Gonorrhea is a common sexually transmitted infection (STI) that affects over 80 million adults each year around the globe. According to the Centers for Disease Control and Prevention (CDC), a total of 601,319 cases of gonorrhea were reported in 2023, making it the second most common nationally notifiable STI in the United States that year.
Despite being preventable and treatable, gonorrhea continues to be a significant public health concern, particularly with the rise of antibiotic resistance. Understanding gonorrhea's symptoms, effective treatment options, and prevention strategies is pertinent to reduce its spread and impact.
[signup]
What Is Gonorrhea?
Gonorrhea is an STI caused by the bacterium Neisseria gonorrhoeae. This bacterium primarily infects the mucous membranes of the body, such as those found in the urethra, cervix, anus, and throat. It can be spread through vaginal, anal, or oral sex with an infected person.
Gonorrhea can also be passed from an infected mother to her baby during childbirth, leading to potential complications like neonatal eye infections.
Prevalence and Statistics
Neisseria gonorrhoeae is the second most common cause of bacterial STIs worldwide, with an estimated 86.9 million new infections occurring annually among adults. Between 2015 and 2019, reported gonococcal infections increased by 53%. However, as many infections may go unreported or undiagnosed, the actual number of cases could be even higher than what is officially recorded.
The prevalence of gonorrhea is highest among certain populations due to higher exposure risk factors. These groups include:
- Men who have sex with men
- Sex workers
- Transgender women and adolescents
- Young people (15-24 years of age) in high-burden countries
Symptoms and Diagnosis
Gonorrhea often doesn't cause symptoms, especially in women. If the infection does cause symptoms, they usually differ based on whether you have a vagina or penis and the location of the infection.
Female Symptoms
In women, Neisseria gonorrhoeae may infect the endocervix, Bortholin glands, Skene ducts, vagina, rectum, or throat. Cervicitis (inflammation of the cervix) is the most common clinical presentation of gonorrhea in women.
More than 95% of women with gonorrhea have no symptoms. When symptoms occur, they are usually mild and include:
- White or yellow vaginal discharge
- Pain with sex
- Abnormal uterine bleeding
- Lower abdominal or pelvic pain
- Pain with urination
- Sore throat
- Swollen lymph nodes
- Anal itching and discharge
Untreated gonorrhea can cause pelvic inflammatory disease (PID), an ascending infection of the female reproductive tract. PID symptoms and complications may include:
- Acute or chronic pelvic pain
- Fever
- Cervical or vaginal discharge
- Nausea and vomiting
- Pain with sex
- Irregular periods
- Painful urination
- Ectopic pregnancy
- Infertility
- Fallopian tube and ovarian abscess
Male Symptoms
Men with gonorrhea typically present with symptoms 2-5 days after exposure to infection. However, about 10% of urethral infections in men may be asymptomatic.
Typical symptoms of gonorrhea in men include:
- Painful urination
- White, yellow, or green penile discharge
- Testicular pain and swelling
- Sore throat
- Swollen lymph nodes
- Anal itching and discharge
Symptoms in Newborns
Babies born to mothers with untreated gonococcal infections can become infected through exposure to cervical secretions during delivery.
Gonococcal conjunctivitis, an eye infection, is the most common manifestation of infection in newborns. Symptoms will typically present within the first 2-5 days of life:
- Redness and inflammation of the conjunctiva (the clear membrane that covers the white of the eye and the inside of the eyelid)
- Thick, pus-like discharge from the eyes
- Swollen eyelids
- Swollen lymph nodes in front of the ears
- Pain when the eyes are touched
Left untreated, gonococcal conjunctivitis can cause tearing in the eye's outer layer and permanent blindness.
Other symptoms and complications of gonococcal infections in newborns include:
- Sepsis (whole-body inflammation triggered by an infection)
- Meningitis (inflammation of the membranes that cover the brain and spinal cord)
- Arthritis (inflammation of the joints)
- Pharyngitis (inflammation of the throat)
- Vaginitis (inflammation of the vagina)
- Urethritis (inflammation of the urethra)
- Pneumonia
- Scalp or skin infections
Diagnostic Methods
Gonorrhea can be diagnosed using culture or nucleic acid amplification testing (NAAT).
Doctors will use one of two methods to collect a sample for testing:
- Urine test (in men)
- Swab test (either patient- or clinician-collected)
The CDC recommends NAAT over culture due to its higher sensitivity, faster results, and the smaller sample size required.
However, culture remains the preferred method for diagnosing pharyngeal, rectal, and conjunctival infections and when antibiotic resistance testing is necessary.
All people who have been diagnosed with gonorrhea should receive comprehensive STI testing, including:
- Chlamydia
- Syphilis
- HIV
Treatment Options
Anyone diagnosed with gonorrhea should be treated immediately with antibiotic therapy.
