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DESCRIPTION
Gonorrhea (common non-medical names for gonorrhea are "clap", "drip", or GC) is an infectious bacterial infection of the reproductive organs that is sexually transmitted (venereal disease). Gonorrhea is caused by a microorganism called Neisseria gonorrhoeae, commonly referred to as gonococci. it is a Gram-negative bacterium. The term comes from Greek, gonórrhoia, literally "flow of seed"; in ancient times it was incorrectly believed that the pus discharge associated with the disease contained semen.
The first place this bacterium infects is usually the columnar epithelium of the urethra and endocervix. Non-genital sites in which it thrives are in the rectum, the oropharynx and the conjunctivae of the eyes. 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.
In females, it involves the urethra (tube from bladder to outside of the body) and the reproductive system; in males, it involves the urethra; and in both sexes the rectum, throat, joints and eyes (sometimes). It can affect all ages (even young children) who have sexual contact with infected persons. The peak incidence is between ages 20 and 30. Although readily treatable, this infection has reached epidemic levels in the USA. Incubation period is from 2 to 10 days.
Gonorrhea is the second most reported sexually transmitted disease (STD) in the United States being spread through sexual intercourse. It is reported annually in about 600,000-800,000 people. It is believed that another 1 million cases go unreported each year. Approximately 75 percent of all cases of gonorrhea reported by health professionals to the Centers for Disease Control and Prevention (CDC) are in people 15 to 30 years old. Teenage girls ages 15 to 19 and men ages 20 to 24 have the highest rates of infection.
Gonorrhea can be spread during vaginal, anal, or oral sex with an infected partner. A pregnant woman may pass the infection to her newborn during delivery. Gonorrhea can be transmitted any time by an infected person, whether or not symptoms are present. An infected person is contagious until he or she has been treated. Gonorrhea among females can also be transmitted from one individual to another via contact to surfaces that may still be damp from prior contact.
SLANG TERMS FOR GONORRHEA
"The Clap": Gonorrhea is also commonly known by the slang term "the clap". One suggested etymology refers to a traditional treatment used to clear the blockage in the urethra from gonorrheal pus, where the penis would be "clapped" on both sides simultaneously. It could also refer to the painful sting in the male urethra, which feels like the sting of a clap (as in clapping hands) when infected with the disease. Yet another suggested source is from the old French word "clapier", meaning "brothel". Another suggested source for the term is from a notorious 18th century keeper of a brothel, Margaret Clap (better known as "Mother Clap"), though perhaps her name itself was derived from the slang term. The term "clap" may be derived from its diplococcoid microscopic morphology, which is suggestive of two cocci "clapping". This term has, in recent years, come to be used by extension to refer to any unspecified sexually transmitted disease.
"Dripping Dick": Used mainly because of the discharge coming from the urethral opening of the penis.
The term gonorrhea is built from the Greek prefix gono (seed) and suffix rrhea (to flow), and stems from the belief that the discharge contained semen.
CAUSES
Infection is caused from Gram-negative gonococcus bacteria (Neisseria gonorrheoeae) that grow well on delicate, moist tissue.
The bacteria are usually transmitted sexually, but some cases are of unknown origin. Sexual activity involving the vagina, anus/rectum or mouth (oral) may transmit infection to those areas if either partner is infected. A pregnant woman may pass the infection to her newborn during delivery.
A person infected with gonorrhea is always contagious until he or she has been treated.
Having a gonorrhea infection does not protect you from another infection in the future. A new exposure to gonorrhea will cause re-infection, even if you were previously treated and cured.
FREQUENT SIGNS & SYMPTOMS
FEMALE SYMPTOMS
Females often have few or no symptoms. When symptoms do occur, they may be mild and are frequently ignored. Symptoms include:
- Symptoms usually appear 7 to 21 days after sexual contact in women (incubation period varies from as little as 2 days to as long as 30 days). A small number of people may be asymptomatic for up to a year. Between 30-60 percent of women with gonorrhea are asymptomatic or have subclinical disease.
- Cervicitis (infection of the cervix).
- Swollen and painful glands at the opening of the vagina (Bartholin glands).
- Frequent urge to urinate with painful burning sensation. Difficulty urinating. Gonorrhea infection is often mistaken for a bladder infection or vaginal infection. There may be urethritis (inflammation of the urethra) with 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.
