Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae.
Gonorrhea is transmitted through direct close contact between individuals, usually sexual. And infection can be passed from mother to infant during passage through the birth canal. However, because N. gonorrhoeae does not survive long outside the human host, and is susceptible to temperature extremes and drying, transmission does not occur through skin to skin contact, or through contact with contaminated objects. Thus, N. gonorrhoeae cannot be contracted through contact with a contaminated toilet seat or other surface.
Gonorrhea is the second most frequently reported communicable infection in North America, second only to chlamydia.
Most cases of gonorrhea are uncomplicated genital tract infections: cervicitis in women, and urethritis in men. Infection of the lower genital tract occurs through direct inoculation of columnar epithelial cells of mucous membranes in the cervix and the urethra. Infection of the vagina does not usually occur, except in prepubescent females, where infection may involve vaginal epithelial cells and the vulva (vulvovaginitis). Changes that occur in the vaginal mucosa at puberty protect vaginal epithelial cells from invasion. Neisseria gonorrhoeae and Chlamydia trachomatis prefer columnar epithelial cells in the cervix.
- gonorrhoeae may also infect columnar epithelial of other mucosal surfaces: conjunctiva, throat (oropharynx) and rectal mucosa.
Most infections occur in the under age-24 group, especially those with multiple sexual partners who engage in unprotected sexual intercourse. In 2016, 340,000 cases of gonorrhea were reported to the Centers for Disease Control and Prevention (CDC). However, it is estimated that only about half of all infections are reported suggesting that approximately 700,000 cases of gonorrhea occur each year in the U.S. alone.
Gonococcal infection (gonorrhea) can be asymptomatic, especially in women. Most women who are infected do not have noticeable symptoms. Symptoms generally present 5-7 days following exposure, but may present as early as 2 days or as late as 30 days following exposure.
Symptoms of gonorrhea in men with acute urethritis include:
- white, yellow or green discharge (scant or copious; clear or purulent),
- frequency of urination,
- burning during urination.
Symptoms of gonorrhea in women with acute cervicitis/urethritis include:
- vaginal discharge,
- pain during urination,
- inflammation of the cervix ,
- irritation of the cervical os (opening),
- vaginal bleeding between periods.
Screening of women at high risk for sexually transmitted infection (STI/STD) is an essential component of the control of gonorrhea. Because gonorrhea is often asymptomatic in women, all sexually active women at increased risk should be screened for gonorrhea.
Risk factors include:
- previous sexually transmitted infection(s),
- new sexual partner(s),
- multiple sexual partners,
- inconsistent condom use,
- drug use,
- commercial sex trade work.
Treatment for uncomplicated gonorrhea includes:
- Ceftriaxone (125 mg single dose intramuscular injection)
- Cefixime (400 mg oral single dose)
- Ciprofloxacin (500 mg oral single dose)
- Ofloxacin (400 mg oral single dose)
- Levofloxacin (250 mg oral single dose)
Plus treatment for chlamydia, as appropriate.
Neisseria gonorrhea may also be involved in a number of other types of infections – conjunctivitis, oropharyngitis, rectal gonorrheae and other more complicated gonococcal infections.