Gonorrhea: A Notorious Infection that Demands Your Attention

Gonorrhea: A Notorious Infection that Demands Your Attention

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In this article, you will learn more about: the origin and background of gonorrhea; its prevalence; how it is transmitted; who is at risk and should be tested; and ways to protect yourself from gonorrhea infection. With proper detection and treatment, we can help reduce the prevalence of gonorrhea worldwide and help prevent serious health consequences.

Gonorrhea is the second-most commonly reported infectious disease in the United States.1 Gonorrhea is a sexually transmitted infection (STI) that is transferred during sex and can infect the genitals, anus, throat and eyes.2 While it is easily treated with antibiotics, it can have long-term consequences for patients who do not receive treatment.

Hologic: A Leader in STI Testing

Hologic is a molecular diagnostics company that provides highly accurate testing for gonorrhea and other STIs. Hologic scientists develop molecular tests like the Aptima Combo 2® assay, which detects gonorrhea and another common STI, chlamydia.3 Hologic works toward the goal of preventing the spread of STIs.

The Origin of Gonorrhea

Gonorrhea is one of the oldest-known diseases in humans, with first written records of gonorrhea-like diseases found in ancient Chinese writing, the Christian Bible and in the writings of the famous Greek physician Hippocrates in 400 BC.4 Later, in 130 AD, the Greek physician Galen of Pergamon coined the term gonorrhoea, which means “flow of seed,” for the disease. This was because he mistook the discharge that often accompanies gonorrhea infection for semen.4

In 1879, Dr. Albert Ludwig Sigesmund Neisser first discovered the bacterium gonococcus that causes gonorrhea, and was thus referred to as “the father of gonococcus.”5 In 1938, sulfanilamide was the first drug introduced that could reliably cure gonorrhea.6 Since then, various antibiotics have been used to treat this disease.6

The State of Gonorrhea Today

Today, an estimated 78 million new infections occur globally each year.7

In the United States, 395,216 cases of gonorrhea were reported in 2015 – a 12.8% increase in cases since 2014.9 More men  than women reported with infection.9 This infection disproportionately affects certain groups with highest rates of infection among teenagers and young adults.2

The prevalence of gonorrhea has fluctuated as a result of social and healthcare changes since its discovery. The use of antibiotics sulfanilamide and penicillin in the 1930s and 1940s to treat gonorrhea greatly reduced its prevalence.4 In the 1960s, when oral birth control was introduced, cases increased again and reached their highest levels yet until that time, at 1 million cases in 1979.4 When the HIV epidemic spread in the 1980s, an increase in condom use again contributed to a decrease in gonorrhea cases by proxy.4

Today, there are highly sensitive tests available for the detection of gonorrhea; however, new treatment challenges have arisen as gonorrhea has become resistant to many commonly prescribed antibiotics.10

How is Gonorrhea Spread?

Gonorrhea is the infection caused by the bacterium Neisseria gonorrhoeae (named after Dr. Neisser).5 It can infect the genitals, rectum, throat and sometimes the eyes.2 It is passed when the secretions or semen from one person comes in contact with any skin covering the openings of the body – that is, the vagina, anus, penis, eyes or mouth.2

Genital and Rectal Infection

Gonorrhea is transmitted during vaginal, anal or oral sex.2 Even if full penetration does not occur, Neisseria gonorrhoeae bacteria can be transferred.11

Eye Infection

In the case of eye infections, gonorrhea can be passed through hand-to-eye contact or when semen or secretions come in contact with the eyes during sex.11

To Newborns

It may also be passed from a mother to her newborn when the baby passes through the birth canal, as infected fluid in the vagina contacts openings on the baby’s body.2

Symptoms of Gonorrhea

Most people with gonorrhea have no symptoms.4 It is very important to note that even if a person does not have symptoms, he or she can pass gonorrhea to another person.2 When symptoms are present, they can vary dependent upon whether the infection exists in the genitals or other area of the body.

