Gonorrhea

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 testsare 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.

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.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.