Gonorrhea – Causes, Signs and symptoms

Gonorrhea in Women

Also called: Clap, Neisseria Gonorrhoeae Infection, Gonococcal Infections

Reviewed By:
Timothy Yarboro, M.D.

Summary

Gonorrhea, also known as “the clap,” is an extremely contagious sexually transmitted disease. It is the second most reported infectious disease in the United States (after chlamydia), according to the Centers for Disease Control and Prevention (CDC).

The gonorrhea bacteria gain access to the body through body fluids associated with sexual activity. Transmission can occur during any kind of sexual contact – vaginal, oral or anal. In men, gonorrhea infects the urethra, which is the tube that leads to the bladder. In women, the disease usually first infects the opening of the uterus (cervix) or the urethra.

Women are rarely symptomatic but, when they are, symptoms usually include abnormal vaginal discharge (possibly bloody) or pain while urinating. The symptoms for men may include discharge from the penis and a burning sensation during urination. Gonorrhea infection in the anal area may be caused by anal sex or contamination by bacteria from the genitals. Oral sex may cause gonorrhea of the throat.

If gonorrhea is left untreated, it can spread to other organs. In women, gonorrhea may spread into the upper reproductive organs, such as the uterus, fallopian tubes and ovaries. Inflammation at those sites can cause pelvic inflammatory disease (PID). In men, one of the most common complications is epididymitis, a condition that causes painful swelling of the scrotum. In rare cases, untreated gonorrhea may spread to other systems in the body and infect the heart, brain or joints.

Nonsexual transmission of gonorrhea may also occur. A pregnant woman with gonorrhea can transmit it to her infant during childbirth, frequently causing eye infections. In addition, an infected person can transmit the bacteria from their original infection site by touching that area and then touching another susceptible body part, such as the eyes.

Sexually active young people are at greatest risk for gonorrhea. More than three-fourths of the cases reported to the CDC occur in sexually active people under age 30. People who have unprotected sex, have multiple sexual partners or have sexual partners who have multiple sexual partners are most likely to contract gonorrhea.

Gonorrhea can be diagnosed with several tests such as a urine test that detects the bacterium’s genes, as well as gram stains and cultures that involve examining tissue samples taken from the infected area. After diagnosis, a patient’s sexual partners should be notified so they may be tested and, if necessary, treated for gonorrhea.

Antibiotics are the standard treatment for gonorrhea. They are usually given orally or by injection. Antibiotic eye drops or ointment and rarely silver nitrate eye drops are also given to newborn infants of gonorrhea-infected women shortly after birth to help prevent gonorrhea infection of the eye. 

Gonorrhea can be prevented by practicing safe sex, which includes limiting sexual partners, knowing the sexual history of partners and using latex condoms and dental dams during sexual activity.

About gonorrhea

Gonorrhea, also called “the clap,” is a type of sexually transmitted disease (STD) caused by bacteria. The bacteria that cause gonorrhea (Neisseria gonorrhoeae) thrive in moist areas of the body in both women and men. Gonorrhea can be spread through any kind of sexual contact (vaginal, oral or anal) with an infected person. Ejaculation is not necessary to spread gonorrhea. Physical contact with the infected area may also spread the disease (e.g., touching the genitals and then touching the inside of the mouth or an eye). It is not spread by kissing.

In women, the gonorrhea bacteria usually enter the body during vaginal intercourse. The cervix (entrance to the uterus) is the most likely site of a gonorrhea infection in women and may become inflamed. Bacteria may also reach the urethra (tube leading to the bladder) and cause inflammation there. Gonorrhea bacteria may also lodge in the vagina and glands near the entrance to the vagina. This can result in painful swelling of the gland. However, this type of gonorrhea is uncommon in adult women.

In men, gonorrhea bacteria are transmitted into the urethra during intercourse, where the bacteria cause inflammation to occur. The most common indication of a gonorrhea infection in men is discharge from the penis and a burning sensation when urinating.

Gonorrhea can also occur in the anus, either from anal sex or by bacteria transmitted to the anus from the genitals. Infection of the anus is rare in heterosexual men and most often occurs in men and women who engage in receptive anal intercourse. People may also contract a gonorrhea infection in the throat by having oral sex with an infected partner. If a person touches an infected area and then touches the eyes, gonorrhea may spread to the eyes, a condition called gonococcal conjunctivitis. However, the gonorrhea bacteria can only survive for brief periods of time away from moist surfaces. The bacteria cannot survive or be transmitted from inanimate objects or surfaces.