Genital Infection

One study estimates that 86% of untreated gonorrhea cases in patients ages 18-29 were left untreated because they were never symptomatic.12 When symptoms of genital gonorrhea infection are present in women, they usually resemble a bladder or vaginal infection. They include4:

  • Discomfort during urination4
  • Increased vaginal discharge4
  • Bleeding between periods4
  • Pain during sex4
  • Abdominal or pelvic pain13

Symptoms of gonorrhea in men are also unlikely. When present, they include:

  • Discomfort during urination4
  • White, yellow or green discharge from the penis4
  • Testicular or scrotal pain4
  • Swelling in one testicle13

Rectal Infection

For both men and women, rectal infection can cause13:

  • Anal itching
  • Pus-like anal discharge
  • Anal bleeding
  • Strain during bowel movements

Eye Infection

For both men and women, gonorrhea infection in the eyes may cause symptoms including13:

  • Eye pain
  • Light sensitivity
  • Pus-like discharge from one or both eyes

Throat Infection

Gonorrhea infection of the throat, also known as pharyngeal gonorrhea, leads to symptoms including13:

  • Sore throat
  • Swollen lymph nodes

Joint Infection

In rare cases, gonorrhea can spread to the joints, creating septic arthritis. Symptoms of septic arthritis include13:

  • Pain in the joints
  • Redness around joints
  • Swelling in one or more joints

Health Consequences of Untreated Gonorrhea

Like many STIs, gonorrhea is easily treatable and typically has no long-term consequences if caught early.4 However, without proper testing and antibiotic medication, the infection can persist and lead to problems.4

There are a few consequences of gonorrhea infection that can affect men and women. When gonorrhea infection persists, it can travel in the blood stream to other areas of the body. This can lead to septic arthritis (joint infection), tenosynovitis (tendon inflammation) and dermatitis (skin inflammation).2

While gonorrhea infection alone can lead to serious health consequences, it can also lead to increased risk for infection with human immunodeficiency virus (HIV), the virus that causes AIDS.2

Consequences in Women

In women, gonorrhea can cause infertility by way of pelvic inflammatory disease (PID).2 When Neisseria gonorrhoeae bacteria travel to the uterus and fallopian tubes, they can cause PID.4 PID can cause tubal scarring, ectopic pregnancy (pregnancy outside of the uterus) and infertility.14 Even after gonorrhea treatment has been administered, the long-term effects of PID can persist.13.14

Complications for Pregnant Women and Their Babies

Gonorrhea infection in pregnant women has been linked with miscarriage, premature birth, low birth weight, premature rupture of membranes and amniotic infection.15

If a woman is infected with gonorrhea when she becomes pregnant or is infected during pregnancy, it is important that she receive treatment before giving birth. Without treatment, the infection can spread to the baby. Babies are at a higher risk of complications due to gonorrhea infection.15

Gonorrhea infection in newborns can cause blindness, arthritis, meningitis and blood infection.2 Left untreated, these can prove life threatening in babies.16

Consequences in Men

For men, gonorrhea may cause epididymitis, or inflammation in a tube that connects the sperm ducts to the urethra.2 Without treatment, epididymitis can damage this tube permanently and cause infertility.2

For men, as in women, septic arthritis is a rare but serious infection that can develop when Neisseria gonorrhoeae bacteria travel through the blood to infect the joints. It can also cause tenosynovitis or dermatitis, all of which may be life threatening.2

People with HIV Infection

In the US, people who have gonorrhea are at higher risk to get HIV than someone who does not have gonorrhea.17 This is because the behaviors and circumstances that lead to gonorrhea infection are also associated with the risk factors for developing HIV.17

Testing for Gonorrhea

The CDC recommends that laboratories use nucleic acid amplification tests (NAATs), which are molecular laboratory tests to detect the presence of Neisseria gonorrhoeae.18 These tests are performed on samples collected from possible infection sites, including vaginal, penile or rectal swabs.18

Who Should Be Screened?

