gonorrhea

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Gonorrhea

 

Definition

Gonorrhea is a highly contagious sexually transmitted disease that is caused by the bacterium Neisseria gonorrhoeae. The mucous membranes of the genital region may become inflamed without the development of any other symptoms. When symptoms occur, they are different in men and women. In men, gonorrhea usually begins as an infection of the vessel that carries urine and sperm (urethra). In women, it will most likely infect the narrow part of the uterus (cervix). If untreated, gonorrhea can result in serious medical complications.

Description

Gonorrhea is commonly referred to as "the clap." The incidence of gonorrhea has steadily declined since the 1980s, largely due to increased public awareness campaigns and the risk of contracting other sexually transmitted diseases, such as AIDS. Still, current estimates range from 400,000 to as many as one million projected cases of gonorrhea in the United States each year. These estimates vary due to the private nature of the disease and the consequent underreporting that occurs. The majority of reported cases of gonorrhea come from public health clinics.
The disease affects people of all ages, races, and socioeconomic levels, but some individuals are more at-risk than others. Adolescents and young adults are the highest risk group, with more than 80% of the reported cases each year occurring in the 15-29 age group. Those individuals with multiple sexual partners and who use no barrier contraception, such as condoms, are most at-risk. Reported rates vary among racial and ethnic groups.
The risk factors for gonorrhea are not unlike those for all sexually transmitted diseases. Both men and women can become infected through a variety of sexual contact behaviors, including oral, anal, or vaginal intercourse. The disease is transmitted very efficiently. In fact, women run a 60-90% chance of contracting the disease after just one sexual encounter with an infected male. The disease can also be transmitted from an infected mother to her infant during delivery.

Causes and symptoms

If treated early, gonorrhea can be cured. Unfortunately, many individuals with gonorrhea, particularly women, will experience no symptoms to alert them to the possibility that they have contracted gonorrhea, and therefore, many do not seek treatment. When present, the symptoms and complications of gonorrhea are primarily limited to the genital, urinary, and gastrointestinal systems and usually begin between one day and two weeks following infection. If left untreated, serious complications can result if the disease spreads to the bloodstream and infects the brain, heart valves, and joints. Untreated gonorrhea can also result in severe damage to the reproductive system, making an individual unable to conceive a child (sterile).

Symptoms of gonorrhea in women

As many as 80% of women with gonorrhea show no symptoms. If present, symptoms may include the following:
  • bleeding between menstrual periods
  • chronic abdominal pain
  • painful urination
  • vaginal discharge, often cloudy and yellow
  • in the case of oral infection, there may be no symptoms or only a sore throat.
  • anal infection may cause rectal itching or discharge.
Because women often do not show any symptoms, complications are more likely to occur as the disease progresses. The most common complication is pelvic inflammatory disease (PID). PID can occur in up to 40% of women with gonorrhea and may result in damage to the fallopian tubes, a pregnancy developing outside the uterus (ectopic pregnancy), or sterility. If an infected woman is pregnant, gonorrhea can be passed on to her newborn through the birth canal during delivery. These infants may experience eye infections that could lead to blindness.

Symptoms of gonorrhea in men

Men are more likely to experience the following symptoms:
  • thick and cloudy discharge from the penis
  • burning or pain during urination
  • more frequent urination
  • in the case of oral infection, there may be no symptoms or only a sore throat
  • anal infection may cause rectal itching or discharge
In men, complications can affect the prostate, testicles, and surrounding glands. Inflammation, tissue death and pus formation (abscesses), and scarring can occur and result in sterility.

