Gonorrhea
Encyclopedia
Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae
. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge
and pelvic pain
. In both men and women if gonorrhea is left untreated, it may spread locally causing epididymitis
or pelvic inflammatory disease
or throughout the body, affecting joints and heart valves.
Treatment is commonly with ceftriaxone
as antibiotic resistance
has developed to many previously used medications.
In 2011, there were reports of some strains of gonorrhea showing resistance to ceftriaxone
.
while others have vaginal discharge
, lower abdominal pain or pain with intercourse
. Most men who are infected have symptoms such as urethritis
associated with burning with urination
and discharge from the penis.
The incubation period
is 2 to 30 days with most symptoms occurring between 4–6 days after being infected.
. The infection is transmitted from one person to another through vaginal, oral, or anal sex. Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for men who have sex with men is higher. Women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with an infected man. A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum
. It cannot be spread by toilets or bathrooms.
; however, newer polymerase chain reaction
(PCR) based testing methods are becoming more common. In those who fail initial treatment culture should be done to determine sensitivity to antibiotics. All people who test positive for gonorrhea should be tested for other sexually transmitted diseases such as chlamydia
, syphilis
and human immunodeficiency virus.
Gonorrhea if left untreated may last for weeks or months with higher risks of complications. As of 2010 injectable ceftriaxone
appears to be one of the few effective antibiotics. Because of increasing rates of antibiotic resistance
local susceptibility patterns need to be taken into account when deciding on treatment. Many antibiotics that were once effective including penicillin
, tetracycline and fluoroquinolones are no longer recommended because of high rates of resistance. Cases of resistance to ceftriaxone have been reported but are still rare.
In 2011, there have been reports of a "Superbug" gonorrhea which is antibiotic resistant, specifically that this new strain is resistant to both cefixime (oral medication) and ceftriaxone (intravenous).
, septic arthritis
, meningitis
or endocarditis
. This occurs in between 0.6 and 3.0% of women and 0.4 and 0.7% of men.
In men, inflammation of the epididymis (epididymitis
); prostate gland (prostatitis
) and urethral stricture (urethritis
) can result from untreated gonorrhea. In women, the most common result of untreated gonorrhea is pelvic inflammatory disease
. Other complications include perihepatitis
, a rare complication associated with Fitz-Hugh-Curtis syndrome
; septic arthritis
in the fingers, wrists, toes, and ankles; septic abortion
; chorioamnionitis
during pregnancy; neonatal or adult blindness from conjunctivitis; and infertility.
Neonates coming through the birth canal are given erythromycin ointment in the eyes to prevent blindness from infection.
The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.
Among persons in the United States between 14 and 39 years of age, 46% of people with gonorrheal infection also have chlamydial infection.
. In the United Kingdom 196 per 100,000 males 20 to 24 years old, and 133 per 100,000 females 16 to 19 years old were diagnosed in 2005. The CDC estimates that more than 700,000 people in the United States get new gonorrheal infections each year. Only about half of these infections are reported to CDC. In 2004, 330,132 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113.5 per 100,000 persons.
In the US, it is the second most common bacterial sexually transmitted infections after chlamydia.
was used as a treatment for gonorrhea. Surgeons' tools on board the recovered English warship the Mary Rose
included a syringe
that, according to some, was used to inject the mercury via the urinary meatus
into any unfortunate crewman suffering from gonorrhea. The name "the clap", in reference to the disease, is recorded as early as the sixteenth century.
Silver nitrate
was one of the widely used drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün
invented this type of colloidal silver, which was marketed by Bayer
from 1897 on. The silver-based treatment was used until the first antibiotics came into use in the 1940s.
The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record. One of the first reliable notations occur in the Acts of the (English) Parliament. In 1161 this body passed a law to reduce the spread of "...the perilous infirmity of burning." The symptoms described are consistent with, but not diagnostic of, gonorrhea. A similar decree was passed by Louis IX
in France in 1256, replacing regulation with banishment. Similar symptoms were noted at the siege of Acre
by Crusaders
.
Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several changes occurred in European medieval society. Cities hired public health
doctors to treat afflicted patients without right of refusal. Pope Boniface
rescinded the requirement that physicians complete studies for the lower orders of the Catholic priesthood.
Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as lepers and other epidemic victims. After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted disease.
