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Definition

Gonorrhea is a highly contagious sexually transmitted disease that is caused by the bacterium Neisseria gonorrhoeae. The mucous membranes of the genital region may become inflamed without the development of any other symptoms. When symptoms do occur, they are different in men and women. In men, gonorrhea usually begins as an infection of the vessel that carries urine and sperm (urethra). In women, it will most likely infect the narrow part of the uterus (cervix). If untreated, gonorrhea can result in serious medical complications.

Description

Gonorrhea is commonly referred to as "the clap." The incidence of gonorrhea has steadily declined since the 1980s, largely due to increased public awareness campaigns and the risk of contracting other sexually transmitted diseases, such as AIDS. Still, current estimates range from 400,000 to as many as one million projected cases of gonorrhea in the United States each year. These estimates vary due to the private nature of the disease and the consequent underreporting that occurs. The majority of reported cases of gonorrhea come from public health clinics.

The disease affects people of all ages, races, and socioeconomic levels, but some individuals are more at-risk than others. Adolescents and young adults are the highest risk group, with more than 80% of the reported cases each year occurring in the 15-29 age group. Those individuals with multiple sexual partners and who use no barrier contraception, such as condoms, are most at-risk. Reported rates vary among racial and ethnic groups.

The risk factors for gonorrhea are not unlike those for all sexually transmitted diseases. Both men and women can become infected through a variety of sexual contact behaviors, including oral, anal, or vaginal intercourse. The disease is transmitted very efficiently. In fact, women run a 60-90% chance of contracting the disease after just one sexual encounter with an infected male. The disease can also be transmitted from an infected mother to her infant during delivery.

Causes and symptoms

If treated early, gonorrhea can be cured. Unfortunately, many individuals with gonorrhea, particularly women, will experience no symptoms to alert them to the possibility that they have contracted gonorrhea, and therefore, many do not seek treatment. When present, the symptoms and complications of gonorrhea are primarily limited to the genital, urinary, and gastrointestinal systems and usually begin between one day and two weeks following infection. If left untreated, serious complications can result if the disease spreads to the bloodstream and infects the brain, heart valves, and joints. Untreated gonorrhea can also result in severe damage to the reproductive system, making an individual unable to conceive a child (sterile).

Symptoms of gonorrhea in women

As many as 80% of women with gonorrhea show no symptoms. If present, symptoms may include the following:

• Bleeding between menstrual periods
• Chronic abdominal pain
• Painful urination
• Vaginal discharge, often cloudy and yellow
• In the case of oral infection, there may be no symptoms or only a sore throat
• Anal infection may cause rectal itching or discharge.

Because women often do not show any symptoms, complications are more likely to occur as the disease progresses. The most common complication is pelvic inflammatory disease (PID). PID can occur in up to 40% of women with gonorrhea and may result in damage to the fallopian tubes, a pregnancy developing outside the uterus (ectopic pregnancy), or sterility. If an infected woman is pregnant, gonorrhea can be passed on to her newborn through the birth canal during delivery. These infants may experience eye infections that could lead to blindness.

Symptoms of gonorrhea in men

Men are more likely to experience the following symptoms:

• Thick and cloudy discharge from the penis
• Burning or pain during urination
• More frequent urination
• In the case of oral infection, there may be no symptoms or only a sore throat.
• Anal infection may cause rectal itching or discharge.

In men, complications can affect the prostate, testicles, and surrounding glands. Inflammation, tissue death and pus formation (abscesses), and scarring can occur and result in sterility.

Diagnosis

The diagnosis of gonorrhea can be made at a public health clinic or a family physician office. First, the doctor will discuss symptoms and the patient's known contact or at-risk behavior. There are three methods available to test for the presence of Neisseria gonorrhoeae. These include a culture, a Gram stain, and an ELISA test. Culture of secretions from the infected area is the preferred method for gonorrhea screening in patients with or without symptoms. A cotton swab can be used to collect enough sample for a culture. The sample is incubated for up to two days, providing enough time for the bacteria to multiply and be accurately identified. This test is nearly 100% accurate.