- Thick yellow, creamy, cloudy, pus-like or bloody abnormal discharge from the vagina. The cervix may appear anywhere from normal to the extreme of marked cervical inflammation (cervicitis) with pus.
- Abnormal menstrual bleeding, bleeding between periods, excessive bleeding during the menses. Bleeding during sexual intercourse.
- Acute inflammation and pain in the pelvic area (lower abdomen). Development of pelvic inflammatory disease (PID) which includes pelvic pain and cramping, bleeding between menstrual periods along with fever and/or vomiting.
- Pain or tenderness with sexual intercourse (sometimes).
- Irritation of the genitals (vulva) and rectal infection.
- Throat infection.
MALE SYMPTOMS
Males usually have more pronounced symptoms and they may include:
- Symptoms usually appear between two and 14 days after sexual contact in men, but sometimes it can take up to 30 days for symptoms to appear. It is not unusual for males to have asymptomatic gonorrhea.
- Abnormal discharge from penis (clear or milky white at first, and then Yellow or greenish, creamy, and excessive, sometimes blood-tinged discharge of pus (called gleet) and mucus from the penis). Examination may show a reddened external urethral meatus.
- Slow, difficult, and painful and frequent urination.
- Infection may move into the prostate, seminal vesicles, and epididymis, causing testicular / scrotal pain, swelling and/or fever.
SYMPTOMS IN BOTH SEXES
Other Symptoms In Both Males & Females:
- Conjunctivitis (pink eye ) (rare).
- Lower abdominal pain.
- Rash, especially on palms.
- Mild sore throat (sometimes).
- Fever and general tiredness.
- Nausea.
- The throat, anus, and rectum are common areas of infection in both men and women.
RECTAL INFECTION
Rectal infection (gonococcal proctitis) may affect both men and women and is often asymptomatic. If symptoms develop they may include:
- Constipation.
- Creamy, pus-like discharge.
- Rectal itching.
- Painful bowel movement with blood in feces.
- Rectal bleeding.
Rectal infection is transmitted by penetrative anal sex and is diagnosed on rectal swab. Protoscopy may show an inflamed mucous membrane with little mucus. It cannot be treated with penicillin because rectal commensal bacteria in the rectum produce ß-lactamase that protects the gonococcus from penicillin.
GONOCOCCAL PHARYNGITIS
Infections of the throat are usually asymptomatic, but in some cases may cause a sore throat. This condition is diagnosed by a throat culture, utilizing a cotton swab. Most cases of gonococcal pharyngitis are caused by oral sex with a partner infected with gonorrhea.
IF LEFT UNTREATED...
If not treated. the infection can travel through the bloodstream and go into the bones, joints, tendons, brain, heart, and other tissues, causing a systemic illness called "Disseminated Gonococcal Infection (DGI)" with:
- Body aches and inflamed, painful joints and tendons, especially in the knees and hands. At this stage, the organism is difficult to detect, and the condition is often misdiagnosed as simple arthritis.
When joints become involved, gonococcal arthritis can develop. Gonococcal arthritis occurs after primary infection of the genitalia, anus, or throat. This occurs in about 1% of patients who are infected with gonorrhea and is more common in women than men. Typical symptoms include a 5-7 day history of fever, shaking, chills, multiple skin lesions, fleeting migratory polyarthralgias and tenosynovitis in fingers, wrists, toes or ankles. This should be evaluated promptly with a culture of the synovial fluid, blood, cervix, urethra, rectum, skin lesion fluid, or pharynx. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.
- Infection of the blood (sepsis).
- Infection of the inner lining of the heart and heart valves (endocarditis).
- Skin lesions (occasionally), infection of the skin (cellulitis).
- Meningitis (infection or inflammation of the membrane covering the brain and spinal cord).
- In females the infection will usually spread to the uterus, fallopian tubes, and ovaries, causing Pelvic Inflammatory Disease (PID). PID causes scarring of the fallopian tubes which leads to increased risks of causing an tubal (ectopic) pregnancy as a fertilized egg may not be able to pass through the narrowed, scarred fallopian tube. Ectopic pregnancies are serious conditions which are potentially life-threatening to the mother. Gonorrhea is the most common cause of female infertility and can cause infertility in up to 10 percent of infected women.
