Infection: Gonorrhea

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Gonorrhea is an infectious disease caused by bacteria called Neisseria gonorrhoeae, or gonococcus. The bacteria are transmitted by sexual intercourse or, now rarely in the Western world, from an infected mother to her baby during childbirth.

Description

Gonorrhea is a sexually transmitted disease (STD) that causes inflammation and a discharge from the urinary tract and the genitals, although it can also cause infections of the throat, eyes, and rectum. Babies can be infected before or during childbirth. In addition to the immediate symptoms of infection, gonorrhea can cause dangerous long-term complications if it is not diagnosed and treated. It can cause blindness in newborns, infertility in adult women, inflammation of the prostate gland in men, and joint infection. Other rare long-term complications include inflammation of the tissues covering the brain and spinal cord or infection of the heart valves.

Demographics

Gonorrhea is the most common infectious disease that doctors in the United States are required to report to public health officials. It is estimated that there are 600,000 new infections in the United States each year; there are about 240 cases reported per 100,000 people. The rates are considerably higher among African Americans than among other racial groups, particularly in inner-city areas and in the southeastern United States. The lowest rates are among Asian Americans and Pacific Islanders.

Age is a major factor in the spread of gonorrhea. Three out of four cases of the disease are found in people younger than thirty. The highest rates of gonorrhea are found in women between fifteen and nineteen years of age and in men between the ages of twenty and twenty-four.

Other risk factors for getting gonorrhea are a large number of sexual partners and having other sexually transmitted diseases (STDs). Gonor-rhea in children almost always points to sexual abuse.

Causes and Symptoms

The gonorrhea bacterium is spread through contact with infected semen or vaginal fluids during unprotected sexual intercourse or during childbirth. People can become carriers of the disease without developing its characteristic symptoms. Men have a 20 percent chance of getting infected by a single sex act with an infected woman, while women have a 50 to 70 percent chance of getting gonorrhea from an infected man during a single sex act. Men who have sex with men run a high risk of getting gonorrhea during anal intercourse, particularly if either partner has HIV infection.

The bacterium enters the body in the semen or vaginal fluids of an infected partner. Once inside the vagina, mouth, or rectum, it attaches itself to the moist tissues that line those parts of the body. There it multiplies and spreads below the uppermost layer of tissue. The body responds by sending white blood cells to attack the invaders and by shedding the infected tissue. The result is inflammation and the production of a whitish or yellowish discharge. Most people develop symptoms between two and ten days after unprotected sex.

Men are more likely to develop noticeable symptoms than women. In men, the most common symptoms of gonorrhea are a sticky discharge of pus from the penis and pain when urinating. In women the most common symptoms are a vaginal discharge, pain during intercourse, bleeding after intercourse, or difficulty urinating.

Between 30 and 60 percent of infected women may not have any noticeable symptoms of infection and may fail to get tested for gonorrhea. They are at high risk of a complication of the disease called pelvic inflammatory disease or PID. In PID, the bacterium travels upward from the vagina through the uterus and the other reproductive organs. It produces inflammation that causes scarring of the tubes that carry fertilized eggs to the uterus. In addition to causing cramps, painful menstrual periods, and fever, PID can leave a woman permanently unable to have

children. It can also cause a complication called an ectopic pregnancy, in which the fertilized egg starts growing inside the tubes leading to the uterus or in the abdomen rather than in the uterus itself.

Another complication of untreated gonor-rhea is called disseminated gonococcal infection or DGI. Disseminated is a medical word that refers to the spread of an infection throughout the body. About 1–2 percent of people infected with gonorrhea develop DGI. The gonorrhea bacteria get into the bloodstream and are carried to other parts of the body. It can cause arthritis if it infects a joint. It can also infect the valves in the heart or the protective tissues that cover the brain and spinal cord.

Diagnosis

Gonorrhea is usually diagnosed by taking a sample of the discharge from the patient 's genitals or rectum, or a throat swab, and sending the sample to a laboratory for analysis. In addition, the doctor will take a careful history of the patient 's sexual contacts in order to determine whether they may have given the disease to others, and whether they may have gotten another sexually transmitted disease as well as gonorrhea. Doctors are required by law to report cases of gonorrhea to the Centers for Disease Control and Prevention (CDC) and to local public health departments.

A Deadly Form of Therapy

From the late Middle Ages to the early twentieth century, gonorrhea was often treated by giving the patient mercury, either by mouth, by rubbing it on the skin, or by injecting it into the opening of a man 's urethra. One way of treating patients with mercury that seems strange nowadays was called fumigation. The infected person was put inside a large wooden box with only their head sticking out. A small quantity of mercury was poured into the box, which was then heated. The heat caused the mercury to vaporize and enter the body when the patient breathed the vapors.

Mercury, however, is known to be toxic, causing teeth to fall out as well as causing chest pains, insomnia, muscle cramps, hallucinations, sleep disorders, paralysis, and depression. It was a common treatment for gonorrhea in spite of its dangers. The Lewis and Clark expedition (1804–1806) carried a supply of mercury for treating members of the group who had contracted gonorrhea from infected Native American women. The poet John Keats (1795–1821) died of tuberculosis, but some medical historians think that he weakened his lungs four years before his death by dosing himself with mercury to cure himself of gonorrhea.