The CDC recommends the following treatment for uncomplicated (urethral, cervical, or rectal) gonococcal infections:
- Ceftriaxone 500 mg intramuscularly as a single dose for patients weighing less than 150 kg
- Ceftriaxone 1 g intramuscularly as a single dose for patients weighing at least 150 kg
If ceftriaxone is not an option, alternative options include:
- Gentamicin 240 mg intramuscularly as a single dose plus azithromycin 2 g orally as a single dose
- Cefixime 800 mg orally as a single dose
If chlamydia coinfection has not been excluded, antibiotic combination therapy is recommended:
- Nonpregnant Patients: add doxycycline 100 mg orally twice daily for seven days
- Pregnant Patients: add azithromycin 1 g orally as a single dose
Sexual Activity
To prevent disease transmission, patients should abstain from all sexual activity until they have completed their prescribed antibiotic regimen. Additionally, sexual partners should be tested and treated, and patients should wait at least seven days after treatment before resuming sexual activity.
Treating Sexual Partners
Treating gonorrhea involves treating not only the infected individual but also referring sexual partners for evaluation and treatment:
- Individuals who have had sexual contact with the infected patient within the last 60 days should be referred for evaluation, testing, and treatment.
- If the patient's last sexual encounter was more than 60 days before symptom onset or diagnosis, only the most recent sex partner should be evaluated.
If sexual partners are unwilling or unlikely to seek timely treatment, doctors may provide prescriptions for their patients to deliver to their sexual partners without examining them. This practice, called expedited partner therapy (EPT), is a public health strategy designed to reduce persistent and recurrent infections.
Prevention Strategies
Abstaining from vaginal, anal, and oral sex is the only way to prevent STIs completely.
Sexually active people can reduce their risk of getting gonorrhea by:
- Male condoms are more than 90% effective at preventing the spread of gonorrhea when used correctly and consistently during any type of sexual contact
- Limit your number of sexual partners
- Be in a mutually monogamous relationship
- Don't have sex with a partner who has STI symptoms
Regular screening also helps prevent STIs. Annual gonorrhea testing is recommended for:
- All sexually active women younger than 25
- Women 25 years and older with risk factors. This includes having new sex partners, multiple sex partners, or a partner who has an STI.
- Sexually active men who have sex with men
The US Preventive Services Task Force (USPSTF) recommends high-intensity behavioral counseling for all sexually active adolescents and adults at high risk of STIs. High-intensity behavioral counseling consists of multiple counseling sessions in a clinical setting and is associated with:
- Increased adherence to STI treatment in females
- Increased contraceptive use in adolescent males
- Decreased nonsexual risky behavior and pregnancy
Living with Gonorrhea
The emotional and psychological toll of gonorrhea extends far beyond the physical symptoms. Feelings of shame, stigma, and anxiety can interfere with relationships, social activities, and overall mental health.
Individuals who experience higher levels of stigma are also less likely to seek testing or treatment, which can delay diagnosis, worsen the severity of infection, and hinder proactive health behaviors like notifying sexual partners and receiving regular testing.
Coping Strategies
- Problem-Focused Coping: Engaging in problem-focused coping strategies, such as seeking information and taking proactive steps to manage the infection, has been associated with more consistent condom use and better psychological outcomes.
- Counseling and Support Groups: Access to counseling and support groups can help individuals process their emotions and has been linked to reduced reinfection rates. Education and Awareness: Increasing awareness and education about sexual health and STIs can help reduce stigma and encourage health-seeking behaviors.
- Shame-Sensitive Practice: Healthcare providers should adopt a shame-sensitive approach, which can improve patient interactions and reduce the negative emotional impact of a diagnosis.
Future Directions and Research
Antimicrobial resistance is a growing concern that necessitates ongoing surveillance and the development of new strategies to effectively prevent and treat gonorrhea.
Overcoming Antibiotic Resistance
Research initiatives are focusing on understanding the mechanisms of antimicrobial resistance in Neisseria gonorrhoeae, using techniques like whole genome sequencing and bioinformatics to identify mutations associated with resistance. Additionally, efforts are being made to develop rapid molecular assays to predict resistance, which could guide more effective treatment strategies.
International surveillance programs tracking the emergence and spread of resistant bacterial strains will continue to shape current and future treatment guidelines and promote responsible antimicrobial use and stewardship.
Advances in Treatment
Advances in gonorrhea treatment are focused on addressing rising antimicrobial resistance. The global trends in reduced susceptibility to first-line antibiotics like ceftriaxone and azithromycin highlight the need for novel antibiotics, alternative therapies, and the development of effective vaccines.
[signup]
Key Takeaways
- Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae.
- The rising rates of gonorrhea infections are driven by factors such as asymptomatic cases, where individuals may unknowingly spread the bacteria, and the growing issue of antimicrobial resistance, which makes treatment more challenging.
- Current treatment for gonorrhea involves antibiotic therapy for both the infected individuals and their sexual partners, alongside the practice of safe sex to prevent further transmission.
- There is a critical need for continued research into novel antibiotics and preventive therapies to address antimicrobial resistance.
- To prevent STIs, individuals must remain proactive about their sexual health by scheduling regular screenings and consistently practicing safe sex. Taking these steps not only helps in preventing gonorrhea but also reduces the risk of its spread and the development of resistance to current treatments.
%201.svg){kind=logo}
