What is Gonorrhea?

Gonorrhea is a curable sexually transmitted disease (STD) caused by a bacterium called Neisseria gonorrhoeae. These bacteria can infect the genital tract, the mouth, and the rectum. In women, the opening (cervix) to the womb (uterus) from the birth canal is the first place of infection. The disease however can spread into the womb and fallopian tubes, resulting in pelvic inflammatory disease (PID). PID affects more than 1 million women in this country every year and can cause infertility in as many as 10 percent of infected women and tubal (ectopic) pregnancy.

In 1997, health care workers reported 324,901 cases of gonorrhea in the United States 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. Health economists estimate that the annual cost of gonorrhea and its complications is close to $1.1 billion.

Gonorrhea is spread during sexual intercourse - vaginal, oral, and anal. People who practice anal intercourse can get gonorrhea of the rectum. Even women who do not engage in anal intercourse can get gonorrhea of the rectum if the bacteria are spread from the vaginal area.

Infected women can pass gonorrhea to their newborn infants during delivery, causing eye infections in their babies. This complication is rare because newborn babies receive eye medicine to prevent infection. When the infection occurs in the genital tract, mouth, or rectum of a child, it is due most commonly to sexual abuse.

The early symptoms of gonorrhea often are mild. Symptoms usually appear within two to 10 days after sexual contact with an infected partner. A small number of people may be infected for several months without showing symptoms.

When women have symptoms, the first ones include:

• bleeding associated with vaginal intercourse
• a painful or burning sensation when urinating
• and/or vaginal discharge that is yellow or bloody

More advanced symptoms, which indicate development of PID, include cramps and pain, bleeding between menstrual periods, vomiting, or fever.

Men have symptoms more often than women. Symptoms include:

• pus from the penis and pain, or
• a burning sensation during urination that may be severe.

Symptoms of rectal infection include discharge, anal itching, and occasional painful bowel movements with fresh blood on the feces.

Doctors usually prescribe a single dose of one of the following antibiotics to treat gonorrhea:

• Ceftriaxone
• Cefixime
• Ciprofloxacin
• Ofloxacin
• Gatifloxacin

If you have gonorrhea and are pregnant or are younger than 18 years old, you should not take ciprofloxacin or ofloxacin. Your doctor can prescribe the best and safest antibiotic for you.

Gonorrhea and chlamydial infection, another common STD, often infect people at the same time. Therefore, doctors usually prescribe a combination of antibiotics, such as ceftriaxone and doxycycline or azithromycin, which will treat both diseases.

If you have gonorrhea, all of your sexual partners should get tested and then treated if infected, whether or not they have symptoms of infection.

In untreated gonorrhea infections, the bacteria can spread up into the reproductive tract, or more rarely, can spread through the blood stream and infect the joints, heart valves, or the brain. The most common result of untreated gonorrhea is PID, a serious infection of the female reproductive organs. Gonococcal PID often appears immediately after the menstrual period. PID causes scar tissue to form in the fallopian tubes. If the tube is only partially scarred, the fertilized egg cannot pass into the uterus. If this happens, the embryo may implant in the tube causing a tubal pregnancy. This serious complication results in a miscarriage and can cause death of the mother. Rarely, untreated gonorrhea can spread through the blood to the joints. If you are infected with gonorrhea, your risk of getting HIV infection increases (HIV, human immunodeficiency virus, causes AIDS). Therefore, it is extremely important for you to either prevent yourself from getting gonorrhea or get treated early if you already are infected with it.

If you are pregnant and have gonorrhea, you may give the infection to your baby as it passes through the birth canal during delivery. A doctor can prevent infection of your baby's eyes by applying silver nitrate or other medications to the eyes immediately after birth. Because of the risks from gonococcal infection to both you and your baby, doctors recommend that pregnant women have at least one test for gonorrhea during pregnancy.

By using male latex condoms correctly and consistently during vaginal or rectal sexual activity, you can reduce your risk of getting gonorrhea and its complications.

Scientists supported by the National Institute of Allergy and Infectious Diseases (NIAID) are continuing to learn more about the bacterium that causes gonorrhea and are working on better methods to prevent, diagnose, and treat the disease. The dramatic rise of antibiotic-resistant strains of the gonococcus bacterium emphasizes the need for an effective means of preventing gonorrhea. Scientists have developed a laboratory method to detect these resistant strains, which helps the doctor select an appropriate treatment.

Developing topical microbicides (preparations that can be inserted into the vagina to prevent infection) and an effective vaccine against gonorrhea remain key research priorities for NIAID-supported scientists.