Neisseria gonorrhoeae
Neisseria gonorrhoeae, also known as gonococci , or gonococcus , is a species of Gram-negative coffee bean-shaped diplococci bacteria responsible for the sexually transmitted infection gonorrhea.N...
. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge
Vaginal discharge
Vaginal discharge is term given to biological fluids contained within or expelled from the vagina.While most discharge is normal and can reflect the various stages of a woman's cycle, some discharge can be a result of an infection, such as a sexually transmitted disease.The term blennorrhea is...
and pelvic pain
Pelvic pain
Pelvic pain is a symptom that can affect both women and men. The pelvic pain that persists for a period of 3 months or more to be considered chronic while less than this duration is considered acute. The pain may indicate the existence of poorly-understood conditions that likely represent abnormal...
. In both men and women if gonorrhea is left untreated, it may spread locally causing epididymitis
Epididymitis
Epididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...
or pelvic inflammatory disease
Pelvic inflammatory disease
Pelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
or throughout the body, affecting joints and heart valves.
Treatment is commonly with ceftriaxone
Ceftriaxone
Ceftriaxone is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram-positive and Gram-negative bacteria. In most cases, it is considered to be equivalent to cefotaxime in terms of safety and efficacy...
as antibiotic resistance
Antibiotic resistance
Antibiotic resistance is a type of drug resistance where a microorganism is able to survive exposure to an antibiotic. While a spontaneous or induced genetic mutation in bacteria may confer resistance to antimicrobial drugs, genes that confer resistance can be transferred between bacteria in a...
has developed to many previously used medications.
In 2011, there were reports of some strains of gonorrhea showing resistance to ceftriaxone
Ceftriaxone
Ceftriaxone is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram-positive and Gram-negative bacteria. In most cases, it is considered to be equivalent to cefotaxime in terms of safety and efficacy...
.
Signs and symptoms
Half of women with gonorrhea are asymptomaticAsymptomatic
In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical...
while others have vaginal discharge
Vaginal discharge
Vaginal discharge is term given to biological fluids contained within or expelled from the vagina.While most discharge is normal and can reflect the various stages of a woman's cycle, some discharge can be a result of an infection, such as a sexually transmitted disease.The term blennorrhea is...
, lower abdominal pain or pain with intercourse
Dyspareunia
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original...
. Most men who are infected have symptoms such as urethritis
Urethritis
Urethritis is inflammation of the urethra. The most common symptom is painful or difficult urination.-Causes:The disease is classified as either gonococcal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis , most commonly caused by Chlamydia trachomatis...
associated with burning with urination
Dysuria
In medicine, specifically urology, dysuria refers to painful urination.Difficult urination is also sometimes described as dysuria.It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria....
and discharge from the penis.
The incubation period
Incubation period
Incubation period is the time elapsed between exposure to a pathogenic organism, a chemical or radiation, and when symptoms and signs are first apparent...
is 2 to 30 days with most symptoms occurring between 4–6 days after being infected.
Cause
Gonorrhea is caused by the bacteria Neisseria gonorrhoeaeNeisseria gonorrhoeae
Neisseria gonorrhoeae, also known as gonococci , or gonococcus , is a species of Gram-negative coffee bean-shaped diplococci bacteria responsible for the sexually transmitted infection gonorrhea.N...
. The infection is transmitted from one person to another through vaginal, oral, or anal sex. Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for men who have sex with men is higher. Women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with an infected man. A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum
Ophthalmia neonatorum
Neonatal conjunctivitis, also known as ophthalmia neonatorum, is a form of bacterial conjunctivitis contracted by newborns during delivery. The baby's eyes are contaminated during passage through the birth canal from a mother infected with either Neisseria gonorrhoeae or Chlamydia trachomatis....
. It cannot be spread by toilets or bathrooms.
Diagnosis
Traditionally, gonorrhea was diagnosed with gram stain and cultureCulture
Culture is a term that has many different inter-related meanings. For example, in 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of "culture" in Culture: A Critical Review of Concepts and Definitions...
; however, newer polymerase chain reaction
Polymerase chain reaction
The polymerase chain reaction is a scientific technique in molecular biology to amplify a single or a few copies of a piece of DNA across several orders of magnitude, generating thousands to millions of copies of a particular DNA sequence....