Diagnosis

The diagnosis of gonorrhea can be made at a public health clinic or a family physician office. First, the doctor will discuss symptoms and the patient's known contact or at-risk behavior. There are three methods available to test for the presence of Neisseria gonorrhoeae. These include a culture, a Gram stain, and an ELISA test. Culture of secretions from the infected area is the preferred method for gonorrhea screening in patients with or without symptoms. A cotton swab can be used to collect enough sample for a culture. The sample is incubated for up to two days, providing enough time for the bacteria to multiply and be accurately identified. This test is nearly 100% accurate.
Gram stains are more accurate in the diagnosis of gonorrhea in men than in women. To perform this test, a small amount of discharge from the infected area will be placed on a slide, stained with a special dye, and examined under a microscope for the presence of the gonococcus bacteria. The advantage to this test is that results can be obtained very quickly at the initial visit. Because it requires that the physician or technician be able to recognize and accurately identify the bacteria simply by looking at it under a microscope, however, this test is only about 70% accurate. As a result, one of the other methods may also be used to confirm the diagnosis.
ELISA, or enzyme-linked immunosorbent assay, has emerged as a rapid and sensitive test for gonorrhea. It is much more sensitive than the gram stain and is more convenient than the culture test, which involves the transport and storage of samples. As of late 1997, several other diagnostic tests were being researched with the goal of providing a cost-effective method of screening for a variety of sexually transmitted diseases. One of the most interesting of these is a home test that can be taken by the patient themselves, allowing for a degree of privacy and confidentiality.
When a patient suspects exposure to or experiences symptoms of gonorrhea, he or she may see a public health provider or family practice physician. Physicians trained in obstetrics or gynecology may also be involved, particularly if gynecological complications occur. Men who experience complications may be referred to a urologist. There are also infectious disease physicians who specialize in the treatment and research of all infectious diseases, including those transmitted sexually. All physicians must report this highly contagious disease to public health officials, and patients are asked to provide the names of sex partners during the suspected period of infection so that they can be notified of the risk.

Treatment

Gonorrhea has become more difficult and expensive to treat since the 1970s, due to the increased resistance of gonorrhea to certain antibiotics. In fact, according to projections from the Centers for Disease Control and Prevention, 30% of the strains of gonorrhea were resistant to routine antibiotics in 1994, and resistance has been increasing steadily. Furthermore, many patients have both gonorrhea and chlamydial infections. Therefore, two drug treatment regimens are common. Medications used to treat gonorrhea include ceftriaxone, cefixime, spectinomycin, ciprofloxacin, and ofloxacin. Ceftriaxone and doxycycline or azithromycin are often given simultaneously to treat possible co-existing chlamydia (in pregnant women, erythromycin should be substituted for the aforementioned anti-chlamydial agents). In 2004, reports said that oral antibiotics were preferred over intramuscular forms of the drugs. Also, researchers reported that cefixime had not been available and that fluoroquinolone had been used by more physicians to treat gonorrhea. However, fluoroquinolone resistance was rising among patients with gonorrhea, and in June 2004 the Centers for Disease Control recommended that clinicians no longer prescribe the drug as first-line treatment for gonorrhea in men who have sex with men.
An extremely important consideration is to make sure that all of the prescribed medication is taken. If a course of antibiotics is not completed, the medication will only kill those organisms that are susceptible to the antibiotic, allowing those that are resistant to the effects of that particular antibiotic to multiply and possibly cause a new infection that will be more difficult to treat. Patients should refrain from sexual intercourse until treatment is complete and return for follow-up testing. Any sexual partners during the time of infection, even if those partners do not show symptoms, should be notified and treated when any sexually transmitted disease is involved.

Alternative treatment

Although there is no known alternative to antibiotics in the treatment of gonorrhea, there are herbs and minerals that may be used to supplement antibiotic treatment:
  • Lactobacillus acidophilus or live-culture yogurts are helpful, while taking antibiotics, to replenish gastrointestinal flora.
  • The following supplements may be used to improve the body's immune function: zinc, multivitamins and mineral complexes, vitamin C, and garlic (Allium sativum).
  • Several herbs may reduce some symptoms or help speed healing: kelp has balanced vitamins and minerals. Calendula (Calendula officinalis), myrrh (Commiphora molmol), and thuja (Thuja occidentalis) may help reduce discharge and inflammation when used as a tea or douche.
  • Hot baths may also help reduce pain and inflammation.
  • A variety of herbs may help with symptoms of the reproductive and urinary systems.
  • If a physician approves, fasting, combined with certain juices, may help cleanse the urinary and gastrointestinal systems.
  • There may be acupressure and acupuncture points that will help with system cleansing. These exact pressure points can be provided and treated by an acupressurist or acupuncturist.

