Gonorrhea: The Basics

Introduction:

Gonorrhea is the third most common sexually transmitted infection (STI) in the United States, with over 600,000 diagnoses made in 2019.(1)  It’s most common among young people ages 15-24 years.

Most genital gonococcal infections in women, and many in men, do not cause symptoms, making it easy to spread.

What is Gonorrhea?

Gonorrhea is a bacterial infection caused by Neisseria gonorrhoeae.  It only affects humans and is primarily transmitted through sexual contact.  Immunity to infection is not long-lived, and as a result, reinfection or persistent infection is common.

Risk of Infection

Anyone having vaginal, oral, or anal sex can become infected.  General features associated with a higher likelihood(2) of getting gonorrhea include:

• Being a sexually active adolescent or young adult
• Having a new sex partner or more than one sex partner in
• Having a history of a prior STI, including gonorrhea

Gonorrhea Symptoms

Gonorrhea can infect the throat, rectum, and lower genital tract including the urethra in both men and women.  Most infections in women and some infection in men cause no symptoms, meaning people can be infected without knowing it and spread it to others.

For women, gonorrhea symptoms can include:

• Pain or burning during urination
• Vaginal bleeding or spotting
• Abnormal vaginal discharge
• Sore throat
• Pain with bowel movements

For men, the most common symptoms of gonorrhea include:

• Penis discharge
• Pain or discomfort with urination
• Rectal pain and or discharge
• Sore throat
• Testicular pain

Gonorrhea Complications

Left untreated, gonorrhea can cause serious medical complications.

Women can develop pelvic inflammatory disease (PID), which occurs when gonorrhea spreads from the cervix to the upper genital tract, infecting the uterus and fallopian tubes.  The subsequent infection can scar the fallopian tubes leading to infertility, an increased risk of ectopic pregnancy, and or chronic pelvic pain.

In men, gonorrhea can infect the epididymis, causing one-sided testicular pain and raising the risk for infertility.

Everyone infected with gonorrhea is at increased risk of becoming infected with HIV, the virus that causes AIDS.

Detecting Gonorrhea

When diagnosing gonorrhea, a vaginal swab specimen, first-catch urine specimen, rectal swab specimen, and or oral swab specimen can all be used.  It is important to test all sites of possible exposure.

The Center for Disease Control (CDC) and Prevention recommends that women be tested at least once a year who are:

• Younger than 25 and sexually active
• 25 or older with several sexual partners
• 25 or older with a new sexual partner
• Pregnant

The CDC also recommends that men be tested at least once a year who are:

• Having sex with other men (gay or bisexual)

Any sexual active individual with signs and symptoms consistent with chlamydial infection should undergoing testing.

We also think it reasonable to screen heterosexual males who have a history of STI or are seeking STI evaluation.

Treatment

The goals of treatment are (a) to prevent complicated infections related to gonorrhea (PID, (b) decrease the transmission to others, (c) resolve symptoms - the vast majority of symptomatic patients improve clinically within two weeks of treatment, and (d) prevent reinfection.

The preferred antibiotic to treat gonorrhea in both men and women is an intramuscular injection (shot) of ceftriaxone.(3) The recommended dosing is dependent upon the individual’s weight.

Gonorrhea Prevention

Wait To prevent reinfection, everyone who tests positive for gonorrhea should be treated and abstain from sexual intercourse until they and their partner(s) can complete treatment.

Outreach If you test positive for gonorrhea, we recommend contacting all sexual partners you had in the last 60 days so that they can be screened and treated for gonorrhea and other STIs.  If you haven’t and sexual contact within anyone in the last 60 days, then we recommend reaching out to the last person you had sex with.

Retest We follow the CDC recommendations and encourage all patients with a documented gonorrhea infection to retest three months after treatment, since reinfection rates are high.

Testing to assess whether treatment eradicated the infection (test for cure) is recommended in a limited number of settings:

• If you’re regnant
• If your symptoms do not improve after treatment
• If you did not complete the recommended treatment

Mona can assist you with with retesting, outreach, and test for cure.

References

1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2018. Atlanta, GA: US Department of Health and Human Services; 2019. https://www.cdc.gov/std/stats18/default.htm (Accessed on October 10, 2019).
2. Klausner JD, Barrett DC, Dithmer D, Boyer CB, Brooks GF, Bolan G. Risk factors for repeated gonococcal infections: San Francisco, 1990-1992. J Infect Dis. 1998 Jun;177(6):1766-9. doi: 10.1086/517442. PMID: 9607868.
3. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. PMID: 34292926; PMCID: PMC8344968.