Certain groups of people have a higher risk of contracting gonorrhea, making it important to follow CDC guidelines for testing. Your healthcare provider will talk with you to determine what screening tests are right for your age and level of risk.

CDC Testing Recommendations19

Gonorrhea Screening Recommendations
  • Sexually active women under 25 years of age.
  • Sexually active women 25 years of age and older if at increased risk.*
  • If tested positive, retesting approximately 3 months after treatment.
Pregnant Women
  • All pregnant women under 25 years of age.
  • Pregnant women, aged 25 and older if at increased risk.*
  • Retesting during the 3rd trimester for women younger than 25 years of age or at increased risk.
  • Pregnant women with gonorrhea infection should have a test-of-cure 3-4 weeks after treatment and be retested within 3 months.
Men Who Have Sex with Men (MSM)
  • At least annually for sexually active MSM at sites of contact (urethra, rectum, pharynx) regardless of condom use.
  • Every 3 to 6 months if at increased risk.†
Persons with HIV
  • For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter.
  • More frequent screening might be appropriate depending on individual risk behaviors and the local epidemiology.

* Those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection.
† More frequent STD screening (i.e., for syphilis, gonorrhea, and chlamydia) at 3-6-month intervals is indicated for MSM, including those with HIV infection if risk behaviors persist or if they or their sexual partners have multiple partners.

Where Should I Find Out About Testing?

If you have questions about testing or are looking for a place to get tested, there are many resources available to you. First, there is a wealth of information on gonorrhea and other STIs on the CDC website and on the site yesmeanstest.org.

You can always choose to speak directly with your healthcare provider about STIs. Your general physician, gynecologist (for women) or urologist (men) can determine if gonorrhea testing is right for you. It is important to be honest with your healthcare provider and let him or her know if you feel you have been exposed to gonorrhea or another STI.

Annual well woman visits are also good opportunities to ask your provider any STI questions. A well woman exam is an annual visit to check in about your reproductive and overall health.

How Do I Talk to My Doctor About Gonorrhea?

It’s natural to feel anxious about discussing gonorrhea and other STIs, but remember: Your healthcare provider has seen everything before. It is important to be as honest as possible with your provider, who wants to help you.

What if I Test Positive for Gonorrhea?

For patients who receive a positive gonorrhea diagnosis, there is a cure. Traditionally, gonorrhea was treated using certain antibiotic drugs.16 Gonorrhea has begun to develop a resistance to some of these, meaning it does not always respond to treatment.16 The CDC has released a specific antibiotic combination for treatment, which currently includes an injectable (shot) dose of ceftriaxone and an oral (pill) dose of azithromycin.16

If you test positive for gonorrhea, your antibiotics may be administered orally, through a shot or both.16 Your provider will administer your shot, and you will likely take your pill in his or her presence as well.16

Remember that if you test positive for gonorrhea, return for retesting three months after your treatment. Gonorrhea reinfection is common, namely because infected patients’ sexual partners fail to receive treatment or the infected person has sex with a new partner with infection.16

You will also need to tell your partner that you have been infected. If you do not, you have increased risk of developing the infection again. The CDC recommends expedited partner therapy (EPT), which is available in some healthcare settings.20 With EPT, you will receive an additional dosage of antibiotic treatment to give to your partner, even if he or she does not visit your healthcare provider.20 Your provider will give you instructions and explain how you can give the treatment to your partner.20

Preventing Gonorrhea Infection and Re-Infection

The only way to completely eliminate your risk of contracting gonorrhea as an adult is through:

  • Abstinence (not having sex of any kind)2
  • The correct and consistent use of latex condoms
  • Being in a long-term monogamous relationship with just one other person who is only having sex with you and who has been tested negative for gonorrhea.2 Again, to prevent gonorrhea reinfection if you have already tested positive and been treated, it is essential that you are tested after three months and that your partner is tested and treated if necessary.2

It’s Better to Know and Take Charge

We know that talking about gonorrhea and other STIs can be embarrassing at times. It is important to know that you have resources available to you for more information on testing and treatment for gonorrhea. The CDC website on STIs has a wealth of information. Additionally, you can talk to your healthcare provider during an annual visit or checkup. You can also visit or call an STI clinic in your area for further advice.

