Back More
Salem Press

Table of Contents

Magill’s Medical Guide, 9th Edition

Gonorrhea

by Michael A. Buratovich, , PhD

Category: Disease/Disorder

Key terms:

contact tracing: also known as partner referral; a process that consists of identifying the sexual partners of infected patients, informing these partners of their exposure to disease, and offering resources for counseling and treatment

Fitz-Hugh-Curtis syndrome: a condition associated with pelvic inflammatory disease that includes inflammation of the Glisson’s capsule surrounding the liver.

pelvic inflammatory disease: infection of the female reproductive organs that usually occurs when sexually transmitted bacteria spread from the vagina or cervix to the uterus, fallopian tubes, or ovaries.

screening procedures: tests that are carried out in populations which are usually asymptomatic and at high risk for a disease to identify those in need of treatment

sexually transmitted disease: an infection caused by organisms transferred through sexual contact (genital-genital, oral-genital, oral-anal, or anal-genital); the transmission of infection occurs through exposure to lesions or secretions that contain the organisms

CAUSES AND SYMPTOMS

The global prevalence of gonorrhea is difficult to ascertain because of the absence of reporting systems and diagnostic capability in many parts of the world. The World Health Organization (WHO) has estimated that the global incidence of gonorrhea in 2008 was 106 million cases, representing a 21 percent increase from 2005. The highest incidence areas include Africa and the Western Pacific.

In the United States, gonorrhea is the second-most reported communicable disease and the second-most prevalent sexually transmitted infection (STI). The incidence of gonorrhea in the United States has undergone cycles of increasing and decreasing. In 1995, the incidence was about 150 cases out of every 100,000 persons, down from the more than 400 cases per 100,000 persons in the mid- 1970s. After 1997, the percentage of infections increased slightly, but by 2009, the rate per 100,000 reached an all-time low of 98.1 cases per 100,000 people. The following two years saw a slight increase in infection rate, reaching 104.2 per 100,000 people in 2011. Thus, from 2007 to 2011, the infection rate decreased by nearly 12 percent, but this was followed by an increase to 146 cases per 100,000 persons in 2016. In 2016, the highest number of cases was among 20-24-year-old women (596 / 100,000), followed by 15-19-year old women (482 / 100,000). Gonorrhea infection rates in Black Americans (481 / 100,000) is 8.6-times higher than in whites (86 / 100,000). The number of cases is probably significantly higher due to under-reporting and asymptomatic infections. Infection rates in the South are consistently the highest in the country, followed by the West, Midwest, and Northeast, respectively.

Gonorrhea is caused by the bacterium Neisseria gonorrhea (N. gonorrhea) a gram-negative diplococcus. The bacterium infects those mucous membranes with which it comes in contact, most commonly the urethra and the cervix and the throat, rectum, and the conjunctiva of the eyes. N. gonorrhea can vary the composition of its outer protein complement, which allows it to escape adaptive immune responses made against it and successfully survive and flourish inside the human body.

In women, up to 80 percent of all gonorrhea infections are asymptomatic. However, if women show symptoms, the particular symptom or combination of symptoms they experience will depend on the type of gonorrheal infection they have contracted. Urethral infections (urethritis) sometimes cause pain upon urination (dysuria), urinary urgency, and increased frequency. Infection of the cervix (cervicitis) can cause vaginal itching (pruritis) and a discharge that is a mixture of mucus and pus (mucopurulent). She may also have lower abdominal pain and pain during sexual intercourse (dyspareunia). Approximately 10-20 percent of women with gonococcal cervicitis can suffer from a spread of the infection throughout their reproductive system, called pelvic inflammatory disease (PID). Symptoms of PID include pelvic or abdominal pain, abnormal vaginal bleeding, and dyspareunia. Complications of PID that result from scarring and chronic inflammation in the fallopian tubes include infertility and an increased risk of ectopic pregnancy. About four percent of women who suffer from PID will experience inflammation of the Glisson’s capsule that surrounds the liver (perihepatitis), a condition known as Fitz-Hugh-Curtis syndrome, which is also associated with Chlamydia infections. Fitz-Hugh-Curtis syndrome causes sharp pain in the right upper quadrant, accompanied by nausea, vomiting, and fever. Up to six percent of women with gonococcal infections will also experience an infection of the Bartholin’s glands, located just behind the labia. Bartholinitis symptoms include pain around the labia, discharge from the Bartholin’s glands, and gland tenderness.

In rare cases (0.5-3 percent of patients), gonorrhea can enter the bloodstream and disseminate throughout the body. Disseminated gonococcal infection (DGI) mainly produces clinical conditions that fall into two classes: 1) a triad of tenosynovitis, dermatitis, and polyarthralgia; and 2) purulent arthritis. Patients with the triad of tenosynovitis, dermatitis, and polyarthralgia will experience fever, chills and generalized weakness (malaise), pain in more than one joint that can migrate from one joint to another, tendon inflammation, particularly at the wrist, fingers, ankle, and toes, and skin lesions that may be blisters, bumps or rash-like. Patients with purulent arthritis will show pain and swelling of the joints (usually the knees, wrists, and ankles), sometimes accompanied by destruction of the joints. DGI can also result in infections of the heart muscle or heart valves (endocarditis), pericardium (myopericarditis), bones (osteomyelitis), blood vessels (vasculitis), and meninges (meningitis).

