Gonorrhea

Gonorrhea
Synonyms	The clap
Field	Infectious disease
Complications	Pelvic inflammatory disease, Epididymitis, Disseminated gonococcal infection
Causes	Neisseria gonorrhoeae
Diagnosis	Nucleic acid amplification test, Gram stain, Culture
Differential	Chlamydia
Prevention	Condoms, PrEP, Mutual monogamy
Treatment	Ceftriaxone, Azithromycin

Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. Infection may involve the urethra, cervix, rectum, pharynx, or conjunctiva, and many individuals, particularly women, experience no symptoms. If left untreated, it can lead to serious complications including pelvic inflammatory disease and infertility.

Signs and symptoms

In men, infection often presents with dysuria and purulent urethral discharge. Women may experience vaginal discharge, dysuria, and intermenstrual bleeding, though a significant proportion are asymptomatic. Rectal infection can cause proctitis, while pharyngeal infection is frequently symptomless. A severe complication is disseminated gonococcal infection, which can manifest as arthritis, tenosynovitis, and dermatitis. In newborns, exposure during childbirth can cause ophthalmia neonatorum, a serious eye infection.

Causes

The disease is caused by the gram-negative diplococcus Neisseria gonorrhoeae. Transmission occurs primarily through sexual contact, including vaginal intercourse, anal sex, and oral sex. The bacteria infect the mucous membranes of the reproductive tract, but can also infect the mouth, throat, eyes, and rectum. Vertical transmission from mother to infant can occur during delivery.

Diagnosis

Diagnosis is typically confirmed through laboratory testing. Nucleic acid amplification tests (NAATs) performed on urine, swabs, or self-collected vaginal swabs are highly sensitive and specific. Traditional methods include Gram stain of a urethral discharge sample, which may show gram-negative diplococci within polymorphonuclear leukocytes, and culture on selective media like Thayer-Martin agar. Culture is essential for antimicrobial susceptibility testing, particularly given rising antibiotic resistance.

Prevention

Consistent and correct use of latex or polyurethane condoms during sexual activity reduces transmission risk. Pre-exposure prophylaxis (PrEP) for HIV has also been associated with reduced incidence. Public health strategies include screening asymptomatic individuals at high risk and partner notification programs. For newborns, the application of erythromycin or tetracycline ophthalmic ointment prevents ophthalmia neonatorum.

Treatment

Due to widespread resistance, the Centers for Disease Control and Prevention recommends dual therapy with a single intramuscular dose of ceftriaxone and an oral dose of azithromycin. For patients with severe penicillin allergy, alternative regimens may include gentamicin combined with azithromycin. It is critical to test for and treat other sexually transmitted infections like chlamydia and syphilis. All sexual partners from the previous 60 days should be referred for evaluation and treatment.

Epidemiology

Gonorrhea is a global public health concern, with an estimated 87 million new cases annually according to the World Health Organization. In the United States, the Centers for Disease Control and Prevention reports over half a million cases annually, with the highest rates among adolescents, young adults, and men who have sex with men. The emergence of multidrug-resistant strains, including resistance to cephalosporins, has been reported in regions like Asia, the Pacific Islands, and the United Kingdom.

History

Descriptions of a condition resembling gonorrhea appear in ancient texts, including the Ebers Papyrus and the writings of Galen, who is credited with naming the disease. For centuries, it was confused with syphilis until the work of Philippe Ricord in the 19th century distinguished the two. The causative agent, Neisseria gonorrhoeae, was identified in 1879 by Albert Neisser. The penicillin era began with its successful use by John Mahoney at the United States Public Health Service in the 1940s, though resistance emerged rapidly.

Category:Sexually transmitted diseases and infections