Gonorrhea Overview

Gonorrhea is one of the most commonly occurring STDs. It affects the mucous membranes of the urethra, cervix, rectum, mouth, throat, and eyes. Both men and women may carry the disease without experiencing symptoms. Gonorrhea frequently occurs with chlamydia/nongonococcal urethritis (NGU).

Incidence and Prevalence of Gonorrhea

According to the Centers for Disease Control and Prevention (CDC), approximately 335,000 cases of gonorrhea were reported in the United States in 2012. This rate indicates about 50 percent infections because as many as one-half of cases are unreported.

Incidence of gonorrhea in the United States declined by 2.9 percent from 2008 to 2012, but increased 4.1 percent in 2011–2012.

About 75 percent of cases occur in people between the ages of 15 and 29. The highest incidence is among women aged 15–19 and men aged 20–24. Depressed socioeconomic areas typically have the highest incidence, particularly where illicit drug use and prostitution are common. Gonorrhea occurs more frequently in men who have sex with men than in heterosexual men.

Causes and Risk Factors for Gonorrhea

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which enters the body and multiplies rapidly. It is usually transmitted by direct contact with an infected person during vaginal, anal, or oral sex, or during birth. Oral sex is probably the least common mode of transmission. Infected pregnant women can pass the disease to newborns (called vertical transmission), where it can cause conjunctivitis and blindness due to corneal scarring.

Signs and Symptoms of Gonorrhea

Symptoms may appear within 5 to 21 days, usually earlier in men than in women. In men, inflammation of the urethra (urethritis), yellow or green discharge with pus, painful urination, and burning and itching are common symptoms. The opening at end of penis (meatus) may become reddened and inflamed. As infection travels up the urethra, frequency and urgency of urination develops.

In women, symptoms may be mild at first and often go unnoticed until sudden and severe onset. Inflammation and reddening of the cervix is common and bleeding between menstrual periods may occur. Urethritis causes painful, frequent urination and thick, yellow discharge. In later stages, the ducts and glands in the genital region and the rectum are affected.

In children who contract gonorrhea through vertical transmission, genital irritation and inflammation occurs and may be accompanied by a discharge.

Gonorrhea Complications

Untreated gonorrhea may cause:

  • abdominal pain
  • vomiting, fever
  • sore throat (pharyngitis)
  • arthritis
  • skin lesions
  • discharge from the eyes

Anal and rectal itching, anal discharge, painful bowel movements, and painful anal sex also may occur. Gonorrhea can affect the prostate and testicles in men. In women, gonorrhea can cause pelvic inflammatory disease (PID), which may lead to infertility, and tubal (ectopic) pregnancy.

Longstanding untreated infections can enter the bloodstream (bacteriuria) and affect the joints (gonococcal arthritis), heart, and brain, though this is rare. A hallmark of gonorrhea is the recurrence of infection.

Gonorrhea Diagnosis

Gonorrhea is diagnosed by observing symptoms and by taking a thorough history of sexual activity. In men, a sample of the discharge is cultured and examined microscopically to confirm the presence of the bacteria (gonococci); infection can usually be diagnosed immediately. In women, a sample of the discharge is usually taken from the cervix, and the culture may require incubation for 2 days before an accurate diagnosis can be made.

Treatment for Gonorrhea

Gonorrhea is resistant to penicillin, ampicillin, and amoxicillin. In some countries, gonorrhea is resistant to the antibiotics that cure strains found in the United States.

Medications that effectively treat uncomplicated gonorrhea include cefixime, ceftriaxone, spectinomycin, and ofloxacin. Ceftriaxone is usually injected intramuscularly in a single dose. Side effects include nausea, rash headache, itching, and pain and redness at the injection site.

Because >NGU or chlamydia occurs simultaneously with gonorrhea in up to one-half of infected patients, ceftriaxone is often given and oral tetracycline, doxycycline, minocycline, or erythromycin prescribed. These oral medications are typically taken for 7 to 10 days. Side effects include nausea, mild abdominal pain, and diarrhea. Pregnant women should consult their physician before taking these drugs. A follow-up examination is recommended 3 to 5 days after completing treatment.

Infants are routinely given an antibacterial antibiotic immediately after birth to treat possible infection and thus prevent blindness.

Publication Review By: Stanley J. Swierzewski, III, M.D.


Last Modified: 17 Sep 2015