September 12, 2011

Gonorrhea refers to infection caused by Neisseria gonorrhoeae, a bacterium that grows in the reproductive tract and moist mucous membranes, such as the mouth, throat, and anus. Gonorrhea is transmitted through sexual contact. Once a person is exposed to gonorrhea, symptoms may appear in several days, or may take up to 1 month. Symptoms of gonorrhea may vary greatly from person to person. Many women are asymptomatic. An abnormal vaginal discharge, burning upon urination, and occasionally pelvic pain may be the initial symptoms of gonorrhea infection. Men infected with gonorrhea, however, often note burning upon urination or a yellow-white discharge from the penis. Gonorrhea more often produces a purulent discharge from the cervix, compared to other sexually transmitted diseases such as chlamydia.

The diagnosis of gonorrhea is made by sampling the infected area, the cervix, urethra, rectum, or throat. Once gonorrhea is diagnosed, tests for other sexually transmitted diseases, including chlamydia, syphilis, and HIV, should be performed. Because gonorrhea and chlamydia have similar symptoms and may be transmitted together, it is appropriate to treat for both infections if one is diagnosed.

Untreated gonorrhea may cause serious morbidity. Gonorrhea may become a life-threatening, bloodborne infection and may spread to the joints producing septic arthritis. Gonorrhea is the leading cause of septic arthritis in young, sexually active adults. Usually only one or two joints are involved, and the joint infection may be accompanied by local inflammation of the tendons (tenosynovitis). Tenosynovitis due to N. gonorrhoeae can occur without joint involvement. The diagnosis of septic arthritis due to N. gonorrhoeae is made by aspirating the affected joint and finding characteristic changes in the synovial fluid. N. gonorrhoeae can be difficult to isolate from synovial fluid and a negative culture does not rule out the diagnosis.

Pregnant women with gonorrhea may pass it on to their fetus at the time of birth, causing newborn blindness or a bloodborne infection. Gonorrhea can cause pelvic inflammatory disease (PID) that can require hospitalization for intravenous antibiotics. Even a single episode of PID can significantly reduce a woman’s fertility. PID may be further complicated by formation of a tubo-ovarian abscess. Treatment of tubo-ovarian abscess may require prolonged hospitalization or surgery. Chronic pelvic pain is a long-term complication of gonorrhea and may require prolonged pain management or surgery. Infertility and ectopic pregnancy are also serious possible complications of gonorrhea. Ectopic pregnancy may be life threatening.

A single dose of antibiotic will treat uncomplicated N. gonorrhoeae cervicitis or urethritis. Ceftriaxone 125 mg given intramuscularly is the standard therapy; singledose oral therapy with quinolone antibiotics is also successful, but there is growing resistance of N. gonorrhoeae to this class of antibiotics worldwide. Therapy of septic arthritis or tubo-ovarian abscess requires a longer course of antibiotics. Reliably utilizing latex condoms and avoiding contact with partners who are infected may prevent gonorrhea.

SEE ALSO: Chlamydia, Herpes simplex virus, Human papillomavirus, Pelvic pain, Sexually transmitted diseases, Syphilis

Suggested Reading

  • Gripshover, B., & Valdez, H. (2002). Common sexually transmitted diseases. In J. S. Tan (Ed.), Experts guide to the management of common infectious diseases (pp. 271—303). Philadelphia: American College of Physicians.

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