In women, untreated gonorrhea can result in cyst and abscess formation in one or more of the greater vestibular glands (bartholinitis), causing trouble walking, PID, and Fitz-Hugh-Curtis syndrome.
- In men, inflammation of the epididymus (epididymitis), prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea. Sterility and urethral stricture may occur in males.
Often there are no symptoms at all in:
- 10-15 percent of men.
- 80 percent of women.
People with no symptoms are at risk of developing complications from gonorrhea and can unknowingly spread the infection. From the time of infection gonorrhea can be spread and will continue to be spread until properly treated. Past infection does not make a person immune to gonorrhea and previous infections with gonorrhea may allow complications to occur more rapidly and increase your risk of getting HIV.
RISK INCREASES WITH
The bacterium that causes gonorrhea can be passed through intercourse, anal sex, and cunnilingus (oral sex). The transmission is by contact of fluids from mucous membranes of infected people and it usually is through sexual activity. Most frequently, these bacteria infect the man's urethra, the tube that carries urine and semen through the penis, and the woman's cervix, the canal into the uterus. Multiple sexual partners, whether heterosexual or homosexual increases the risk of becoming infected with gonorrhea. Any person who is sexually active can be infected with Gonorrhea. Gonorrhea is spread through sexual contact including:
- Penis to vagina (infection rate for males 30-50%, females 60-90%).
- Penis to mouth.
- Penis to rectum.
- Mouth to vagina.
Gonorrhea is common among younger people, ages 15 to 30 and in those starting sexual activity before the age of 18. Risk increases in having multiple partners, having high risk partner(s) (partner has multiple sex partners or gonorrhea-infected sex partners).
Having unprotected sexual contact (not using condoms). See STDs and Condom Use for more information.
Increases in gonorrhea have been found among men who have sex with men.
Gonorrhea occurs more frequently in urban areas than in rural areas.
Women are at higher risk of getting gonorrhea than men.
Prostitution. Brief sexual encounters with multiple (potentially infected) sexual partners with unknown sexual health history is a key factor and may be combined with poor hygiene, poor medical care and treatment and possible lack of symptoms and/or the misuse or non-use of condoms.
Childbirth. Gonorrhea can be passed from an infected mother to her child as the child passes through the birth canal during delivery causing eye infections.
Child sexual abuse. In children, gonorrhea infection due to sexual abuse is found in the genital tract, mouth, and rectum. Any child with gonorrhea infection should be evaluated by a health professional to determine the cause and to assess for possible sexual abuse.
An infected person can spread the infection to another area of their body by touching the infected area and transferring the excretions. Clothing or wash cloths of infected people can spread the infection.
PREVENTIVE MEASURES
Avoid any sexual contact, especially with sexual partners whose health practices and status are uncertain.
Do not wait for symptoms to appear, particularly if you or your partner have other sexual contacts. Regular check-ups for STD's should be part of your regular medical examination. This is very important if you are sexually active. Visit a local sexually transmitted disease (STD) clinic, hospital, health care provider.
Use a latex condom during sexual intercourse. Sexual relations should be handled responsibly by limiting the number of sexual partners and using condoms. See Male Condom and Female Condom for more information about condom usage.
Proper hand washing is essential as the bacteria can be transferred to the eyes.
This condition must be reported to the local health department to prevent its spread. It sometimes occurs simultaneously with syphilis and chlamydia. Your cooperation is important, and your confidentiality will be maintained. Gonorrhea is the most common reportable sexually transmitted infection in the United States, with an estimated 800,000 cases of Gonorrhea reported annually.
EXPECTED OUTCOME
Usually curable in 1 to 2 weeks with treatment.
POSSIBLE COMPLICATIONS
Gonococcal eye infection (the conjunctiva, the membrane that lines the eyelid and eye surface). This may cause blindness in children. This is the reason why eye prophylaxis is given at the time of a newborn baby's birth.
Blood poisoning (gonococcal septicemia).
Infectious arthritis in the joints.
Approximately 2 percent of persons with untreated gonorrhea may develop Disseminated Gonococcal Infection (DGI). The symptoms include arthritis type pain, fever and skin lesions.
Endocarditis. An infection/inflammation of a heart valve.
Infection or inflammation of the membrane covering the brain and spinal cord (meningitis).
