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Many people view gonorrhea as an old-fashioned venereal disease, one that's been almost wiped out by modern antibiotics. But in reality gonorrhea (known informally as the clap, the drip, or GC) is still one of the most common sexually transmitted diseases in the United States. Transmitted by a bacterium shaped like a coffee bean, it's highly contagious and can enter the body through any opening -- mouth, vagina, or rectum. The bacteria may cause an infection anywhere in the body, although a woman's cervix or a man's urethra (the tube that urine travels through) are usually the first to be infected. The infection can then spread farther up the reproductive tract and into the bloodstream, where it may cause serious health problems that can include arthritis, meningitis, sterility, or death. Experts believe more than 700,000 Americans per year are infected with gonorrhea, although only 358,366 cases were reported to the CDC in 2006.

If you have sex with someone who has it, you're very likely to get it. The chances of being infected with gonorrhea in a single act of sexual intercourse with an infected partner who isn't using a condom are 60 to 90 percent for women and 20 to 50 percent for men. It can also be spread through oral and anal sex.

One of the most dangerous features of gonorrhea is that most women (some 70 to 80 percent) experience no symptoms until the disease has already done serious damage, weeks or months after they were infected.

If you do have early symptoms, they usually surface 7 to 21 days after infection and may include these: a cloudy yellow, foul-smelling vaginal discharge; pain during intercourse; itching, swelling, redness, or soreness of the vulva (the opening to the vagina); heavy menstrual bleeding; pain or discomfort in the lower abdomen; and painful or frequent urination.

Most men, on the other hand, develop highly noticeable symptoms within 2 to 5 days of exposure, although they occasionally appear two weeks or so after exposure. On rare occasions, men may have no symptoms. If you're male and you've been infected, a fluid that looks like pus may drip uncontrollably out of your penis after you urinate (this explains one of the disease's nicknames). The tip of your penis may also be red and irritated, or you might have a foul-smelling yellowish discharge from the urethra or need to urinate frequently; you may also feel a burning sensation while urinating. (These symptoms can disappear later, but urination usually becomes painful enough to send men to the doctor.) Pain in the scrotum, testicles, or lower abdomen is another common symptom.

In the case of anal gonorrhea, both men and women may experience rectal pain or itching or have a constant urge to move their bowels. Often, though, there are no symptoms. In pharyngeal (throat) gonorrhea, which is less common, people of both sexes can get a severe sore throat or show no symptoms at all.

First of all, you'll probably pass the disease to your sexual partner or partners.

If you're female, the infection can spread to your uterus and Fallopian tubes and cause pelvic inflammatory disease, which might scar your tubes and lead to ectopic (tubal) pregnancy, sterility, or even death. If you're pregnant, your unborn child is at serious risk as well. Pregnant women with untreated gonorrhea may infect their babies during childbirth; this can result in pneumonia or gonococcal ophthalmia, a severe eye infection that may leave newborns blind.

If you're male, the disease can be equally devastating. The bacteria may cause inflammation of your testes and scrotal tubes or of your prostate. They can also cause sterility, and your urethra can become scarred and obstructed so that you can't urinate normally.

Whether you're male or female, you run a 1 to 3 percent risk that the infection will travel through the bloodstream and infect your joints, producing gonococcal arthritis; it can also cause fever, chills, and sores on your hands, fingers, feet, and toes. As if that weren't enough, the bacteria can multiply in your bloodstream and cause septicemia, a dangerous blood infection that's capable of infiltrating vital organs like the brain and heart. From this can come meningitis, heart-valve infection, and death.

The good news is that gonorrhea can be fully cured. But both you and your partner do need to get treatment immediately, and to learn how to avoid any further infections with STDs as well.

Your doctor will most likely test you for gonorrhea by taking a sample from the infected area (vagina, urethra, and rectum) and sending it to the lab for a culture or testing for the nucleic acid. (Since a chlamydia infection often coexists with gonorrhea, you'll usually be screened for it at the same time.) If you have gonorrhea, antibiotics will be prescribed to kill the bacteria, as well as analgesics to relieve any pain. You'll usually take the antibiotics in pill form, although some clinics administer a one-dose injection. (If you're allergic to penicillin or other drugs, let your doctor know.) Be sure to take all the antibiotics the doctor gives you, even if your symptoms disappear; if you don't, the disease may not go away. Your sexual partner or partners will also need to see a doctor and, if they're infected, get treatment. For that reason, be prepared to answer questions about your sexual history.

Don't have sex until your doctor tells both you and your partner that your infections are gone. If symptoms persist or if new ones develop, make an appointment for a follow-up exam. Because it's very common for people with gonorrhea to be infected with chlamydia as well, the doctor will often treat you for both infections simultaneously.

That depends on how long you had the disease before it was diagnosed, and how much it has spread. If it's caught in the early stages, when only the cervix (in a woman) or the urethra (in a man) has been infected, it will clear up in about two days -- although, again, you must continue to take your oral medication for the full time prescribed. Certain strains of gonorrhea have become resistant to specific antibiotics like penicillin, so in some cases an alternative antibiotic may be necessary.

If your partner is male, make sure he uses a condom during sexual foreplay and intercourse. Don't use condoms lubricated with spermicides -- according to 2002 guidelines issued by the Centers for Disease Control, spermicides don't protect against HIV or other STD's. In fact, says the CDC, frequent use of spermicides containing nonoxynol-9 can cause genital lesions that may actually increase your risk of contracting HIV.

If your partner develops the symptoms of the disease, both of you need to be tested and treated by a doctor. And remember, no vaccine is available to prevent gonorrhea and a past gonorrhea infection doesn't make you immune to reinfection.

Wash sex toys (including vibrators) after every use; some studies show that the virus can be spread by them if they're shared. Don't share towels or other personal items that could harbor the bacteria.

If you're pregnant, you'll typically be tested for gonorrhea during your first trimester to diagnose a silent infection and prevent gonococcal ophthalmia and other problems in your newborn. (You'll probably be screened for chlamydia at the same time, and possibly for syphilis as well.)

If you're considering having sex with a new partner, both of you should first be tested for STDs, according to the Centers for Disease Control and Prevention. And any time you've had unprotected sex, it's a good idea to get tested for a range of sexually transmitted diseases, including gonorrhea. Your insurance will probably cover the test; if you don't have insurance, a city health clinic may provide the screening at little or no cost.

-- Paige Bierma has written for Hippocrates, Safety + Health, and other publications.

Further Resources

American Social Health Association Facts &Answers About STDs http://www.ashastd.org/stdfaqs/index.html

Centers for Disease Control STD and AIDS hotlines (24 hours a day/7 days a week) 1-800-227-8922 or 1-800-342-2437

References

First published July 19, 1999
Last updated March 3, 2008
Copyright © 1999 Consumer Health Interactive

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