Gonorrhea is one of the longest-known widespread diseases to afflict the human race. Fortunately, the advances of modern medicine and the control efforts of the Centers for Disease Control (Centers for Disease Control and Prevention) have made serious inroads into the spread of gonorrhea in this country. After falling steadily from 1975 until 1997, rates gradually increased by 9 percent and thereafter remained about the same. While gonorrhea must by law be reported to the Centers for Disease Control and Prevention, many cases probably go undetected or unreported. Estimates place the actual number of new cases anywhere from 600,000 to 2 million per year, many times the reported number (358,995 for the year 2000).
What causes gonorrhea?
Gonorrhea is caused by a true bacterium named Neisseria gonorrheae — for Dr. Albert Neisser, who first described it in 1879. Gonorrhea bacteria live within cells, notably in the cervix in women and inside the urethra in men.
How do you get gonorrhea?
Gonorrhea is transmitted by direct contact from mucous membrane to mucous membrane. It can be transmitted to the mouth during oral sex and to the anus or rectum during anal sex. Newborns traveling through an infected birth canal can get gonococcal eye infections, which if left untreated can cause blindness.
Who is at high risk?
Anyone with multiple sexual partners is at increased risk for gonorrhea. Risk increases if you have another sexually transmitted disease. Women are at higher risk than men. It has been estimated that a man having unprotected sex once with an infected partner has a 20-25 percent chance of catching the disease, while a woman’s risk under the same circumstances is 80-90 percent. Statistically, city dwellers, adolescents, people with past gonorrheal infections, and drug users are at increased risk — perhaps because people in these groups indulge in high-risk behavior.
Will condoms prevent the transmission of gonorrhea?
If used properly, latex condoms can protect against exposure to gonorrhea bacteria. Spermicides may also offer some protection.
How is gonorrhea diagnosed?
The infection can be diagnosed in women without symptoms by culturing tissue from the infected area, usually the cervix. Your doctor will probably also test for chlamydia at the same time.
How is gonorrhea treated?
Because gonorrhea is caused by a bacterium, not a virus, it can be treated successfully with antibiotics. For many years the appropriate drug was penicillin taken as injections, or ampicillin taken as tablets. However, ten or fifteen years ago in this country, the bacterium started to become resistant to these drugs. When the resistance rate reached about 6 percent, physicians changed drugs. Two new families of drugs were introduced, cephalosporins and quinolones. The current drug of choice for gonorrhea is ceftriaxone, given as a single intramuscular injection in the buttocks. Other frequently used drugs are ciprofloxacin and ofloxacin, both given orally in a single dose.
If you are allergic to cephalosporins or quinolones, you can take tetracycline or doxycycline, which are given as pills. Therapy with tetracycline or doxycycline lasts a week; one dose will not cure you.
If you are diagnosed with gonorrhea, you will also be treated for chlamydia. Because these two diseases occur together so frequently, the Centers for Disease Control and Prevention recommends that any woman treated for gonorrhea should also be treated for chlamydia, whether her culture for that disease is positive or negative. If you are taking tetracycline or doxycycline for gonorrhea, it will halt the chlamydia as well.
Gonorrhea is a reportable disease; your physician is required by law to notify the local board of health of all cases. The Centers for Disease Control and Prevention recommends that any sexual partner you have had in the past thirty days also be treated. If you do have gonorrhea, your physician will ask about your partners and see that they are treated, either by your doctor or their own physicians.
Should you have a follow-up visit after you’ve been treated?
I always recommend a follow-up culture to make sure the medication has eradicated the infection. Occasionally there are “failures,” though in many cases these are probably reinfections. Certainly you should contact your physician if your symptoms persist after therapy.