In extreme cases when gonorrhea is left untreated, infection can spread to other parts of the body, causing inflammation of areas such as the brain and spinal chord (meningitis), heart (endocarditis) or joints (arthritis). In women, gonorrhea can spread to the upper reproductive organs where it can cause pelvic inflammatory disease (PID). PID that is not treated in a timely manner can scar the tissue within the fallopian tubes and can cause infertility. In men, gonorrhea can cause epididymitis, a condition that causes painful swelling of the scrotum. Epididymitis can also lead to infertility. Gonorrhea can also increase the risk of becoming infected with human immunodeficiency virus (HIV), the virus that leads to acquired immune deficiency syndrome (AIDS). Some studies suggest that a history of gonorrhea may increase a man’s risk of developing prostate cancer. This risk may be even higher if the man has a history of multiple gonorrhea infections. 

More than 330,000 cases of gonorrhea were reported to the U.S. Centers for Disease Control and Prevention (CDC) in 2004, the last year for which figures are available. However, the CDC estimates that this number accounts for only half of the nation’s gonorrhea cases since many of the cases go unreported. Because gonorrhea in women is frequently asymptomatic, an important element in controlling the spread of gonorrhea is to screen women who are at risk for STDs. African-Americans are most affected by the disease, with almost 20 times the incidence in 2004 than was found among white Americans. Other minority groups, including Hispanics, may also have a higher rate of incidence. For the past four consecutive years, the gonorrhea rate has been higher for women than men.

Risk factors and causes of gonorrhea

Gonorrhea is spread primarily through sexual activity, including vaginal, oral and anal sex. Risk factors are elements that increase the risk of developing a disease. However, people with one or more risk factors may not contract the disease and those without any risk factors may develop the disease. Factors known to increase the risk for gonorrhea include:

  • Age. Gonorrhea is more prevalent among sexually active people under age 30. In 2004, more than 75 percent of the cases reported to the U.S. Centers for Disease Control and Prevention were among people age 15 to 29.
  • Sexual activity. People who engage in unprotected sex, have multiple partners, or who have sex with people who have multiple sexual partners or high risk partners are more likely to contract gonorrhea.
  • History of sexually transmitted diseases (STDs). People who have had other STDs are at greater risk for contracting gonorrhea.
  • Illicit drug use. Using illicit drugs, especially those taken intravenously (into a vein), increases the risk of contracting STDs such as gonorrhea.

Signs and symptoms of gonorrhea

Signs and symptoms of gonorrhea differ in women and men. Women generally experience no symptoms at all or symptoms so mild they are not noticed. Men are more likely to experience symptoms that are mild to moderate. Gonorrhea symptoms may appear several days after exposure to the disease or may take up to 30 days to appear. Gonorrhea symptoms may include:

MenTingling sensation during urination (early symptom) Discharge from the penis Swollen testicles
WomenAbnormal vaginal discharge Bleeding following intercourse
Men and WomenPain or burning during urination (dysuria) Rectal pain Itching of genitals or anus Painful bowel movements Sore throat following oral sex Red eyes (sign that bacteria has spread to eyes)

Many of these symptoms are also common for other conditions, including other sexually transmitted diseases and urinary tract infections. A person who experiences any of these symptoms should consult a physician for an evaluation. All sexual activity should be stopped until the condition has been treated.

Diagnosis methods for gonorrhea

Physicians begin diagnosis of gonorrhea by compiling a complete medical history of the patient. This may include questions about the patient’s sexual activity and sexual partners. A physician will also perform a physical examination and, for women, a pelvic examination. In men, gonorrhea is determined by the presence of symptoms and a positive result of one or more laboratory tests. In women, because gonorrhea is often asymptomatic, several laboratory tests may be conducted to confirm a diagnosis of gonorrhea. 

Several laboratory tests are available to diagnose gonorrhea, including:

  • Gram stain test. Involves taking swabs of cells from the infected area. The cells are stained with dye and the bacteria can be identified under a microscope. This quick test is the most effective way of confirming the presence of gonorrhea in men. However, it is reliable in only about 50 percent of women with gonorrhea. It is also not effective for testing for gonorrhea in the throat or the anus.

  • Nucleic acid amplification test (NAAT). This test uses a urine sample or a sample of discharge from the infected area and is able to detect the presence of genes from the gonorrhea bacteria.

  • Culture test. Requires swabs of sample tissue from the cervix, urethra, rectum or throat. The sample is placed in a culture media and allowed to grow for at least 48 hours. Culture tests are more accurate than some other tests, but take more time.