Prognosis

The prognosis for patients with gonorrhea varies based on how early the disease is detected and treated. If treated early and properly, patients can be entirely cured of the disease. Up to 40% of female patients who are not treated early may develop pelvic inflammatory disease (PID) and the possibility of resulting sterility. Although the risk of infertility is higher in women than in men, men may also become sterile if the urethra becomes inflamed (urethritis) as a result of an untreated gonorrhea infection. Following an episode of PID, a woman is six to 10 times more likely, should a pregnancy occur, to have a pregnancy develop outside the uterus (ectopic pregnancy), which can result in death. Liver infection may also occur in untreated women. In approximately 2% of patients with untreated gonorrhea, the gonococcal infection may spread throughout the body and can cause fever, arthritis-like joint pain, and skin lesions.

Key terms

Cervix — The narrow part or neck of the uterus.
Chlamydia — The most common bacterial sexually transmitted disease in the United States that often accompanies gonorrhea and is known for its lack of evident symptoms in the majority of women.
Ectopic pregnancy — A pregnancy that occurs outside the uterus, such as in the fallopian tubes. Although the fetus will not survive, in some cases, ectopic pregnancy can also result in the death of the mother.
ELISA — Enzyme-linked immunosorbent assay. This test has been used a screening test for AIDS for many years and has also been used to detect gonorrhea bacteria.
HIV — Human immunodeficiency virus, the virus that causes AIDS. The risk of acquiring AIDS is increased by the presence of gonorrhea or other sexually transmitted diseases.
Neisseria gonorrhoeae — The bacterium that causes gonorrhea. It cannot survive for any length of time outside the human body.
Pelvic inflammatory disease (PID) — An infection of the upper genital tract that is the most serious threat to a woman's ability to reproduce. At least 25% of women who contract the disease, which can be a complication of gonorrhea, will experience long-term consequences such as infertility or ectopic pregnancy.
Sexually transmitted diseases (STDs) — A group of diseases which are transmitted by sexual contact. In addition to gonorrhea, this groups generally includes chlamydia, HIV (AIDS), herpes, syphilis, and genital warts.
Sterile — Unable to conceive a child.
Urethra — The canal leading from the bladder, and in men, also a path for sperm fluid.
Urethritis — Inflammation of the urethra.

Prevention

Currently, there is no vaccine for gonorrhea, but several are under development. The best prevention is to abstain from having sex or to engage in sex only when in a mutually monogamous relationship in which both partners have been tested for gonorrhea, AIDS, and other sexually transmitted diseases. The next line of defense is the use of condoms, which have been shown to be highly effective in preventing disease (and unwanted pregnancies). To be 100% effective, condoms must be used properly. A female birth-control device that blocks the entry of sperm into the cervix (diaphragm) can also reduce the risk of infection. The risk of contracting gonorrhea increases with the number of sexual partners. Any man or woman who has sexual contact with more than one partner is advised to be tested regularly for gonorrhea and other sexually transmitted diseases.

Resources

Books

Sparling, P. Fredrick. "Gonococcal Infections." In Cecil Textbook of Medicine, edited by Russel L. Cecil, et al. Philadelphia: W.B. Saunders Company, 2000.

Periodicals

"Fluoroquinolone-resistant Gonorrhea on the Rise: Exposure History is Critical." Emergency Medicine Alert July 2004: 11-12.
Georgia, Kristen. "Revised Approach to Gonorrhea Treatment." Patient Care July 2004: 11.

Organizations

American Foundation for the Prevention of Venereal Disease, Inc. 799 Broadway, Suite 638, New York, NY 10003. (212) 759-2069.
National Institute of Allergy and Infectious Diseases. National Institutes of Health, Bethesda, MD 20892.

gonorrhea

 [gon″o-re´ah]
a highly contagious bacterial infection of the genitourinary system, one of the most common sexually transmitted diseases in the United States. It is caused by the bacterial organism Neisseria gonorrhoeae, or gonococcus. Characteristically, the bacteria attacks the mucous membranes of the genital and urinary organs, producing inflammation and pus. In adults the disease is almost always contracted by coitus or intimate contact with an infected person. Gonococcal pharyngitis and proctitis occur in both males and females as a result of orogenital or anogenital contact with an infected partner. These infections frequently present no symptoms in the early stages. However, if left untreated, gonococcal proctitis can produce rectal abscesses, fistulas, or strictures. adj., adj gonorrhe´al.
Symptoms. The first symptoms of genital gonorrhea usually appear within a week after exposure to the gonococcus, but they may take as long as 3 weeks to develop; 10–40 per cent of males and 10–80 per cent of females with gonorrhea are asymptomatic. In men the inflammation generally causes a painful burning sensation during urination, and the infected penis discharges a whitish fluid, or pus. If the condition remains untreated, the discharge increases and continues for 2 or 3 months. As the infection spreads to other membranes, complications such as inflammation of the prostate and the testes may result and can cause sterility.