COMPLICATIONS IN WOMEN
Pelvic inflammatory disease. PID is an ascending infection that spreads from the vagina and cervix to the uterus and fallopian tubes, which can lead to sterility. The risk of infertility increases with each episode of PID.
Ectopic pregnancy (pregnancy outside of the uterus, usually in the fallopian tubes). The fertilized egg does not pass into the uterus if the tubes are partially scarred causing the embryo to implant in the fallopian tube. This can result in miscarriage and sometimes death of the mother if not caught early. This can be a life-threatening situation.
Perihepatitis. An infection/inflammation around the liver. Fitz-Hugh-Curtis syndrome occurs when pelvic inflammatory disease (PID) causes inflammation of the capsule covering the liver and the surrounding area. It causes pain and tenderness in the upper right abdomen over the liver. This syndrome develops when bacteria enter the abdominal cavity through the fallopian tubes and then follow the flow of peritoneal fluid to the right upper abdomen, where they infect the liver.
Infertility in women.
An abscess in or near the ovaries (tubo-ovarian abscess) in women from PID.
Chronic pelvic pain. This is pain in the lower abdomen and pelvis that has been present for at least 6 months. The pain may be intermittent, recurrent, or constant. The pain may fluctuate from mild to severe.
COMPLICATIONS IN PREGNANT WOMEN
Problems related to untreated gonorrhea in pregnancy include:
- The possibility of a miscarriage.
- Preterm labor. The woman may be given drugs to prevent premature birth, which could require a stay in the hospital.
- Premature rupture of the membranes (PROM).
- Premature delivery. A premature infant has an increased risk of health problems.
- Infection of the lining of the uterus (endometritis).
If a woman has gonorrhea when she gives birth, her newborn can be infected. Women with untreated gonorrhea and infected newborns are more likely to develop long-term complications of gonorrhea.
COMPLICATIONS IN NEWBORNS
Newborns of women with untreated gonorrhea may have any of the following complications:
- Pinkeye (conjunctivitis). Most newborns who have gonorrhea get conjunctivitis.
- Build up of toxins in the blood or tissues (sepsis).
- Inflammation of a joint (arthritis).
- Scalp infections at the site of a fetal monitoring device.
- Infection of the fluid and tissues that surround the brain and spinal cord (meningitis).
COMPLICATIONS IN MEN
Men with untreated gonorrhea may develop:
- An infection of the urethra (urethritis).
- An inflammation and infection of the epididymis (epididymitis).
- An inflammation of the prostate gland (prostatitis).
- Infertility.
Sexual impotence in men, if untreated. This is usually the result of gonorrheal epididymitis (inflammation of the testicles) and result in sterility in the long term. Gonorrhea can also spread into other organs, cause skin problems, and swelling of the testicles and penis.
TREATMENT
GENERAL MEASURES
MEDICAL HISTORY
Diagnosis of gonorrhea include a medical history and a physical examination. Your health care provider may ask you questions about how you may have been exposed to any sexually transmitted diseases (STDs) and how you found out you may have been exposed (such as your partner telling you). You will be asked about any symptoms you may have and what method of birth control you use and whether or not you use condoms to protect against STDs. You may be asked about your sexual behavior and whether you or your partner engage in high risk sexual behaviors and if you have been treated for an STD in the past and the treatment given.
PHYSICAL EXAMINATION
For women, after your medical history is taken, the initial exam for gonorrhea will include a gynecological (pelvic) exam. See Pelvic Exam and Pelvic Pap Smear for more information.
For men, a genital exam for urethritis and epididymitis will be done.
DIAGNOSTIC TESTS
Several gonorrhea tests can be used to detect infection. Many health care providers prefer to use more than one test to increase the chance of an accurate diagnosis. Except for the culture, which can take 3 days to obtain results, the tests give relatively quick test results.
Diagnostic tests may include blood studies, laboratory culture and microscopic analysis of the discharge from the reproductive organs, rectum or throat. Many health care providers prefer to use more than one test to increase the chance of accurate diagnosis. There are three types of laboratory techniques used to diagnose gonorrhea.
- Staining Biological Samples: This is called gram strain, which is usually more accurate for men then for women, as only 1 in 2 women with the infection have a positive stain. The test consists of placing a smear of the discharge from the penis or cervix on a slide that has a dye in it and when examined under a microscope shows the presence of gonorrhea. The health care provider can usually give you the test results during the consultation.
