Gonorrhea
Gonorrhea is a sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae that infects the inner lining of the urethra, cervix, rectum, and throat, or the membranes (conjunctivae) of the eyes.
While the rate of gonorrhea has declined by 75% since 1985, there were still 360,000 reported cases in the United States in 1999. Gonorrhea usually causes problems only at the site of infection, although the disease can spread through the bloodstream to other parts of the body, especially the skin and joints. In women, the disease may ascend the genital tract and infect the membranes inside the pelvis, causing pelvic pain and reproductive problems.
Symptoms
In men, the first symptoms usually appear 2 to 7 days after infection. Symptoms start with mild discomfort in the urethra, followed a few hours later by mild to severe pain during urination, discharge of pus from the penis, and a frequent and urgent need to urinate, which worsens as the disease spreads to the upper part of the urethra. The penile opening may become red and swollen.
Infected women often have no symptoms for weeks or months, and the disease may only be discovered after the woman's male partner is diagnosed and she is examined as a contact. If symptoms do occur, they usually appear 7 to 21 days after infection and are usually mild. However, some women have severe symptoms, such as a frequent need to urinate, pain while urinating, a discharge from the vagina, and fever. The cervix, uterus, fallopian tubes, ovaries, urethra, and rectum may be infected, causing tenderness or severe deep pelvic pain, especially during intercourse. Pus, which appears to come from the vagina, may be coming from the cervix, urethra, or glands near the vaginal opening.
Anal sex with an infected partner may result in gonorrhea of the rectum. The disease may cause discomfort around the anus and a discharge from the rectum. The area around the anus may become red and raw, and the stool may be coated with mucus and pus. When a doctor examines the rectum with a viewing tube (anoscope), mucus and pus may be visible on the wall of the rectum.
Oral sex with an infected partner may result in gonorrhea of the throat (gonococcal pharyngitis). Usually, the infection produces no symptoms, but sometimes it causes a sore throat and discomfort during swallowing.
If infected fluids come into contact with the eyes, gonococcal conjunctivitis may develop (see Section 20, Chapter 229), causing swelling of the eyelids and a discharge of pus from the eyes. A pregnant woman with gonorrhea can infect the eyes of her baby during birth. In adults, often only one eye is affected. Newborns usually have infection in both eyes. Blindness may result if the infection is not treated early.
Gonorrhea in infant and young girls is usually the result of sexual abuse by adults or teens. Symptoms may include irritation, redness, and swelling of the vulva, with a discharge of pus from the vagina. The girl may be sore in the vaginal area or have pain during urination. The rectum also may be inflamed. The underpants may be stained with discharge.
In some people, gonorrhea spreads through the bloodstream to one or more joints, causing them to become swollen, tender, and extremely painful and limiting movement. A bloodstream infection may also cause fever, a general feeling of illness, pain that moves from joint to joint, and the formation of red pus-filled spots on the skin (arthritis-dermatitis syndrome).
The interior of the heart may become infected (endocarditis). Infection of the covering of the liver (perihepatitis) causes pain in the upper right part of the abdomen similar to that of gallbladder disease. These infections are treatable and rarely fatal, but recovery from arthritis or endocarditis may be slow.
Diagnosis
A doctor can make a diagnosis almost immediately by identifying the bacterium (gonococcus) under a microscope. In more than 90% of infected men, this diagnosis can be made using a sample of discharge from the penis. The sample is usually obtained by passing a small swab a few centimeters into the urethra. Microscopic examination of a sample of the discharge from the cervix is less reliable; gonococci can be seen in only about 60% of infected women. The sample of discharge is also sent to the laboratory for culture, which is very reliable in both sexes but takes longer than a microscopic examination. If a doctor suspects an infection of the throat or rectum, samples from these areas are sent for culture.
Recently developed, highly sensitive methods for finding the DNA of the bacteria that cause gonorrhea and chlamydia allow laboratories to test for both infections in a single specimen. Because these tests can be performed on urine samples from both sexes, they are convenient for screening people who have no symptoms or who are unwilling to have urethral, rectal, or cervical specimens taken.
Because a person may have more than one STD, a doctor may take a sample of blood to determine whether the person also has syphilis or human immunodeficiency virus (HIV) infection.
Treatment
People with gonorrhea are usually given antibiotics to kill both Chlamydia and gonococci, because people with gonorrhea are often infected with Chlamydia at the same time. A single injection of ceftriaxone into a muscle or a single dose of cefixime, levofloxacin, ciprofloxacin, or ofloxacin by mouth is usually adequate to cure gonorrhea but a week-long course of another oral antibiotic (doxycycline or levofloxacin) is routinely given to cure chlamydia. Alternatively, a single large dose of azithromycin can be used to cure both infections. If gonorrhea has spread through the bloodstream, the person usually is treated in the hospital with intravenous antibiotics.
If symptoms recur or persist at the end of treatment, the doctor may obtain specimens for culture to make sure the person is cured. Symptoms of urethritis may recur in men (postgonococcal urethritis) and are most commonly caused by Chlamydia and other organisms that do not respond to treatment with ceftriaxone.
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