A woman infected with gonorrhea may feel no pain and notice no early symptoms. She may, however, experience pain in the lower abdomen, with or without a burning sensation during urination or a whitish discharge from the vagina. If the infection is allowed to reach other organs of her reproductive system, the ovaries and the fallopian tubes may become inflamed and sterility can result.

If uncontrolled, the gonococcal infection may spread to contiguous organs, or it can become blood borne, so that sites of infection may occur in multiple and varied locations, such as the valves of the heart, meninges, joints, peritoneum, and skin.

Occasionally the gonococci may attack the membranes of the eye, resulting in blindness if untreated. This is not common in adults, but the eyes of babies may be infected at birth during passage through the birth canal of an infected mother. The condition that results is called ophthalmia neonatorum, and in the past it was a major cause of blindness in babies. Today it is usual (and required by law in some states) for all newborn infants to receive eye drops of penicillin or silver nitrate at birth as a protection against gonorrheal infection.
Diagnosis and Treatment. Diagnosis is confirmed by the presence of gonococci in the discharge from the penis or vagina or in fluid from any affected area. Gonorrhea is treated aggressively with antibiotics. Penicillin is no longer the treatment of choice because of the development of resistant organisms. ceftriaxone, ciprofloxacin, and ofloxacin are the current treatments of choice. The patient is usually treated for concurrent chlamydial infection with doxycycline hyclate or tetracycline.

Education and social support are critical to eliminating the disease in at-risk populations. The possibility of reinfection or infection of sexual partners should be discussed with the patient, as well as the importance of identifying and treating all sexual partners. Sexual abstinence or the use of a condom should be stressed. Oral sexual activity should be avoided if there is a pharyngeal infection.

gon·or·rhe·a (GC),

(gon'ō-rē'ă),
A contagious catarrhal inflammation of the genital mucous membrane, transmitted chiefly by coitus and due to Neisseria gonorrhoeae; may involve the lower or upper genital tract, especially the urethra, endocervix, and uterine tubes, or spread to the peritoneum and rarely to the heart, joints, or other structures by way of the bloodstream.
[G. gonorrhoia, fr. gonē, seed, + rhoia, a flow]

gonorrhea

/gon·or·rhea/ (gon″ah-re´ah) infection with Neisseria gonorrhoeae, most often transmitted venereally, marked in males by urethritis with pain and purulent discharge; commonly asymptomatic in females, but may extend to produce salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. Bacteremia may occur in both sexes, causing skin lesions, arthritis, and rarely meningitis or endocarditis.gonorrhe´al

gonorrhea

(gŏn′ə-rē′ə)
n.
A sexually transmitted disease caused by gonococcal bacteria that affects the mucous membrane chiefly of the genital and urinary tracts and is characterized by an acute purulent discharge and painful or difficult urination, though women often have no symptoms.

gon′or·rhe′al, gon′or·rhe′ic adj.