  • Enzyme linked immunoabsorbent assay test (ELISA test). This test uses a discharge sample from the infected area. It detects antibodies (substances that fight the infection) to the bacteria. It is more sensitive in women than the gram stain test but not as accurate as the culture test.
  • DNA probe test. Uses a discharge sample from the infected area and tests for genetic material of the gonorrhea bacteria. It is less accurate for samples collected from the throat. The DNA probe test may also identify chlamydia, a sexually transmitted disease (STD) that frequently occurs with gonorrhea.

The NAAT urine test is becoming more widely used. It is more accurate than the gram stain test and faster than culturing specimens. However, the culture test provides information about drug-resistant strains of bacteria, which can help determine which antibiotic to use for treatment.

In addition, there have been pilot studies on the use of in-home diagnostic tests for gonorrhea in women. Early research has indicated that self-collected vaginal swabs are as effective as doctor’s cervical examinations for diagnosing STDs. Researchers plan to continue work on the development of home test kits for the general public. So far, there are no effective home testing methods for men.

Physicians are required to report all diagnosed cases of gonorrhea to the U.S. Centers for Disease Control and Prevention (CDC), and usually to local and state health agencies as well. CDC monitoring of certain “notifiable” diseases, including gonorrhea, assists with control and prevention of the disease. Anyone diagnosed with gonorrhea should notify their sexual partners of the diagnosis so they may seek medical testing and treatment. This should include all sexual partners from 60 days prior to the appearance of symptoms or the medical visit. If an infected person does not notify sexual partners of the diagnosis, a local health agency may attempt to do so.

Treatment options for gonorrhea

Gonorrhea is treated with antibiotics, usually given in the form of a pill or injection. In recent years, some strains of the gonorrhea bacteria have become resistant to certain antibiotics. A culture of the gonorrhea infection may indicate if it is a drug-resistant strain. Because of the increase in resistant strains, physicians may treat all gonorrhea cases as if they were drug-resistant strains and use nonresistant antibiotics.

Most antibiotics can be administered in a single dose or as a week’s worth of pills. The patient should refrain from sexual activity for seven days (for either form of medication) to give the medication time to work. Patients should also wait before resuming sexual activity with their previous sexual partners until their partners have been both tested and seven days after being treated for gonorrhea. Patients should have a follow-up physician visit after a week of medication to recheck symptoms and possibly repeat cultures and verify that the gonorrhea infection has been cured. They should be certain to complete any oral medication or the infection may not be completely eradicated. Patients treated for gonorrhea can be reinfected with the disease if they have sexual contact with another infected person.

Pregnant women with gonorrhea have additional treatment considerations. They cannot take certain antibiotics because the drugs may affect fetal development. For example, tetracycline antibiotics may discolor the developing baby’s teeth. Gonorrhea also makes women more likely to have a miscarriage or a premature birth. In addition to treatment with antibiotics, pregnant women may be treated with other drugs to avoid preterm labor.

People infected with gonorrhea are frequently infected with chlamydia, another sexually transmitted disease with few symptoms. When gonorrhea is diagnosed, physicians may prescribe a combination of antibiotics in order to treat the patient for chlamydia as well. This is because the antibiotics used to treat chlamydia are usually less expensive than the test used to diagnose it.

Prevention methods for gonorrhea

Although scientists are currently working to develop a safe, effective vaccine for gonorrhea, no vaccine exists at this time. However, people can help prevent gonorrhea by practicing safe sex. This includes always using latex condoms during sex, minimizing the number of sexual partners, knowing the sexual history of sexual partners and testing for sexually transmitted diseases (STDs). The use of a latex dental dam during oral sex can minimize the risk of contracting gonorrhea in the throat. Abstinence from all sexual activity can completely prevent the disease.

People at high risk for STDs should be tested regularly for gonorrhea and have frank discussions with their physician about their sexual activity. STD testing is not a standard part of gynecological exams, so women should request an STD test if they are concerned about their exposure. Pregnant women should be tested for gonorrhea and treated if necessary. Babies born in hospitals may be treated with silver nitrate eye drops to prevent gonorrhea in their eyes.

Questions for your doctor regarding gonorrhea

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to gonorrhea:

  1. How can I tell if my symptoms are due to gonorrhea?
  2. What tests will be used to diagnose the condition?
  3. How can I tell if the infection has spread elsewhere in my body?
  4. What type of antibiotic will you prescribe for me?
  5. How long will it take for the medication to work?
  6. How long will I need to abstain from sexual relations?
  7. Is there any way for me to tell if my sexual partner has gonorrhea?
  8. Do I need to contact all of my sexual partners?
  9. What will be done if the antibiotic does not work?
  10. Will having gonorrhea affect my or my partner’s fertility?
  11. How will I be treated if I am pregnant?
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