What Is Gonorrhea?

Gonorrhea is amongst the most common sexually transmitted diseases in the world, caused by Neisseria gonorrhœae.

Non-genital sites in which it thrives are in the rectum, the throat (oropharynx), and the eyes (conjunctivae). The vulva and vagina in women are usually spared because they are lined by stratified epithelial cells—in women the cervix is the usual first site of infection. Gonorrhea spreads during sexual intercourse. Infected women also can pass gonorrhea to their newborn infants during delivery, causing eye infections (conjunctivitis) in their babies (which if left untreated, can cause blindness). Doctors have often attempted to treat this immediately by applying small amounts of silver nitrate or other antibiotic to the eyes of all newborn babies.

The incubation time varies from 2 to 14 days with most symptoms occurring between the second and fifth days after being infected from an infected partner. A small number of people may be asymptomatic for up to a year. Between 30–60% of women with gonorrhea are asymptomatic or have subclinical disease. The woman may complain of vaginal discharge, difficulty urinating (dysuria), off-cycle menstrual bleeding, or bleeding after sexual intercourse. The cervix may appear anywhere from normal to the extreme of marked cervical inflammation with pus. Possibility of increased production of male hormones is common in many cases. Infection of the urethra (urethritis) causes little dysuria or pus. The combination of urethritis and cervicitis on examination strongly supports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients. Gonorrhea is caused by the Neisseria gonorrhoeae bacteria. The infection is transmitted from one person to another through vaginal, oral, or anal sexual relations.

Men have a 20% chance of getting the infection by having sexual relations with a woman infected with gonorrhea. Women have a 50% chance of getting the infection by having sexual relations with a man infected with gonorrhea. An infected mother may transmit gonorrhea to her newborn during vaginal childbirth.

Less advanced symptoms, which may indicate development of pelvic inflammatory disease (PID), include cramps and pain, bleeding between menstrual periods, vomiting, or fever. It is not unusual for men to have asymptomatic gonorrhea. Men may complain of pain on urinating and thick, copious, urethral pus discharge (also known as gleet) is the most common presentation. Examination may show a reddened external urethral meatus. Ascending infection may involve the epididymis, testicles or prostate gland causing symptoms such as scrotal pain or swelling.

Gonorrhea is a very common infectious disease. The CDC estimates that more than 700,000 persons in the U.S. 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 CDC. In the period from 1975 to 1997, the national gonorrhea rate declined, following the implementation of the national gonorrhea control program in the mid-1970s. 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.

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