(PCR) based testing methods are becoming more common. In those who fail initial treatment culture should be done to determine sensitivity to antibiotics. All people who test positive for gonorrhea should be tested for other sexually transmitted diseases such as chlamydia
Chlamydia
Chlamydia infection is a common sexually transmitted infection in humans caused by the bacterium Chlamydia trachomatis. The term Chlamydia infection can also refer to infection caused by any species belonging to the bacterial family Chlamydiaceae. C. trachomatis is found only in humans...
, syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
and human immunodeficiency virus.
Screening
The United States Preventive Services Task Force recommends screening for gonorrhea in women at increased risk of infection which includes all sexually active women younger than 25 years. It is not recommended in males without symptoms or low risk women.Prevention
While the only sure way of preventing gonorrhea is abstaining from sexual intercourse, the risk of infection can be reduced significantly by using condoms correctly and by having a mutually monogamous relationship with an uninfected person.Treatment
Ceftriaxone
Ceftriaxone is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram-positive and Gram-negative bacteria. In most cases, it is considered to be equivalent to cefotaxime in terms of safety and efficacy...
appears to be one of the few effective antibiotics. Because of increasing rates of antibiotic resistance
Antibiotic resistance
Antibiotic resistance is a type of drug resistance where a microorganism is able to survive exposure to an antibiotic. While a spontaneous or induced genetic mutation in bacteria may confer resistance to antimicrobial drugs, genes that confer resistance can be transferred between bacteria in a...
local susceptibility patterns need to be taken into account when deciding on treatment. Many antibiotics that were once effective including penicillin
Penicillin
Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
, tetracycline and fluoroquinolones are no longer recommended because of high rates of resistance. Cases of resistance to ceftriaxone have been reported but are still rare.
In 2011, there have been reports of a "Superbug" gonorrhea which is antibiotic resistant, specifically that this new strain is resistant to both cefixime (oral medication) and ceftriaxone (intravenous).
Partners
It is recommended that sexual partners be tested and potentially treated. One option for treating sexual partners of people infected is patient-delivered partner therapy (PDPT) which involves providing prescriptions or medications to the person to take to their partner without the health care provider first examining them.Complications
One of the complication of gonorrhea is systemic dissemination resulting in skin pustules or petechiaPetechia
A petechia is a small red or purple spot on the body, caused by a minor hemorrhage ."Petechiae" refers to one of the three major classes of purpuric skin conditions. Purpuric eruptions are classified by size into three broad categories...
, septic arthritis
Septic arthritis
Septic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis. People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment. Septic...
, meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
or endocarditis
Endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
. This occurs in between 0.6 and 3.0% of women and 0.4 and 0.7% of men.
In men, inflammation of the epididymis (epididymitis
Epididymitis
Epididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...
); prostate gland (prostatitis
Prostatitis
Prostatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
) and urethral stricture (urethritis
Urethritis
Urethritis is inflammation of the urethra. The most common symptom is painful or difficult urination.-Causes:The disease is classified as either gonococcal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis , most commonly caused by Chlamydia trachomatis...
) can result from untreated gonorrhea. In women, the most common result of untreated gonorrhea is pelvic inflammatory disease
Pelvic inflammatory disease
Pelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
. Other complications include perihepatitis
Perihepatitis
Perihepatitis is inflammation of the serous or peritoneal coating of the liver.Perihepatitis is often caused by one of the inflammatory disorders of the female upper genital tract, known collectively as Pelvic inflammatory disease....
, a rare complication associated with Fitz-Hugh-Curtis syndrome
Fitz-Hugh-Curtis syndrome
Fitz-Hugh-Curtis syndrome is a rare complication of pelvic inflammatory disease named after the two physicians, Thomas Fitz-Hugh, Jr and Arthur Hale Curtis who first reported this condition in 1934 and 1930 respectively. It involves liver capsule inflammation.-Pathophysiology:Fitz-Hugh-Curtis...
; septic arthritis
Septic arthritis
Septic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis. People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment. Septic...
in the fingers, wrists, toes, and ankles; septic abortion
Septic abortion
A septic abortion or septic miscarriage is a form of miscarriage that is associated with a serious uterine infection. The infection carries risk of spreading infection to other parts of the body and cause septicaemia, a grave risk to the life of the woman.-Causes:A septic abortion can occur when...