As late as World War I (1914–1918) the medical department of the U.S. Army used a mercury compound to treat soldiers diagnosed with gonorrhea. Soldiers who lacked “moral stamina and self-control,” as the War Department put it, could ask for a tube of ointment containing mercury and silver for use after a night on the town. It was only with the mass production of penicillin in the 1940s that doctors had a treatment for gonorrhea that was safe as well as effective.

Treatment

The treatment of gonorrhea has become complicated in recent years because the bacteria have developed resistance to many of the antibiotics that were formerly effective against it. In April 2007 the Centers for Disease Control and

Prevention (CDC) added gonorrhea to the list of so-called superbugs—that is, diseases that are resistant to many antibiotics in common use. The standard treatment for uncomplicated gonorrhea is a single dose of an antibiotic, most commonly ceftriaxone (by injection) or cefixime (by mouth).

People with symptoms of either DGI or PID may need to be treated in a hospital, particularly if the heart or central nervous system is affected.

Prognosis

The prognosis for recovering from uncomplicated gonorrhea is very good provided that treatment is given promptly. Women have a 15 percent risk of being unable to have children after one episode of PID; if they have another attack, the risk rises to 50 percent. Most people can be successfully treated for DGI; however, a small percentage die of heart failure caused by infection of the heart valves.

Prevention

Gonorrhea can be prevented by abstinence or by having sex only with a faithful partner who is free of disease. Condoms offer excellent protection. It is best to avoid oral sex altogether.

People who are being treated for gonorrhea should not have sex with anyone until they are completely cleared of infection. They should tell their partners so that they can be tested for gonorrhea and treated if necessary.

Babies are protected against the disease by having silver nitrate drops placed in the eyes to prevent eye infection.

Having had gonorrhea offers no protection at all against reinfection. There is also no vaccine against the disease.

The Future

Gonorrhea is likely to continue to be a major public health problem for the foreseeable future for several reasons. One is the high rate of infection with other STDs among people diagnosed with gonorrhea. A second reason is complacency about the ease of treatment with older antibiotics; many people do not yet realize that drug-resistant strains of gonorrhea are increasingly widespread. A third reason is that many men, as well as women, are willing to have unprotected sex in exchange for alcohol or recreational drugs. In addition, the use of drugs and alcohol affects

people 's judgment about the health risks involved in sex with a large number of partners. Last, the Internet has made it increasingly easy for people to meet others for casual or risky sex.

SEE ALSO AIDS; Chlamydia; Genital herpes; Syphilis

WORDS TO KNOW

Abstinence: Not having sexual intercourse with anyone.

Carrier: A person who has an infectious disease and can transmit it to others but has no symptoms of the disease themselves.

Clap: A slang term for gonorrhea.

Disseminated gonococcal infection (DGI): A complication of gonorrhea in which the disease organisms get into the bloodstream and cause arthritis, eye disease, skin rashes, or inflammation of the heart valves.

Ectopic pregnancy: A pregnancy in which the fertilized egg starts growing outside the uterus, usually in the abdomen or in the tubes leading to the uterus.

Gonococcus: The bacterium that causes gonorrhea.

Pelvic inflammatory disease (PID): A complication of gonorrhea that can leave a woman permanently unable to have children.

Pus: A body fluid produced in response to bacterial infections. It consists of dead white blood cells and tissue fluid.

Urethra: The tube that allows urine to pass from the bladder to the outside of the body.

For more information

BOOKS

Kollar, Linda, and Brian Schmaefsky. Gonorrhea. Philadelphia: Chelsea House Publishers, 2005.

Michaud, Christopher. Gonorrhea. New York: Rosen Publishing Group, 2007.

PERIODICALS

Altman, Lawrence K. “Sex Infections Found in Quarter of Teenage Girls.” New York Times, March 12, 2008. Available online at http://query.nytimes.com/gst/fullpage.html?res=9507E6D6113BF931A25750C0A96E9C8B63&sec=&spon=&pagewanted=all (accessed April 15, 2008).

Specter, Michael. “Higher Risk.” New Yorker, May 23, 2005. Available online at http://www.newyorker.com/archive/2005/05/23/050523fa_fact?currentPage=all (accessed April 15, 2008). This is an article about the role of crystal methamphetamine addiction and the Internet in fueling an epidemic of sexually transmitted diseases among gay men.

WEB SITES

Centers for Disease Control and Prevention (CDC). Fact Sheet: Antimicrobial Resistance and Neisseria gonorrhoeae. http://www.cdc.gov/std/Gonorrhea/arg/stdfact-resistant-gonorrhea.htm (accessed April 13, 2008). This fact sheet contains the most recent CDC recommendations about treating antibiotic-resistant gonorrhea.

Mayo Clinic. Gonorrhea. Available online at http://www.mayoclinic.com/health/gonorrhea/DS00180 (accessed April 15, 2008).

National Institute of Allergy and Infectious Diseases (NIAID). Gonorrhea. Available online at http://www3.niaid.nih.gov/healthscience/healthtopics/gonorrhea/index.htm (accessed April 15, 2008).