What Is Gonorrhea?
Gonorrhea, a prevalent sexually transmitted infection (STI), spreads primarily through sexual contact. It is a bacterial condition that can target diverse areas of the body, including the eyes, mouth, throat, reproductive organs, genitals, and rectum—the latter being the final section of the large intestine.
In the United States, gonorrhea ranks as the second most common bacterial STI according to self-reports, with substantial documentation provided by the Centers for Disease Control and Prevention (CDC).
Globally, the World Health Organization (WHO) estimated approximately 82.4 million cases in 2020. Meanwhile, the United States witnessed about 710,000 cases in 2021, with individuals aged 15 to 24 comprising over half of these infections.
Though many cases remain asymptomatic, untreated gonorrhea can escalate into serious health issues.
Locations of Infection
Gonorrhea can affect multiple parts of the body: mouth, throat, eyes, reproductive organs, urethra (responsible for expelling urine), and rectum. Its diagnosis hinges on identifying the specific site of infection, as the bacteria can travel between different body regions.
Rectal Gonorrhea This variant manifests in the rectum or anal area. It often spreads through anal intercourse but can migrate to the genital region.
Oropharyngeal Gonorrhea Oropharyngeal gonorrhea infects the mouth and throat. Transmission typically occurs via oral sex with an infected partner, but kissing or any oral-genital contact can also spread the bacteria.
Urogenital Gonorrhea Urogenital gonorrhea involves the urinary and reproductive systems. It may affect the urethra and various reproductive organs—external ones like the penis, prostate, and epididymis, or internal ones such as the cervix, uterus, and fallopian tubes.
Conjunctival Gonorrhea Conjunctival gonorrhea targets the eyes and is more prevalent among newborns exposed to genital secretions during childbirth. An estimated 30% to 50% of babies born to mothers with gonorrhea contract this form of the infection.
Symptoms of Gonorrhea
Many individuals show no symptoms, but when symptoms occur, they differ depending on the infection site.
Rectal Gonorrhea Symptoms Often silent, rectal gonorrhea may cause:
- Discharge or pain in the rectum
- Rectal bleeding
- Painful bowel movements
- Anal itching
Oropharyngeal Gonorrhea Symptoms This form is generally asymptomatic but may present:
- Sore or scratchy throat
- Swollen lymph nodes
- Difficulty swallowing
Urogenital Gonorrhea Symptoms For those with internal reproductive organs, over half remain asymptomatic. Symptoms, when present, may resemble bladder or vaginal infections:
- Pain during urination
- Abnormal vaginal discharge
- Pain during intercourse
- Vaginal itching or irregular bleeding
- Pelvic or lower abdominal pain
Individuals with external reproductive organs typically show symptoms:
- Painful urination
- Penile discharge or itching
- Testicular pain or swelling
Conjunctival Gonorrhea Symptoms This condition may include:
- Eye redness
- Swelling of the eyelids
- Eye discharge
- Vision issues
Causes
The bacterium Neisseria gonorrhoeae causes gonorrhea. Sexual activities—oral, vaginal, or anal—facilitate its transmission, even without ejaculation. Non-intercourse sexual contact and shared, unclean sex toys can also spread the infection.
Diagnosis
Healthcare providers typically request a urine sample for nucleic acid amplification testing (NAAT), which detects minute bacterial traces. Additional tests, like swabs from the vagina, cervix, urethra, rectum, or throat, may be performed to identify infection.
Treatment
Treatment involves a single intramuscular injection of antibiotics, usually 500 mg of Rocephin (ceftriaxone) for adults under 330 pounds, or 1 gram for those over this weight.
Alternatives exist for individuals allergic to cephalosporins, including a combination of Garamycin (gentamycin) and Zithromax. Chlamydia, often co-occurring with gonorrhea, may require doxycycline.
It is crucial to complete all antibiotics, abstain from sex for seven days after finishing treatment, and ensure partners receive treatment to prevent reinfection.
Prevention
Preventative measures include:
- Consistent use of condoms and dental dams
- Limiting sexual partners or maintaining monogamy
- Regular STI screenings, especially for sexually active individuals under 25
High-risk groups, including those with other STIs or multiple partners, should prioritize screening. Pregnant individuals are screened early and, if needed, treated to avoid neonatal complications.
Complications and Related Conditions
If untreated, gonorrhea can lead to pelvic inflammatory disease (PID) in individuals with internal reproductive organs, causing chronic pain, scarring, ectopic pregnancy, and infertility. For those with external reproductive systems, it raises the risk of epididymitis, prostatitis, and proctitis.
Infants exposed during birth risk blindness, joint infection, or severe blood infections.
Living With Gonorrhea
Regular STI screening, completing antibiotics, and notifying partners are vital steps in managing gonorrhea. Awareness and responsible sexual behavior are key to curbing its spread and preventing serious health repercussions.