Gram stains are more accurate in the diagnosis of gonorrhea in men than in women. To perform this test, a small amount of discharge from the infected area will be placed on a slide, stained with a special dye, and examined under a microscope for the presence of the gonococcus bacteria. The advantage to this test is that results can be obtained very quickly at the initial visit. Because it requires that the physician or technician to be able to recognize and accurately identify the bacteria simply by looking at it under a microscope, however, this test is only approximately 70% accurate. As a result, one of the other methods will also probably be used to confirm the diagnosis.

ELISA, or enzyme-linked immunosorbent assay, has emerged as a rapid and sensitive test for gonorrhea. It is much more sensitive than the gram stain and is more convenient than the culture test, which involves the transport and storage of samples. As of late 1997, several other diagnostic tests were being researched with the goal of providing a cost-effective method of screening for a variety of sexually transmitted diseases. One of the most interesting of these is a home test that can be taken by the patient themselves, allowing for a degree of privacy and confidentiality.

When a patient suspects exposure to or experiences symptoms of gonorrhea, he or she may see a public health provider or family practice physician. Physicians trained in obstetrics or gynecology may also be involved, particularly if gynecological complications occur. Men who experience complications may be referred to a urologist. There are also infectious disease doctors who specialize in the treatment and research of all infectious diseases, including those transmitted sexually. All doctors must report this highly contagious disease to public health officials, and patients are asked to provide the names of sex partners during the suspected period of infection so that they can be notified of the risk.

Treatment

Gonorrhea has become more difficult and expensive to treat since the 1970s, due to the increased resistance of gonorrhea to certain antibiotics. In fact, according to projections from the Centers for Disease Control and Prevention, 30% of the strains of gonorrhea were resistant to routine antibiotics in 1994, and resistance has been increasing steadily. The following antibiotics may be given orally or by injection:

• Ciprofloxacin (Cipro)
• Ofloxacin (Floxin)
• Azithromycin (Zithromax)
• Amoxicillin
• Doxycycline (Doxy)
• Ceftriaxone (Rocephin).

If the patient is allergic to penicillin (or pregnant), erythromycin may be substituted. The most important consideration is to make sure that all of the prescribed medication is taken. If a course of antibiotics is not completed, the medication will only kill those organisms that are susceptible to the antibiotic, allowing those that are resistant to the effects of that particular antibiotic to multiply and possibly cause a new infection that will be more difficult to treat. Patients should refrain from sexual intercourse until treatment is complete and return for follow-up testing. Since another sexually transmitted disease, called chlamydia, often occurs with gonorrhea, patients may be treated for both infections. Any sexual partners during the time of infection, even if those partners do not show symptoms, should be notified and treated when any sexually transmitted disease is involved.

Alternative treatment

Although there is no known alternative to antibiotics in the treatment of gonorrhea, there are herbs and minerals that may be used to supplement antibiotic treatment:

• Lactobacillus acidophilus or live-culture yogurts are helpful, while taking antibiotics, to replenish gastrointestinal flora.
• The following supplements may be used to improve the body's immune function: zinc, multivitamins and mineral complexes, vitamin C, and garlic (Allium sativum).
• Several herbs may reduce some symptoms or help speed healing: kelp has balanced vitamins and minerals. Calendula (Calendula officinalis), myrrh (Commiphora molmol), and thuja (Thuja occidentalis) may help reduce discharge and inflammation when used as a tea or douche.
• Hot baths may also help reduce pain and inflammation.
• A variety of herbs may help with symptoms of the reproductive and urinary systems.
• If a physician approves, fasting, combined with certain juices, may help cleanse the urinary and gastrointestinal systems.
• There may be acupressure and acupuncture points that will help with system cleansing. These exact pressure points can be provided and treated by an acupressurist or acupuncturist.

Prognosis

The prognosis for patients with gonorrhea varies based on how early the disease is detected and treated. If treated early and properly, patients can be entirely cured of the disease. Up to 40% of female patients who are not treated early may develop pelvic inflammatory disease (PID) and the possibility of resulting sterility. Although the risk of infertility is higher in women than in men, men may also become sterile if the urethra becomes inflamed (urethritis) as a result of an untreated gonorrhea infection. Following an episode of PID, a woman is 6-10 times more likely, should a pregnancy occur, to have a pregnancy develop outside the uterus (ectopic pregnancy), which can result in death. Liver infection may also occur in untreated women. In approximately 2% of patients with untreated gonorrhea, the gonococcal infection may spread throughout the body and can cause fever, arthritis-like joint pain, and skin lesions.

