The ancient disease with modern treatments
Gonorrhea has plagued millions of people from the earliest times. But what was once known as a fatal disease is now fully curable with antibiotics and proper medical treatment.
A bacterial infection that is usually spread through sexual contact, gonorrhea affects the reproductive tissue in both men and women. Untreated, it can spread to the circulatory system and infect the heart, liver, joints, tendons, and other vital organs. Symptoms include burning and itching during urination, and a thick, yellowish fluid from the penis or vagina. But since women are less likely to show immediate symptoms than men, a doctor should check sexual partners if either has any of the signs of gonorrhea. Sometimes there are no symptoms so if you have been exposed to gonorrhea but see no signs of it, it is still critical to get tested.
While the number of people with gonorrhea has been dropping since 1975, more than 800,000 new cases of gonorrhea still occur every year in the United States. You can prevent gonorrhea by adopting safer-sex practices, such as regularly using latex condoms and refraining from oral and anal sex unless you're confident that your partner is not infected. Also, you should not share personal items such as douche equipment.
This sexually transmitted bacteria is passed between partners during oral, anal, or genital sexual contact. The bacteria thrive in the delicate, moist tissue found in the reproductive tract and genitals. They can also live in the throat, rectum, joints, or eyes.
Symptoms are generally easier to notice in men than in women. In men, the first symptoms usually appear two to seven days after infection. Mild discomfort in the urethra (which carries urine and semen through the penis) is followed in a few hours by mild to severe pain during urination and a flow of pus from the penis. Frequent, urgent needs to urinate gradually get stronger. The opening of the penis may become red and swollen.
In women, symptoms may first appear within seven to 21 days after infection. But weeks or months can pass with no sign of infection. Often doctors discover the disease in women only after diagnosing her male partner. The symptoms for women are usually mild, but they can become severe: pain during urination, frequent need to urinate, vaginal discharge, and fever. Women may notice pelvic pain and tenderness during intercourse because of infections in the cervix, uterus, fallopian tubes, ovaries, urethra, and rectum. The cervix, urethra, or glands near the vaginal opening may be the source of pus discharged from the vagina. A skin rash is another symptom.
While oral antibiotics such as penicillin and tetracycline used to be standard treatments for gonorrhea, some types of gonorrhea are now growing resistant to these drugs. To overcome this, doctors now prescribe for most people both an oral antibiotic and a potent injectable antibiotic, such as Rocephin (ceftriaxone). This combination will usually cure gonorrhea.
If you have symptoms of gonorrhea, it is critical that you abstain from sexual activity until you are tested and cured. If you are exposed to gonorrhea but don't have any symptoms, it is still vital that you get checked for the disease. Gonorrhea symptoms may take a while to become noticeable, but during that time the disease can progress and you can spread it to others. Because women often have no symptoms of a gonorrhea infection, it is especially important to know your sexual partner's history and to get checked if you see any signs of gonorrhea infection.
If you do not get treatment, the disease may cause pelvic inflammatory disease, which can infect internal reproductive organs and cause infertility; gonococcal arthritis; and infections of the heart, liver, tendons, joints and other vital organs.
If you have gonorrhea, you may also be infected with chlamydia, which is often difficult to detect. When you are tested for gonorrhea, your doctor should also check for chlamydia and potentially treat you on the assumption you have it, too.
How Common Is Gonorrhea?
Gonorrhea has reached epidemic proportions in the United States. Most new infections occur in people ages 18 to 30, but the disease may affect anyone who engages in sexual activity with an infected person. Infants are at high risk of being born with a severe eye infection (gonococcal conjunctivitis) if the mother is infected. Males and females are both affected, but symptoms are usually more noticeable in males.
Goals of Treatment
Since there are effective treatments currently available, the goals of treating gonorrhea are both to get rid of symptoms and to cure the infection.
Treatment usually includes oral antibiotics and an injection of an antibiotic called ceftriaxone. You may also have other sexually transmitted diseases (STDs), which may mean your treatment will be more complex. Also, if the gonorrhea has spread to other organs, treatment may include a regimen of intravenous antibiotics for three to 10 days. No matter how severe the infection, anyone exposed to gonorrhea should have a follow-up culture study four to seven days after finishing treatment to make sure the medication got rid of the infection.
Your treatment probably won't require a hospital stay you'll be treated in your doctor's office (usually by a gynecologist or family practitioner) and go home the same day. However, if complications arise you may need to stay in the hospital.
The following antibiotics are most commonly prescribed to treat gonorrhea and should always be taken with another antibiotic effective against chlamydia such as doxycycline or azithromycin:
While not an alternative to antibiotics, analgesics (acetaminophen or aspirin) can also be used to reduce fever or pain.
Considerations When Selecting Treatment
In the past, doctors used oral antibiotics as the solitary treatment for gonorrhea, an approach that cured infections quickly. But a growing problem exists with this form of treatment: certain strains of gonorrhea are developing a resistance to these drugs, lowering their effectiveness. Most doctors now also prescribe ceftriaxone, an injectable antibiotic.