- Detection of Bacterial Genes or Nucleic Acid (DNA) Test: Detection of bacterial genes or nucleic acid (DNA) test is carried out using urine or cervical swabs to detect the genes of the bacteria. This test is often more accurate than culturing the bacteria.
- Cultures: The next test is a culture test, this one is usually used to tell if women have gonorrhea or not. It involves taking a sample of the discharge and placing it on a culture plate to incubate for two days, to allow the bacteria to multiply. Cervical samples are more accurate, to tell if the woman has gonorrhea or not. Cultures of cervical samples detect infection approximately 90 percent of the time. A culture can also be taken to detect gonorrhea in the throat. The culture test allows testing for drug-resistant bacteria.
Other sexually transmitted diseases may be present with gonorrhea infection. Your health care provider may recommend testing for chlamydia (40% of people with gonorrhea also have chlamydia), syphilis, hepatitis B, and human immunodeficiency virus (HIV).
In the United States, your health care provider must report that you have gonorrhea to the state health department so the department can inform your sex partner(s) that they also need treatment.
Early Detection: If you engage in high-risk sexual behaviors, you may want to consider being tested for gonorrhea even though you don't have symptoms. Testing will allow gonorrhea to be quickly diagnosed and treated. This helps reduce the risk of transmitting gonorrhea and avoid complications of the infection.
The CDC also recommends screening for pregnant women with high-risk sexual behaviors to prevent them from transmitting gonorrhea to their babies. All pregnant women should be screened during their first prenatal visit. If a pregnant woman is at high risk for gonorrhea, she may be tested again during the third trimester before delivery to prevent transmitting the infection to her newborn.
TREATMENT
Historically it has been suggested that mercury 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 meatus into any unfortunate crewman suffering from gonorrhea.
The mainstay of treatment is the appropriate use of antibiotics. While penicillin was the most common antibiotic used to treat gonorrhea up until the 1970s, an increase in antibiotic resistance has led to a decline in its use. Recommendations for first choice treatment of gonorrhea must therefore depend on local information on resistance patterns and it is not possible to make treatment recommendations that are applicable to all parts of the world.
The CDC released a report on Thursday, April 12, 2007 officially adding gonorrhea to a list of super bugs that are now resistant to common antibiotics
Treatment is with antibiotic medication, such as penicillin or other antibiotics in pill form or by injection. However, the disease is becoming more and more resistant to many standard medications. Antibiotics that are currently used for non pregnant women and men are:
- Cefixime, 400 mg orally.
- Ceftriaxone (Rocephin), 125 to 250 mg by intramuscular injection.
- Ciprofloxacin (Cipro), 500 mg orally.
- Ofloxacin (Floxin), 400 mg orally.
- Levofloxacin (Levaquin), 250 mg orally.
- Doxycycline (Doryx).
- Azithromycin (Zithromax), 2 g orally.
- Tetracycline.
- Cefotaxime, 500 mg by intramuscular injection.
- Cefpodoxime (Vantin), 400 mg orally.
- Cefoxitin, 2 g by intramuscular injection, plus probenecid, 1 g orally.
- Spectinomycin, 2 g by intramuscular injection.
- Amoxycillin, 2 g, plus probenecid, 1 g orally.
- Ampicillin, 2 to 3 g, plus probenecid, 1 g orally.
These drugs are all given as a single dose.
The level of tetracycline resistance in Neisseria gonorrheae is now so high as to make it completely ineffective in most parts of the world. The fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) cannot be used in pregnancy. It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected with gonorrhea. Patients should also be offered screening for other sexually transmitted infections. In areas where co-infection with chlamydia is common, health care providers may prescribe a combination of antibiotics, such as ceftriaxone with doxycycline or azithromycin, to treat both diseases.
Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria within the rectum produce Beta-lactamases that destroy penicillin. All current treatments are less effective at treating gonorrhea of the throat, so the patient must be rechecked by throat swab 72 hours or more after being given treatment, and then retreated if the throat swab is still positive.
Although gonorrhea usually does not require follow-up (with the exception of rectal or pharyngeal disease), patients are usually advised to phone for results 5 to 7 days after diagnosis to confirm that the antibiotic they received was likely to be effective. Patients are advised to abstain from sex during this time.