gonorrhea

[gon′ərē′ə]
Etymology: Gk, gone + rhoia, flow
a common sexually transmitted disease that most often affects the genitourinary tract and occasionally the pharynx or rectum. Infection results from contact with an infected person or with secretions containing the causative organism Neisseria gonorrhoeae. Infants born to infected women may acquire conjunctival infection from passage through the birth canal. Gonorrheal infections must be reported to local health departments in the United States. The Centers for Disease Control and Prevention estimate that more than 700,000 new infections occur annually. Also spelled gonorrhoea. gonorrheal, gonorrheic, adj.
observations Urethritis; dysuria; purulent, greenish-yellow urethral or vaginal discharge; red or edematous urethral meatus; and itching, burning, or pain around the vaginal or urethral orifice are characteristic. The vagina may be massively swollen and red, and the lower abdomen may be tense and very tender. As the infection spreads, as occurs more commonly in women than in men, nausea, vomiting, fever, and tachycardia may occur as salpingitis, oophoritis, or peritonitis develops. Inflammation of the tissues surrounding the liver also may occur, causing pain in the upper right quadrant of the abdomen. Severe disseminated infection is also more common in women than in men and is characterized by signs of septicemia with polyarthritis, tender papillary lesions on the skin of the hands and feet, and inflammation of the tendons of the wrists, knees, and ankles. Gonococcal ophthalmia involves infection of the conjunctiva and may lead to scarring and blindness. Gonorrhea is diagnosed by bacteriological culture of the organism from a smear obtained from a specimen of exudate. In men a microscopic study of a Gram's-stained specimen of exudate that reveals gram-negative intracellular diplococci is diagnostic of gonorrheal infection, but this finding is not diagnostic in women.
interventions The recommended regimen for uncomplicated gonorrhea is ceftriaxone, 125 mg, intramuscularly once or doxycycline, 100 mg, orally twice daily for 7 days. Generally patients with gonorrhea infections should be treated simultaneously for presumptive chlamydial infections. Alternative medications are ciprofloxacin, ofloxacin, cefixime, and azithromycin. Treatment failure of this regimen is rare; therefore a follow-up culture for test of cure is not essential. The routine instillation of 1% solution of silver nitrate or topical ophthalmic antibiotic into the eyes of the newborn provides effective prophylaxis against conjunctival infection in the newborn period that might otherwise result from contact with the infected secretions of an asymptomatic infected mother during vaginal delivery.
nursing considerations It is important that the patient's sexual contacts be treated. Before administration of any antibiotic it is ascertained that the patient does not have any known sensitivity to the drug being given and that equipment and drugs are available to treat any hypersensitivity reaction that may occur. Precaution against spread of the disease is recommended through condom use or monogamous sexual relations.
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Gonorrhea in the male patient
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Gonorrhea in the female patient

gonorrhea

STD An STD caused by Neisseria gonorrhoeae, which commonly affects the genitourinary tract in the form of PID, salpingitis, and urethral involvement; hematogenous spread may result in arthritis, hepatitis, and myocarditis; the gold standard for detecting N gonorrhoeae is culturing the organism in the microbiology lab Epidemiology 150 cases/100,000 population in 1995, most prevalent in young adults, especially with multiple partners; of infected ♀, 25-40% are co-infected with other bacteria–eg, chlamydia Clinical > Half of ♀ with gonorrhea are asymptomic; Sx include burning or urinary frequency, yellowish vaginal discharge, redness and swelling of genitals, vaginal burning or itching; untreated gonorrhea can lead to severe pelvic infections Specimen Swab from infected site–eg, vaginal, cervical, throat, anal, or urethral; DNA probes are the current diagnostic method of choice, and are performed from a swab. See Neisseria gonorrhoeae.

gon·or·rhe·a

(gon'ŏr-ē'ă)
A contagious catarrhal inflammation of the genital mucous membrane, acquired through sexual contact and due to Neisseria gonorrhoeae; may involve the lower or upper genital tract, especially the urethra, endocervix, and uterine tubes, or may spread to the peritoneum and rarely to the heart, joints, or other structures by way of the bloodstream.
Synonym(s): gonorrhoea.
[G. gonorrhoia, fr. gonē, seed, + rhoia, a flow]

gon·or·rhe·a

(gon'ŏr-ē'ă)
A contagious catarrhal inflammation of the genital mucous membrane, transmitted chiefly by coitus and due to Neisseria gonorrhoeae; may involve the lower or upper genital tract, especially urethra endocervix, and uterine tubes, or spread to the peritoneum and, rarely, to the heart, joints, or other structures by way of the bloodstream.
Synonym(s): gonorrhoea.
[G. gonorrhoia, fr. gonē, seed, + rhoia, a flow]

gonorrhea (gon´ərē´ə),

n a sexually transmitted disease of the genitourinary tract that is spread by direct contact with an infected person or fluids containing the infectious microorganism. It may also affect the conjunctiva, oral tissue, and other tissues and organ systems.