Until your infection is cured, be sure to stop having sex. If you have been exposed to gonorrhea but don't have any symptoms, you should still refrain from all sexual activity until you and your partner have been thoroughly checked for the disease. A follow-up culture after completion of treatment will show if the infection is cured.
In most cases, gonococcus bacteria disappear after antibiotic treatment, but symptoms may come back. However, recurrent cases of gonorrhea are usually the result of re-infection, not treatment failure. Your doctor may need to take a culture to check whether the treatment worked.
If caught in time, gonorrhea can be cured without any permanent damage. The following complications can arise if the infection is left untreated:
- Pelvic inflammatory disease in females
- Infectious arthritis
- Infection of the interior of the heart (endocarditis)
- Infection of the covering of the liver (perihepatitis)
- Increased risk of HIV infection
Quality of Life
If you are diagnosed with gonorrhea, inform all sexual partners who may have been exposed to the disease so they can also be tested, both now and after you are both treated. Be sure to abstain from sex until the infection is fully cured. Your doctor is required to report your infection to the local health department.
If you're infected with gonorrhea during your pregnancy, your baby may become infected with the bacteria as he or she passes through the birth canal. This may cause swelling of both your baby's eyelids and discharge of pus from the eyes. All babies are treated at birth to prevent eye infections, and possible blindness. Doctors recommend that a pregnant woman have at least one test for gonorrhea before labor.
If you are nursing, check with your doctor before taking antibiotics. They could pass through your breast milk to your baby.
Considerations for Children and Adolescents
Genital infections in infants and young children may be a result of sexual abuse by adults. Any genital infection should be thoroughly examined by a doctor.
Teens will be treated for gonorhea, and also be taught about safer sex and STDs.
Considerations for Older People
Aging hampers the immune system, opening the way for infections such as gonorrhea. The characteristic signs and symptoms of gonorrhea may change or be absent in older people.
Last updated 24 May 2012
- The clap
- Gonococcal Infection
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. Aside from cases where the bacterium is transmitted to a newborn through its mother's birth canal, the majority of cases are due to oral, anal, or vaginal sexual contact with an infected partner.
Risk factors for becoming infected with gonorrhea include the following:
- Having unprotected sex
- Frequent sex
- High number of sexual partners (heterosexual or homosexual)
- Being a newborn of an infected mother
Symptoms & Diagnosis
The following are all signs and symptoms of gonorrhea:
- Burning and itching during urination
- Thick, yellowish discharge from penis or vagina
- Increased urinary frequency
- Pus in the urine (pyuria)
- Swelling or redness of urethral opening
- Vulvar itching, burning, or pain (in women)
- Vaginal swelling and redness (in women)
- Abnormal menstrual bleeding
- Abdominal pain
- Rectal burning, itching, or discharge; constant urge to move bowels
- Rectal redness and rawness
- Stool coated with mucus or pus
- Swelling of one of the eyelids (in adults) or both eyelids (in infants), and discharge of pus from the eyes
- Sore throat
- Discomfort when swallowing
- Joint pain
- A slight fever
- Pain or tenderness during sexual intercourse
Conditions That May Be Mistaken for Gonorrhea
The following conditions may have symptoms that resemble those of gonorrhea:
- Urethritis and other urinary tract infections
How Gonorrhea Is Diagnosed
Your doctor will take your medical history and physically examine you. Diagnosing gonorrhea is relatively simple: the doctor will take a sample of the discharge from the penis or cervix and either send it to a laboratory or observe it under a microscope to detect the bacteria. If none are found, the doctor will send a different sample to the lab for a culture.
Home remedies or folk medicine treatments generally do not work in treating gonorrhea. You should avoid these types of treatments if using them means that you are not seeking conventional medical care for the infection. Without proven treatment gonorrhea will get worse, and could lead to serious health complications.
Self care & Prevention
Preventing Genital Herpes
Abstaining from sex, and adopting safer-sex practices, are the surest ways you can prevent gonorrhea infections. You should consistently use a latex barrier like a condom during intercourse, even if you also use other forms of birth control. Avoid unprotected sex unless you know the full history and current state of your partner's sexual health.
Another way to prevent gonorrhea is to understand the less common ways in which it can be spread. You should never share personal items, like a douche or undergarments. Non-living, dry surfaces (such as bedding and clothing, eating utensils, and even toilet seats) can carry the bacteria for up to four hours from contact, though this is rare. Make every effort to avoid intimate contact with these types of surfaces if you suspect or are aware that they carry gonorrhea.
You should reduce the alcohol and caffeine you drink during treatment, because they can irritate the urethra, further complicating the symptoms and discomfort of gonorrhea.
Though you don't need to restrict most activity, you do need to stop sexual activity. If you continue to have sex, protect your partner from infection by using a latex barrier like a condom. Until a follow-up culture study from the doctor shows the infection is cured, any sexual activity may spread gonorrhea.