Gonorrhea

Gonorrhea - colloquially known as "the clap" - is a common sexually transmitted infection, and is thought to be the second most prevalent STI in the US and UK.

Gonorrhea is caused by a bacterium called neisseria gonorrhoeae. It is transmitted through vaginal, anal and oral sex. The chance for men to get the infection through vaginal intercourse with an infected woman is roughly 20%, and is higher for homosexual intercourse. In women the chance of getting the infection is much higher, roughly 60-80% when having sex with an infected man. Gonorrhea, like other STIs such a chlamydia, may be passed on to babies by infected women, and can infect the infant's eyes (ophthamia neonatorum).

Signs and Symptoms

Around 50% of case of gonorrhea in women are asymptomatic, showing no symptoms. In other cases, symptoms may include vaginal discharge, lower abdominal pain, or pain during intercourse.

In men symptoms usually present as burning during urination as well as discharge from the penis.

Either sex may be infected with gonorrhea of the throat during oral intercourse, although the chances are higher in men. 90% of gonorrhea of the throat are asymptomatic, and only produces a sore throat in the remaining 10% of cases.

The incubation period of gonorrhea ranges between 2 to 14 days, with most symptoms occurring in the first week. Gonorrhea can rarely cause skin lesions as well as joint infection as it travels through the blood stream. Very rarely it can cause endocarditis in the heart, or meningitis if it settles in the spine, although both of these generally only occur in those with suppressed immune systems.

If left untreated gonorrhea may last for months and can lead to severe complications, which may include skin pustules, septic arthritis, meningitis, and endocarditis.  In men it can lead to epididymitis, prostatitis and urethritis. In women the most common result of untreated gonorrhea is pelvic inflammatory disease.

Diagnosis and Treatment

Gonorrhea is often diagnosed with either gram stain and culture, or polymerase chain reaction based tests, with the latter becoming more popular and common in recent times. A culture may be done multiple times, such as after a failed course of treatment, to determine any sensitivity to antibiotics. It is common for those who test positive for gonorrhea to be screened for other STIs including chlamydia, syphilis and HIV.

In the United States, women under the age of 25 are encouraged to attend regular screenings for gonorrhea if they are sexually active, and regardless of whether they show signs or symptoms, but this practice has not been extended to men. Women are also encouraged to attend screenings if they are intending to get pregnant, and are at a high risk for STIs.

It has recently come to light that gonorrhea has developed resistance to many conventional antibiotics previously used to treat it, and as such ceftriaxone is frequently used in combination with azithromycin and doxycycline. However certain strains of gonorrhea have begun to show resistance to ceftriaxone.