What is gonorrhea?

Gonorrhea

Gonorrhea is an STD that is caused by the bacteria Neisseria gonorrhea. In women, this infection often causes no symptoms and can therefore often go undiagnosed. In contrast, men usually have the symptoms of urethritis, burning on urination, and penile discharge. Gonorrhea can also infect the throat (pharyngitis) and the rectum (proctitis). Proctitis results in diarrhea (frequent bowel movements) and an anal discharge (drainage from the rectum). Gonorrhea can also cause epididymitis and orchitis. What is more, gonorrhea can cause systemic disease (throughout the body) and most commonly results in swollen and painful joints or skin rash. Many patients with gonorrhea also are infected with Chlamydia.

Symptoms of gonorrhea usually develop in men within 4 to 8 days after genital infection, although in some cases they may occur after a longer time period.

How is gonorrhea diagnosed?

Gonorrhea may be diagnosed by demonstration of the characteristic bacteria when urethral secretions are examined microscopically. Gonorrhea can also be diagnosed by a culture from the infected area, such as the urethra, anus, or throat. In patients with systemic gonorrhea with, for example, arthritis or skin involvement, the organism can occasionally be cultured from the blood. Newer, rapid diagnostic tests that demonstrate the genetic material of N. gonorrhea are also available.

How is gonorrhea treated?

The treatment of uncomplicated gonorrhea affecting the urethra or rectum is usually a single-dose injection of ceftriaxone 125 mg. Because of developing bacterial strains that are resistant to certain antibiotics, ceftriaxone is the recommended treatment for all patients in Hawaii and California, for men who have sex with other men, and for persons who acquired the infection in certain parts of the world. In all other patient populations, alternative treatments include oral doses of cefixime (Suprax) 400 mg, ciprofloxacin (Cipro) 500 mg, ofloxacin (Oflox) 400 mg, cefpodoxime 400 mg, or levofloxacin 250 mg daily. An intramuscular injection of 2 g of spectinomycin is also an alternative treatment.

Many patients with gonorrhea are simultaneously infected with chlamydia. Patients treated for gonorrhea, therefore, should also be treated for chlamydia with a single dose of azithromycin 1 gram or doxycycline 100 mg twice per day for 7 days, both of which are taken by mouth. Throat infection (pharyngitis) caused by gonorrhea is somewhat more difficult to treat than genital infection. Recommended antibiotics for treatment of gonococcal pharyngitis include ceftriaxone 125 g intramuscularly, ciprofloxacin 500 mg orally, and ofloxacin 400 mg orally.

Systemic gonorrheal infections involving the skin and/or joints is generally treated with either daily injections of ceftriaxone 1 gram in the muscle tissue (intramuscularly) or in the vein (intravenously) every 24 hours, or cefotaxime or ceftizoxime 1 gram intravenously every 8 hours. If the patient does not need admission to the hospital or is stable enough for discharge, the treatment can be one of the quinolone antibiotics (ciprofloxacin 500 mg twice per day orofloxacin 400 mg once daily) for 14 days, along with the treatment for Chlamydia. However, the increasing development of bacteria resistant to quinolones, make these drugs less reliable in certain geographic areas, including Hawaii and other Pacific areas, and possibly California. Another option for the treatment of disseminated (throughout the body) gonococcal infections is spectinomycin 2 g intramuscularly every 12 hours.

What should a person do if exposed to someone with gonorrhea?

A person who is sexually exposed to an individual that is infected with gonorrhea should seek medical attention. If the last sexual contact was within 60 days of the partner's diagnosis, the person should be treated for both gonorrhea and Chlamydia. People whose last sexual contact was more than 60 days before the partner's diagnosis should be evaluated for symptoms and have diagnostic studies performed. Treatment for individuals whose exposure was relatively in the more distant past should be limited to those who have symptoms or positive diagnostic tests.