or other medications to the baby’s eyes immediately
after birth. Because of the risks from gonococcal infection
to both mother and child, doctors recommend that a pregnant
woman have at least one test for gonorrhea.
Gonorrhea also increases the risk
of HIV infection (HIV, human immunodeficiency virus, causes
AIDS), so prevention and early treatment of gonorrhea is
critically important.
Prevention
By using male condoms correctly
and consistently during sexual activity, sexually active
people can reduce their risk of gonorrhea and its complications.
Research
Scientists supported by the National
Institute of Allergy and Infectious Diseases (NIAID) are
continuing to learn more about the organism that causes
gonorrhea and are working on better methods to prevent,
diagnose, and treat it. The dramatic rise of antibiotic-resistant
strains of the gonococcus underscores the need for a means
of preventing gonorrhea. Scientists have developed a laboratory
method to detect these resistant strains, which helps the
physician select an appropriate treatment.
An effective vaccine against gonorrhea
remains a key research priority for NIAID-supported scientists.
Determining the sequence of the bacterial genome is expected
to aid scientists in identifying new vaccine candidates.
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