Drug resistant strains are known to exist.
US recommendations: The US does not have a federal system of sexual health clinics, and the majority of infections are treated in family practices. A third-generation cephalosporin antibiotic such as ceftriaxone is recommended for use in most areas. Since some areas such as Hawaii and California have very high levels of resistance to fluoroquinolone antibiotics (ciprofloxacin, ofloxacin, levofloxacin) they are no longer used empirically to treat infections originating in these areas.
UK recommendations: In the UK, the majority of patients with gonorrhea are treated in dedicated sexual health clinics. The current recommendation is for ceftriaxone or cefixime as first line therapy; no resistance to either drug has yet been reported in the UK. Levels of spectinomycin resistance in the UK are less than 1%, which would make it a good choice in theory, but intramuscular spectinomycin injection is very painful.
Azithromycin (given as a single dose of 2 g) is recommended if there is concurrent infection with chlamydia. A single dose of oral ciprofloxacin, 500 mg, is effective if the organism is known to be sensitive, but fluoroquinolones were removed from the UK recommendations for empirical therapy in 2003 because of increasing resistance rates. In 2005, resistance rates for ciprofloxacin were 22% for the whole of the UK (42% for London, 10% for the rest of the UK).
SPECIAL CIRCUMSTANCES
- Pregnant. Pregnant women may only take Ceftriaxone and possibly Spectinomycin.
- Younger than 18 years of age. Ceftriaxone is recommended for babies.
Gonorrhea and chlamydial infection, another common STD, often infect people at the same time. A combination of antibiotics is taken which will treat both diseases, such as:
- Azithromycin.
- Ceftriaxone.
- Doxycycline.
TREATMENT RECOMMENDATIONS
Follow up laboratory cultures will confirm cure.
Patients should be tested for other sexually transmitted diseases.
Use separate linens and disposable eating utensils during treatment.
Wash hands frequently especially after urination and bowel movements.
Don't touch eyes with hands.
Inform all sexual contacts so they can seek treatment.
Additional information available from:
Sexually Transmitted Diseases Hotline (800) 227-8922.
SURGERY
If untreated, gonorrhea causes complications, such as an abscess. surgery to drain or remove the abscess may be needed.
MEDICATION
Antibiotics to fight the infection will be prescribed (See treatment above for list of commonly used antibiotic medications). Antibiotic treatment, if taken exactly as directed, normally cures gonorrhea infections. If antibiotics are not taken properly, the infection will not be cured. Prompt antibiotic treatment also prevents the spread of the infection and decreases complications, such as PID.
Antibiotic treatment, if taken exactly as directed, normally cures gonorrhea infections over 97% of the time. All sex partners within the last 60 days of people diagnosed with gonorrhea also need to be tested and treated to prevent reinfection.
Having a gonorrhea infection does not protect you from another infection in the future. A new exposure to gonorrhea will cause reinfection, even if you were previously treated and cured. Symptoms that occur after treatment are usually caused by reinfection rather than treatment failure.
Many people who have gonorrhea also have chlamydia, a similar sexually transmitted disease. When both infections are present, medication treatment includes antibiotics that are effective in treating both chlamydia and gonorrhea.
Non-prescription drugs, such as acetaminophen or aspirin, may be suggested to reduce discomfort but not in place of antibiotics.
Certain strains of the gonorrhea bacteria have become resistant to some antibiotics, including penicillin, tetracycline, and sulfa drugs. In areas of Asia and the Pacific and in the western United States, the gonorrhea bacteria have also become resistant to quinolones (quinolone-resistant gonorrhea, QRNG). When bacteria become resistant to an antibiotic, they no longer can be killed by that particular medication. If gonorrhea is found to be resistant to an antibiotic, you may need to take another antibiotic to cure the infection. If you have been treated for gonorrhea and still have symptoms, you will need to be retested with a gonorrhea culture to determine whether there is bacterial resistance to the medication you were taking for the infection.
Antibiotics Recommended For Infections of the Cervix, Urethra, & Rectum
The Centers for Disease Control and Prevention (CDC) recommends the following medications for adults and children over 99 pounds (44.9 kg).
