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.

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 through culturing of the material from the swab (growing the bacteria) in the laboratory. The culture is positive when the gonorrhea bacteria are found to be growing on a culture plate. Sometimes the test does 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 penicillin, and are therefore more difficult to treat. Fortunately, gonorrhea can still be treated by other injectable or oral medications. Gonorrheal infections that infect the cervix, rectum, urethra, or throat are usually treated with one 400 mg oral dose of cefixime or an intramuscular injection of 125 mg of ceftriaxone. Alternative antibiotic regimens include: cefpodoxime, one 400 mg oral dose; ciprofloxacin, one 500 mg oral dose; ofloxacin, one 400 mg oral dose; levofloxacin, one oral 250 mg dose; and levofloxacin, one 250 mg oral dose. An intramuscular injection of 2 g of spectinomycin is also an alternative treatment in nonpregnant patients, but this treatment is not effective for throat infections caused by gonorrhea.

Treatment should always include medication that will treat chlamydia (such as azithromycin or doxycycline) as well as gonorrhea, because gonorrhea and chlamydia commonly 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. Recommended treatment regimens for PID include:

• Cefotetan: 2 g intravenously every 12 hours (or cefoxitin 2 g every six hours), plus 100 mg doxycycline intravenously or orally every 12 hours until improvement, then 100 mg doxycycline orally twice per day until 14 days have been completed.

• Clindamycin: 900 mg intravenously every 8 hours, plus one 2 mg per kilogram of body weight intravenous dose of gentamycin followed by 1.5 mg of gentamycin per kilogram body weight every eight hours, then 100 mg doxycycline orally twice per day until 14 days have been completed.

Acceptable alternative regimens for treatment of PID are:

• Ofloxacin: 400 mg intravenously every 12 hours or 500 mg of levofloxacin intravenously once per day, plus 500 mg of metronidazole intravenously every eight hours until improvement, then 100 mg of doxycycline orally twice per day until 14 days have been completed.

• Ampicillin/sulbactam: 3 g intravenously every six hours, plus 100 mg of doxycycline orally or intravenously every 12 hours until improvement, then 100 mg of doxycycline orally twice per day until 14 days have been completed.

Sometimes oral antibiotic regimens are used to treat PID. Oral antibiotics used to treat PID include:

• Ofloxacin: 400 mg twice per day for 14 days.

• Levofloxacin: 500 mg once daily, plus 500 mg of metronidazole twice daily for 14 days.

• Cefoxitin: one 2 g dose, along with 100 mg of doxycycline twice per day for 14 days.

It is important to note that doxycycline, one of the recommended drugs for treatment of PID, is not recommended for use in pregnant women.

Note: 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.