Prevention

Currently, there is no vaccine for gonorrhea, but several are under development. The best prevention is to abstain from having sex or to engage in sex only when in a mutually monogamous relationship in which both partners have been tested for gonorrhea, AIDS, and other sexually transmitted diseases. The next line of defense is the use of condoms, which have been shown to be highly effective in preventing disease (and unwanted pregnancies). To be 100% effective, condoms must be used properly. A female birth-control device that blocks the entry of sperm into the cervix (diaphragm) can also reduce the risk of infection. The risk of contracting gonorrhea increases with the number of sexual partners. Any man or woman who has sexual contact with more than one partner is advised to be tested regularly for gonorrhea and other sexually transmitted diseases.

Key Terms

Cervix

The narrow part or neck of the uterus.

Chlamydia

The most common bacterial sexually transmitted disease in the United States that often accompanies gonorrhea and is known for its lack of evident symptoms in the majority of women.

Ectopic pregnancy

A pregnancy that occurs outside the uterus, such as in the fallopian tubes. Although the fetus will not survive, in some cases, ectopic pregnancy can also result in the death of the mother.

ELISA

Enzyme-linked immunosorbent assay. This test has been used a screening test for AIDS for many years and has also been used to detect gonorrhea bacteria.

HIV

Human immunodeficiency virus, the virus that causes AIDS. The risk of acquiring AIDS is increased by the presence of gonorrhea or other sexually transmitted diseases.

The bacterium that causes gonorrhea. It cannot survive for any length of time outside the human body.

Pelvic inflammatory disease (PID)

An infection of the upper genital tract that is the most serious threat to a woman's ability to reproduce. At least 25% of women who contract the disease, which can be a complication of gonorrhea, will experience long-term consequences such as infertility or ectopic pregnancy.

Sexually transmitted diseases (STDs)

A group of diseases which are transmitted by sexual contact. In addition to gonorrhea, this groups generally includes chlamydia, HIV (AIDS), herpes, syphilis, and genital warts.

Sterile

Unable to conceive a child.

Urethra

The canal leading from the bladder, and in men, also a path for sperm fluid.

Urethritis

Inflammation of the urethra.

Further Reading

For Your Information

Books

• Balch, James F. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing Group, 1997.
• Committee on Prevention and Control of Sexually Transmitted Diseases. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Edited by Thomas R. England and William T. Butler. Washington, DC: National Academy Press, 1997.
• Ross, Linda A. Sexually Transmitted Diseases Sourcebook: Basic Information About Herpes, Chlamydia, Gonorrhea, Hepatitis, Nongonococcal Urethritis, Pelvic Inflammatory Disease, Syphilis, AIDS , and More, Along with Current Data on Treatments and Preventions. Detroit, MI: Omnigraphics, 1997.

  Periodicals

• Centers for Disease Control and Prevention. "Gonorrhea Among Men Who Have Sex With Men: Selected Sexually Transmitted Diseases Clinics, 1993-1996." Journal of the American Medical Association, 278 (October 15, 1997): 1228-1229.
• Newland, Jamesetta A. "Gonorrhea in Women." American Journal of Nursing, 97 (August 1997): 16AA.
• Newland, Jamesetta A. "Urethritis in Men." American Journal of Nursing, 97 (August 1997): 16BB.
• "Tips from Other Journals: Trends in Antibiotic Resistance of Gonorrhea." American Family Physician, 56 (October 1, 1997): 5.

  Organizations

• American Foundation for the Prevention of Venereal Disease, Inc. 799 Broadway, Suite 638, New York, NY 10003. (212) 759-2069.
• American Social Health Association. P.O. Box 13827, Research Triangle Park, NC 27709. (800) 227-8922 (National STD Hotline) or voice line at (919) 361-8400. http://sunsite.unc.edu/ASHA/.
• National Center for HIV, STD, and TB Prevention. Centers for Disease Control and Prevention, 1600 Clifton NE, Atlanta, GA 30333. http://www.cdc.gov/nchstp/od/nchstp.html. NCHST@cpsod1.em.cdc.gov.
• National Institute of Allergy and Infectious Diseases. National Institutes of Health, Bethesda, MD 20892.

Gale Encyclopedia of Medicine. Gale Research, 1999.