We hope you will take an active role in your healthcare and get treated for STIs like gonorrhea. By talking about STIs and following screening guidelines, you can help avoid any long-term effects from the infection. The more you know about your health, the more you can live healthier.

References: 1. CDC. Chlamydia and Gonorrhea — Two Most Commonly Reported Infectious Diseases in the United States. https://www.cdc.gov/Features/dsSTDData/. Updated April 22, 2011. 2. CDC. Gonorrhea – CDC Fact Sheet (Detailed Version).  https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm. Updated October 28, 2016. Accessed April 10, 2017. 3. Aptima Combo 2 Assay [package insert]. 502446, Rev. 003. San Diego, CA: Hologic, Inc.; 2017. 4. Edwards JL, Apicella MA. The Molecular Mechanisms Used by Neisseria gonorrhoeae To Initiate Infection Differ Between Men and Women. Clin Microbiol Rev. 2004;17(4):965-981. Dio:10.1128/CMR.17.4.965-981.2004. 5. Ligon BL. Albert Ludwig Sigesmund Neisser: Discoverer of the Cause of Gonorrhea. Sem Ped Infect Dis. 2005;16(4):336-341. doi:10.1053/j.spid.2005.07.001. 6. Benedek T. Gonorrhea and the Beginnings of Clinical Research Ethics. Perspect in Biol and Med. 2005;48(1):54-73. 7. World Health Organization. Sexually Transmitted Infections (STIs). http://www.who.int/mediacentre/factsheets/fs110/en/. Updated August 2016. Accessed April 10, 2017. 8. Newman L, et al. Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. PLOS One. doi:10.1371/journal.pone.0143304. Published December 8, 2015. Accessed April 10, 2017. 9. CDC. Sexually Transmitted Disease Surveillance 2015. Atlanta, GA: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. U.S. Department of Health and Human Services; October 2016. 10. CDC. Antibiotic-Resistant Gonorrhea. https://www.cdc.gov/std/gonorrhea/arg/default.htm. Updated July 15, 2016. Accessed April 10, 2017. 11. American Sexual Health Association. Gonorrhea. http://www.ashasexualhealth.org/stdsstis/gonorrhea/. Accessed April 10, 2017. 12. Farley TA, et al. Asymptomatic sexually transmitted diseases: the case for screening. Prev Med. 2003;36(4):502-509. doi:10.1016/S0091-7435(02)00058-0. 13. Mayo Clinic. Gonorrhea. http://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/dxc-20258681. Published October 25, 2016. Accessed April 10, 2017. 14. Walker CK. Gonorrhea infection in women: prevalence, effects, screening, and management. Int J Womens Health. 2011;3:197-206. doi:10.2147/IJWH.S133427. 15. CDC. STDs during Pregnancy – CDC Fact Sheet (Detailed). https://www.cdc.gov/std/pregnancy/stdfact-pregnancy-detailed.htm. Updated February 11, 2016. Accessed April 10, 2017. 16. CDC. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR. 2015;64(3):1-140. 17. CDC. STDs and HIV – CDC Fact Sheet. https://www.cdc.gov/std/hiv/stdfact-std-hiv.htm. Updated May 19, 2016. Accessed April 11, 2017. 18. CDC. Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae – 2014. MMWR. 2014;63(RR02):1-19. 19. CDC. Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources. https://www.cdc.gov/std/tg2015/screening-recommendations.htm. Updated August 22, 2016. Accessed April 11, 2017. 20. CDC. Sexually Transmitted Diseases (STDs): Expedited Partner Therapy. https://www.cdc.gov/std/ept/. Updated February 17, 2017. Accessed April 11, 2017.

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