Information on Gonorrhea

Causes: Bacterial infection through intercourse

Symptoms: In women, sometimes vaginal discharge and itching, urinary discomfort, urethral discharge, lower abdominal discomfort, and pain with sexual intercourse, with possible pelvic inflammatory disease, infertility, and increased risk of ectopic pregnancy

Duration: Acute or chronic if untreated

Treatments: Antibiotics, counseling regarding safe sex

Neonatal gonococcal infection occurs in less than one percent of pregnant women. However, its incidence varies substantially between developed and underdeveloped countries. Transmission of gonococci to infants during delivery, through contact with the infected birth canal, leads to newborn conjunctivitis (ophthalmia neonatorum). This infection can damage the eye and permanently impair vision, even causing, in some cases, blindness.

TREATMENT AND THERAPY

Treatment for gonorrhea consists of the use of antibiotics. With the evolution of penicillin-resistant strains of gonorrhea, effective therapy relies on antibiotics, such as ceftriaxone, to which 98-99 percent of gonococcal strains remain susceptible. In uncomplicated cases of gonorrheal infection, such as cervicitis or urethritis, a single dose of ceftriaxone is given intramuscularly (50 mg) in combination with oral doxycycline (100 mg for seven days).

A patient who has risk factors for STIs (primarily contact with a suspected infected partner) or a clinical picture suggestive of gonorrhea may receive treatment presumptively before confirmatory laboratory test results for gonorrhea are available. Once laboratory test results confirm the diagnosis of gonorrhea, CDC recommendations advise that patients be tested for other STIs, such as human immunodeficiency virus (HIV), hepatitis B and C, and syphilis. Because many patients with gonorrhea also have chlamydia, patients are provided dual therapy in which they are given ceftriaxone in combination with an antibiotic directed against chlamydia, such as doxycycline. Occasionally oral azithromycin (one gram) may be substituted for doxycycline.

As with all STIs, a key therapy component includes counseling regarding safer sex, including using barrier contraceptives, such as condoms, and avoiding high-risk sexual behaviors. Contact tracing is another important element in STI treatment. It notifies the patient’s sexual partners of their exposure to gonorrhea or other STIs. Contact tracing can prevent both reinfection of the patient through subsequent sexual encounters and the spread of STIs from the patient’s partner to her subsequent sexual partners. Contact tracing also involves offering resources to these partners for medical attention.

Treatment of ophthalmia neonatorum formerly consisted of topical erythromycin, but this is no longer recommended. Instead, newborns should be given a single dose of intravenous or intramuscular ceftriaxone (25-50 mg/kg, not to exceed 125 mg). Infants receiving intravenous nutrition or with excessively high bilirubin levels should be given intravenous or intramuscular cefotaxime (100 mg/kg). The eyes should also be rinsed with sterile saline solution until the discharge from the eyes clears.

PERSPECTIVE AND PROSPECTS

The symptoms of gonorrhea have been described in numerous cultures in the past, including those dating back to the ancient Chinese, Egyptians, and Romans. Albert Neisser first identified the actual gonorrhea bacterium in the 1870s. It was one of the first bacteria ever discovered. Neisseria gonorrhea has continued to be well-studied on molecular and epidemiological levels.

Sulfanilamide was the first antibiotic therapy used to combat N. gonorrhea in the 1930s. By the 1940s, however, gonococcal strains resistant to this antibiotic appeared, and the therapy of choice became penicillin. Over the next several decades, N. gonorrhea evolved resistance to penicillin, forcing clinicians to use other drugs to combat the bacterium, such as ceftriaxone and the fluoroquinolone antibiotic ciprofloxacin (although present high levels of resistance to fluoroquinolones preclude their use against N. gonorrhea). In the 1980s, the Centers for Disease Control instituted surveillance programs to monitor antibiotic resistance patterns in different US cities. Continued success in combating N. gonorrhea will depend on the ability to minimize the development of antibiotic resistance.

Finally, since many patients with gonorrhea infection have no symptoms, screening programs of asymptomatic patients in high-risk groups (those younger than twenty-five or with multiple sexual partners) play a vital role in decreasing the incidence of N. gonorrhea infections.

For Further Information::

Antimicrobial Resistant Threats. National Institute of Allergy and Infectious Disease, 11 Feb. 2020, www.niaid.nih.gov/research/antimicrobial-resistance-threats#gonorrhoeae. Accessed 26 Mar. 2022, Gonorrhea - CDC Fact Sheet. Centers for Disease Control and Prevention, 28 Feb. 2022, www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm. Accessed 26 Mar. 2022.

Gonorrhea. Cleveland Clinic, 25 Nov. 2020, my.clevelandclinic.org/health/diseases/4217-gonorrhea. Accessed 16 Mar. 2022.

Morris, Sheldon R. “Gonorrhea.” Merck Manual Consumer Version, Jan. 2021, www.merckmanuals.com/home/infections/sexually-transmit ted-diseases-stds/gonorrhea. Accessed 26 Mar. 2022.

Raypole, Crystal. “Everything You Need to Know About Gonorrhea.” Healthline, 14 Mar. 2022, www.healthline.com/health/gonorrhea. Accessed 26 Mar. 2022.

Smith, Lori. “What to Know About Gonorrhea.” MedicalNewsToday, 14 Mar. 2022, www.medicalnewstoday.com/articles/155653. Accessed 26 Mar. 2022.

Citation Types

Type
Format
MLA 9th
Buratovich, Michael A. "Gonorrhea." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_0591.
APA 7th
Buratovich, M. A. (2022). Gonorrhea. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Buratovich, Michael A. "Gonorrhea." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed October 22, 2025. online.salempress.com.