; chorioamnionitis
Chorioamnionitis
Chorioamnionitis is an inflammation of the fetal membranes due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labour...
during pregnancy; neonatal or adult blindness from conjunctivitis; and infertility.
Neonates coming through the birth canal are given erythromycin ointment in the eyes to prevent blindness from infection.
The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.
Among persons in the United States between 14 and 39 years of age, 46% of people with gonorrheal infection also have chlamydial infection.
Epidemiology
Gonorrhea is a common infectious diseaseInfectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
. In the United Kingdom 196 per 100,000 males 20 to 24 years old, and 133 per 100,000 females 16 to 19 years old were diagnosed in 2005. The CDC estimates that more than 700,000 people in the United States get new gonorrheal infections each year. Only about half of these infections are reported to CDC. In 2004, 330,132 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113.5 per 100,000 persons.
In the US, it is the second most common bacterial sexually transmitted infections after chlamydia.
History
It has been suggested that mercuryMercury (element)
Mercury is a chemical element with the symbol Hg and atomic number 80. It is also known as quicksilver or hydrargyrum...
was used as a treatment for gonorrhea. Surgeons' tools on board the recovered English warship the Mary Rose
Mary Rose
The Mary Rose was a carrack-type warship of the English Tudor navy of King Henry VIII. After serving for 33 years in several wars against France, Scotland, and Brittany and after being substantially rebuilt in 1536, she saw her last action on 1545. While leading the attack on the galleys of a...
included a syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
that, according to some, was used to inject the mercury via the urinary meatus
Urinary meatus
The urinary meatus is an orifice of the urethra. It is the point at which urine and, in males, semen exits the urethra. The meatus features varying degrees of sensitivity to the touch among males and females....
into any unfortunate crewman suffering from gonorrhea. The name "the clap", in reference to the disease, is recorded as early as the sixteenth century.
Silver nitrate
Silver nitrate
Silver nitrate is an inorganic compound with chemical formula . This compound is a versatile precursor to many other silver compounds, such as those used in photography. It is far less sensitive to light than the halides...
was one of the widely used drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün
Arthur Eichengrün
Arthur Eichengrün was a German chemist, best known through a controversy about who invented aspirin.- Life :Arthur Eichengrün was born in Aachen as the son of a Jewish cloth merchant and manufacturer...
invented this type of colloidal silver, which was marketed by Bayer
Bayer
Bayer AG is a chemical and pharmaceutical company founded in Barmen , Germany in 1863. It is headquartered in Leverkusen, North Rhine-Westphalia, Germany and well known for its original brand of aspirin.-History:...
from 1897 on. The silver-based treatment was used until the first antibiotics came into use in the 1940s.
The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record. One of the first reliable notations occur in the Acts of the (English) Parliament. In 1161 this body passed a law to reduce the spread of "...the perilous infirmity of burning." The symptoms described are consistent with, but not diagnostic of, gonorrhea. A similar decree was passed by Louis IX
Louis IX
Louis IX may refer to:* Louis IX of France .* Louis IX, Duke of Bavaria "the Rich" * Louis IX, Landgrave of Hesse-Darmstadt ....
in France in 1256, replacing regulation with banishment. Similar symptoms were noted at the siege of Acre
Siege of Acre
The Siege of Acre was one of the first confrontations of the Third Crusade, lasting from August 28, 1189 until July 12, 1191, and the first time in history that the King of Jerusalem was compelled to personally see to the defence of the Holy Land...
by Crusaders
Crusaders
The Crusaders are a New Zealand professional rugby union team based in Christchurch that competes in the Super Rugby competition. They are the most successful team in Super Rugby history with seven titles...
.
Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several changes occurred in European medieval society. Cities hired public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
doctors to treat afflicted patients without right of refusal. Pope Boniface
Pope Boniface
There have been nine Popes named Boniface.There have been nine Popes named Boniface.There have been nine Popes named Boniface.:Pope Boniface I :Pope Boniface II :Pope Boniface III :Pope Boniface IV...
rescinded the requirement that physicians complete studies for the lower orders of the Catholic priesthood.
Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as lepers and other epidemic victims. After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted disease.