Gonorrhea

ANATOMY OR SYSTEM AFFECTED: Eyes, genitals, reproductive system, throat, urinary system

DEFINITION: A common treatable sexually transmitted disease that primarily infects the reproductive tract and is caused by the bacterium Neisseria gonorrhea.

CAUSES: Bacterial infection through intercourse

SYMPTOMS: In men, sometimes urinary discomfort and discharge, with long-term complications of epididymitis, prostatitis, and urethral scarring; in women, sometimes vaginal discharge, urinary discomfort, urethral discharge, lower abdominal discomfort, and pain with intercourse, with possible pelvic inflammatory disease, infertility, and increased risk of ectopic pregnancy

DURATION: Acute

TREATMENTS: Antibiotics, counseling regarding safe sex

Causes and Symptoms

Gonorrhea is the second-most common bacterial sexually transmitted infection (STI) in the United States, the most common being chlamydia. In the United States, the incidence of gonorrhea has fluctuated. For example, in 1995, the incidence was about 150 cases out of every 100,000 persons, down from the mid-1970s of more than 400 cases per 100,000 persons. After 1997, the percentage of infections increased slightly, but by 2009, the rate per 100,000 reached an all-time low of 98.1. According to the Centers for Disease Control and Prevention (CDC), in 2020, during the initial shelter-in-place orders during the COVID-19 pandemic, the weekly number of cases was lower than a comparable time during the previous year. However, later in 2020, the number of cases of gonorrhea increased again. From 2020 to 2021, the rates of gonorrhea rose again among both men and women to 710,151 cases. However, by 2022, the rates had dropped 9.3 percent to 648,056 cases, according to the CDC.

Gonorrhea is caused by the bacterium Neisseria gonorrhea, a gram-negative diplococcus. The bacterium infects the mucous membranes with which it comes in contact, most commonly the and the but also the throat, rectum, and eyes. Some men will be asymptomatic, but most will experience urinary discomfort and a purulent urethral discharge. Long-term complications of this infection in men include epididymitis, prostatitis, and urethral strictures (scarring). In women, the disease is more likely to be asymptomatic.

Women with symptoms may have purulent vaginal discharge, urinary discomfort, urethral discharge, lower abdominal discomfort, or pain with intercourse. Pelvic inflammatory disease (PID) and its consequences may occur if gonorrheal infection ascends past the cervix into the upper genital tract (uterus, Fallopian tubes, ovaries, and pelvic cavity) in women. Complications of PID include infertility and an increased risk of ectopic pregnancy.

In rare cases, gonorrhea can enter the bloodstream and disseminate throughout the body, causing fever, joint pain, and skin lesions. Gonorrhea can infect the heart valves, pericardium, and meninges as well. When it infects the joints, a condition known as septic arthritis occurs, characterized by pain and swelling of the joints and potential destruction of the joints.

Gonorrhea can be transmitted to infants through the birth canal, leading to an eye infection that can damage the eye and impair vision. Fortunately, erythromycin eye drops are routinely given to newborns to prevent eye infection. These eyedrops are effective against Neisseria gonorrhea as well as Chlamydia trachomatis.

Treatment and Therapy

Treatment for gonorrhea consists of the use of antibiotics. With the development of penicillin-resistant strains of gonorrhea, effective therapy relies on antibiotics, such as ceftriaxone, to which gonorrhea remains susceptible. In uncomplicated cases of gonorrheal infection, such as cervicitis or urethritis, a single dose is given.

At the same time, in the summer of 2017, the World Health Organization (WHO) released a report warning that the bacteria that causes gonorrhea has proven increasingly intelligent, evolving consistently to resist each new class of antibiotics created to fight the infection. Therefore, gonorrhea is becoming more difficult to treat than in the past. In an analysis of data collected between 2009 and 2014, the WHO found evidence in 97 percent of countries reporting of strains that are resistant to ciprofloxacin, in 81 percent of countries of strains showing increasing resistance to azithromycin, and in 66 percent of countries of strains becoming resistant to extended-spectrum cephalosporins (ESCs) oral cefixime or injectable ceftriaxone. In 2020, the WHO estimated that 82.4 million people were newly infected with gonorrhea. The investigation also found that three strains of the bacteria, found in Japan, France, and Spain, cannot be killed by the best antibiotic available. To combat this issue, the WHO released a document listing the preferred product characteristics to develop a vaccine for the infection. The organization believed that an effective vaccine was biologically possible as of 2023.

A patient who has for STIs (primarily contact with a suspected infected partner) or a clinical picture suggestive of gonorrhea, or both, may receive treatment presumptively, before confirmatory laboratory test results for gonorrhea are available. Because a large number of patients with gonorrhea also have chlamydia, patients are treated concomitantly with an directed against chlamydia, such as azithromycin. Occasional doxycycline may be used as well. Once laboratory test results confirm the diagnosis of gonorrhea, patients should be advised that it is recommended that they be tested for other STIs, such as Human immunodeficiency virus (HIV), hepatitis B and C, and syphilis.

As with all STIs, a key component of therapy includes counseling regarding safer sex. This includes the use of barrier contraceptives, such as condoms, and the avoidance of high-risk sexual behaviors. Contact tracing is another important element to STI treatment. It notifies the patient’s sexual partners of their exposure to gonorrhea or other STIs. Contact tracing also involves offering resources to these partners for medical attention. Contact tracing can prevent both reinfection of the patient through subsequent sexual encounters and can prevent the spread of STIs from the patient’s partner to his or her subsequent sexual partners.

Perspective and Prospects

The symptoms of gonorrhea have been described in numerous cultures in the past, including those dating back to the ancient Chinese, Egyptians, and Romans. The actual gonorrhea bacterium was first identified by Albert Neisser in the 1870s, and it was one of the first ever discovered. Neisseria gonorrhea has continued to be well-studied on both the molecular and the epidemiological level.

Antibiotic therapy, in the form of sulfanilamide, was first used to combat N. gonorrhea in the 1930s. By the 1940s, however, gonococcal strains resistant to this antibiotic appeared, and the therapy of choice became penicillin. Over the next several decades, N. gonorrhea evolved the ability to resist penicillin, forcing clinicians to use other drugs to combat the bacterium, such as ceftriaxone and ciprofloxacin. In the 1980s, the Centers for Disease Control instituted surveillance programs to monitor antibiotic resistance patterns in different US cities. Continued success in combating N. gonorrhea will depend on the ability to minimize the development of antibiotic resistance.

Finally, since many patients with gonorrhea infection have no symptoms, programs of patients who are in high-risk groups (those younger than twenty-five and/or with multiple sexual partners) play a vital role in decreasing the incidence of N. gonorrhea infections.

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