Gonorrhea
What is gonorrhea?
Gonorrhea is a bacterial infection
caused by the organism Neisseria gonorrheae that is transmitted by sexual
contact. Gonorrhea is one of the oldest known sexually transmitted diseases. It
is estimated that over one million women are currently infected with gonorrhea.
Among women who are infected, 25%-40% also will be infected with chlamydia,
another type of bacteria that causes another STD. (Chlamydia infection is
discussed later in this article.)
Contrary to popular belief, gonorrhea
cannot be transmitted from toilet seats or door handles. The bacterium that
causes gonorrhea requires very specific conditions for growth and reproduction.
It cannot live outside the body for more than a few seconds or minutes, nor can
it live on the skin of the hands, arms, or legs. It survives only on moist
surfaces within the body and is found most commonly in the vagina, and, more
commonly, the cervix. (The cervix is the end of the uterus that protrudes into
the vagina.) It can also live in the tube (urethra) through which urine drains
from the bladder. Gonorrhea can even exist in the back of the throat (from
oral-genital contact) and in the rectum.
Symptoms of gonorrhea
Over 50% of infected women have no
symptoms, especially in the early stages of the infection. Symptoms of
gonorrhea include burning or frequent urination, a yellowish vaginal discharge,
redness and swelling of the genitals, and a burning or itching of the vaginal
area. If untreated, gonorrhea can lead to a severe pelvic infection with
inflammation of the Fallopian tubes and ovaries. Gonorrheal infection of the
Fallopian tubes can lead to a serious, painful infection of the pelvis known as
pelvic inflammatory disease or PID. PID occurs in 10%-40% of women with
gonorrheal infection of the uterine cervix. Symptoms of pelvic infection
include fever, pelvic cramping, abdominal pain, or pain with intercourse.
Pelvic infection can lead to difficulty in becoming pregnant or even sterility.
Occasionally, if the infection is severe enough, a localized area of infection
and pus (an abscess) forms, and major surgery may be necessary and even
lifesaving. Gonorrhea infection in people with conditions causing serious
abnormal immune function, such as AIDS, can also be more serious.
Diagnosis of gonorrhea
Testing for gonorrhea is done by
swabbing the infected site (rectum, throat, cervix) and identifying the
bacteria in the laboratory either through culturing of the material from the
swab (growing the bacteria) or identification of the genetic material from the
bacteria. Sometimes the tests do not show bacteria because of sampling errors
(the sampled area does not contain bacteria) or other technical difficulties,
even when the woman has an infection. Newer tests to diagnose gonorrhea involve
the use of DNA probes or amplification techniques (for example, polymerase
chain reaction, or PCR) to identify the genetic material of the bacteria. These
tests are more expensive than cultures but typically yield more rapid results.
Treatment of gonorrhea
In the past, the treatment of
uncomplicated gonorrhea was fairly simple. A single injection of penicillin
cured almost every infected person. Unfortunately, there are new strains of
gonorrhea that have become resistant to various antibiotics, including
penicillins, and are therefore more difficult to treat. Fortunately, gonorrhea
can still be treated by other injectable or oral medications.
Uncomplicated gonococcal infections of
the cervix, urethra, and rectum, are usually treated by a single injection of
ceftriaxone intramuscularly or by 400mg of cefixime (Suprax) in a single oral
dose. For uncomplicated gonococcal infections of the pharynx, the recommended
treatment is 125 mg of ceftriaxone in a single IM dose.
Alternative regimens for uncomplicated
gonococcal infections of the cervix, urethra, and rectum are 2 g of
spectinomycin in nonpregnant women (not available in the United States) in a
single IM dose or single doses of cephalosporins (ceftizoxime, 500 mg IM; or
cefoxitin, 2 g IM, administered with probenecid (Benemid), 1 g orally; or
cefotaxime, 500 mg IM).
Treatment should always include
medication that will treat chlamydia [for example, azithromycin (Zithromax,
Zmax) or doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others)] as well
as gonorrhea, because gonorrhea and chlamydia frequently exist together in the
same person. The sexual partners of women who have had either gonorrhea or
chlamydia must receive treatment for both infections since their partners may
be infected as well. Treating the partners also prevents reinfection of the
woman. Women suffering from PID require more aggressive treatment that is
effective against the bacteria that cause gonorrhea as well as against other
organisms. These women often require intravenous administration of antibiotics.
It is important to note that
doxycycline, one of the recommended drugs for treatment of PID, is not
recommended for use in pregnant women.
Gonorrhea is one of the easier STDs to
prevent because the bacterium that causes the infection can survive only under
certain conditions. The use of condoms protects against gonorrhea infection.
Since the organism can live in the throat, condoms should be used during
oral-genital contact as well.
