An Overview of Gonorrhea

Infections continue to rise as antibiotic resistance grows

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Gonorrhea, also known as "the clap," is a sexually transmitted disease (STD) caused by Neisseria gonorrhoeae bacteria. While gonorrhea can cause signs and symptoms, including vaginal or penile discharge and pain when urinating or during sex, it often comes with no such hints at all. 

Over the years, these bacteria have become very resistant to most antibiotics. While a single dose of azithromycin and ceftriaxone can clear most infections, reinfection is common. If left untreated, gonorrhea can cause severe complications including miscarriage, infertility, septic arthritis, and even blindness.

Gonorrhea affects both men and women and can be transmitted to newborns at birth. More than 500,000 cases are reported in the United States each year—and the rate is rising.

Symptoms

Symptoms of gonorrhea, if they appear, are often mild and non-specific and easily mistaken for other illnesses, including a urinary tract infection, strep throat, yeast infection, or hemorrhoids.

According to various studies, up to 90% of women and 50% of men with certain types of gonorrhea don't have symptoms.

Common symptoms in women include:

  • Vaginal discharge
  • Pain when urinating
  • Bleeding between periods
  • Lower abdomen or pelvic pain

Common symptoms in men include:

  • A greenish-yellow discharge from the penis
  • Pain when urinating
  • Pain or swelling in the scrotum or testicles

Pharyngeal (throat) gonorrhea can cause a mild sore throat, while rectal gonorrhea most commonly manifests with symptoms of itchiness, discomfort, and pain during a bowel movement. An infection of the eye is also possible, resulting in symptoms of conjunctivitis (pink eye).

Untreated gonorrhea can cause pelvic inflammatory disease (PID) in women and epididymitis in men, both of which can lead to infertility.

Less commonly, disseminated gonococcal infection (DGI), meningitis, and other serious issues can occur.

Gonorrhea can also increase your risk of getting HIV as the inflamed mucosal tissues provide the virus easier access into the body.

Newborn babies exposed to and infected with the bacterium during childbirth can sometimes develop an eye infection known as ophthalmia neonatorum, which, if left untreated, can lead to blindness and other complications.

Causes

Neisseria gonorrhoeae bacterium is primarily passed during oral, vaginal, or anal sex. Transmission from mother to child doesn't typically occur while the baby is in the womb. Rather, it takes place as the baby passes through the birth canal.

Semen, vaginal secretions, rectal secretions, and, to a lesser extent, saliva can be responsible for transmission. Gonorrhea cannot be passed through blood or breast milk.

Risk factors for gonorrhea include:

  • A younger age (sexually active people under 25 are at greatest risk)
  • Multiple sex partners
  • Inconsistent condom use
  • Having had a past gonorrheal infection
  • Having had other STDs in the past

Reinfection is common in people previously treated for gonorrhea. A seven-year study conducted by the U.S. Army reported that, among 17,602 service personnel, 13.7 percent of men and 14.4 percent of women experienced at least one gonorrheal reinfection.

Unlike some communicable diseases, having been treated for gonorrhea does not afford you any immune protection.

Diagnosis

There are three tests commonly used to diagnose gonorrhea, each of which has its appropriate use and limitations:

  • Nucleic acid amplification test (NAAT) is genetic test recommended in the first-line diagnosis of uncomplicated gonorrhea of the cervix/vagina or penis. While the NAAT is extremely fast and accurate, it is not approved for the diagnosis of rectal or pharyngeal gonorrhea.
  • Bacterial cultures can be used to diagnose gonorrhea of the genitals, rectum, throat, and eyes. While useful, a culture is a specialized, non-automated test that can be marred by lab error and improper sample collection.
  • Gram staining is a traditional form of diagnosis in which dyes are used to differentiate bacteria under the microscope. While the procedure can render a definitive result in men, it is less able to do so in women.

While at-home tests are also available, their accuracy is highly variable; user error is common.

Treatment

Over the course of about 50 years, gonorrhea strains circulating in the population have become increasingly resistant to the antibiotics used to treat them. From the 1960s when penicillin started losing effectiveness to 2007 when fluoroquinolones were no longer deemed effective, the treatment arsenal has been pared down to only a handful of antibiotics that can clear this otherwise uncomplicated infection.

To this end, in 2015, the CDC recommended against the use of oral antibiotics in monotherapy to treat gonorrhea. What they realized was that people were not completing their treatment as prescribed and, rather than killing the bacterium, they were allowing it to mutate and become increasingly more resistant—a resistance they would pass to others.

The CDC now endorses the use of dual therapy to treat uncomplicated gonorrhea of the cervix, urethra, rectum, or throat in adults: a combination of an intramuscular injection of ceftriaxone and an oral dose of azithromycin

By eradicating the infection with one dose, rather than several, the CDC hopes to slow the speed of resistance that's developing.

Alternative antibiotics are available for those who are allergic to the recommended drugs. Higher doses or more extensive treatment would be needed for cases such as DGI and gonococcal infection of the eye.

Most newborns can also be treated with a single dose, although disseminated infections may require up to a 14-day course of antibiotics.

A Word From Verywell

While the very thought of getting gonorrhea can be unsettling, it shouldn't stop you from taking action if you think you've been infected.

Getting tested for gonorrhea is confidential. You should get the results in two to three days.

The earlier you find out you're positive if you are, the earlier you can start treatment. This can not only reduce your risk of complications but your vulnerability to HIV.

If the results are negative, it can help reinforce safer sex practices, including the consistent use of condoms and the reduction in the number of sex partners.

To find a testing site near you, visit the CDC's online locator. Many of the listed clinics offer low-cost or no-cost testing for qualified residents.

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