Medication Dose Days of Treatment Ceftriaxone 125 mg IM Single dose Ciprofloxacin 500 mg orally Single dose Ofloxacin 400 mg orally Single dose Levofloxacin 250 mg orally Single dose
Medication Dose (if chlamydia is also present) Days of Treatment Azithromycin 1 g orally Single dose Doxycycline 100 mg orally twice a day 7 Days
Spectinomycin 2 g in a single IM dose is an alternative medication given to people who cannot take the cephalosporin and quinolone medications recommended above.
Antibiotics Recommended For Infection of the Throat (Pharynx)
Medication Dose Days of Treatment Ceftriaxone 125 mg IM Single dose Ciprofloxacin 500 mg orally Single dose
Medication Dose (if chlamydia is also present) Days of Treatment Azithromycin 1 g orally Single dose Doxycycline 100 mg orally twice a day 7 Days
Antibiotics Recommended For Infection of the Conjunctiva of the Eyes
Ceftriaxone, 1 g IM is given in a single dose for infected eyes.
Antibiotics Recommended In Pregnant Women
The CDC recommends ceftriaxone for pregnant women infected with gonorrhea.
Doxycycline, ciprofloxacin, ofloxacin, and levofloxacin are not used to treat pregnant women.
If chlamydia is also present: Erythromycin and amoxicillin are equally effective, though some pregnant women may have fewer side effects with amoxicillin. Azithromycin may also be used.
People also infected with HIV are prescribed the same medication treatment presented in the tables.
Newborns and infants are treated with ceftriaxone or cefotaxime intravenously (IV) or intra muscularly (IM).
Side Effects
The most common side effects of medications used to treat gonorrhea are nausea and vomiting.
Doxycycline causes less nausea and vomiting but may cause yeast infections in women. Doxycycline and ofloxin (or any "floxin") cannot be given to pregnant women or babies. Exposure to sunlight while taking doxycycline can cause a painful, severe sunburn or a rash reaction.
If side effects occur and cannot be controlled, contact your health care provider. Other antibiotics may be prescribed that cause fewer side effects.
See Physicians Desk Reference for a full list of side effects or consult with your health care provider or pharmacist. PDR Health: For Online Drug Information
ACTIVITY
No restrictions, except don't resume sexual activity until a follow-up culture shows the infection is cured. Abstaining from sexual contact while you are being treated for an STD is vital. People taking a single dose of medication should abstain from sexual contact for 7 days after treatment so the medication will be effective. Exposed sex partners need treatment whether they have symptoms or not. Treatment failures and resistance to antibiotics can occur.
DIET
No diet restrictions. Eat a well balanced diet to maintain a healthy immune system. Reduce consumption of caffeine and alcohol during treatment. These irritate the urethra. See Sexually Transmitted Diseases (STDs) for more information about nutrition and nutritional supplements.
BENEFICIAL DIETARY SUPPLEMENTS
The following supplements are suggested for use in conjunction with antibiotic treatment.
AHCC (Active Hexose Correlated Compound), NOW Foods, Vegetarian, 500 mg, 60 Vcaps
NOW Foods AHCC is a rich source of polysaccharides such as beta glucan 1,3 and activated hemicellulose produced by enzymatic modification of organic medicinal mushrooms, including shiitake.
Antibiotic, Natural, Support Tincture, 100% Organic, 2 fl. oz.
Use this natural antibiotic to support the immune system.
Silver Biotics Liquid, Silver Supplement, 8 fl. oz.
Silver Biotics was tested by researchers and was found to kill every strain of bacteria that it was tested against and that these bacteria, many of which have become resistant to antibiotics, cause many human ailments.
Silver Tonic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.
WaterOz Ionic Silver is a pure liquid Silver supplement. Silver is a food supplement that has a long history of use in health care. It is believed that silver may support the immune system as a systemic disinfectant.
Momordica Tincture, 100% Organic, 2 fl. oz.
It has been suggested that Bitter Melon, Momordica, has anti-tumor and antiviral actions. MAP 30 is a protein found in Bitter Melon that is believed to have multiple functions that could be beneficial in treating HIV infection.
Mountain Rose Herbs, Bulk Herbs C: Calendula
Calendula reduces vaginal discharge and inflammation when used as a tea or douche. Calendula bulk herb is available from Mountain Rose Herbs.
Myrrh Oil (20%) in Grape Seed Oil Base, NOW Foods, 100% Natural, 1 fl. oz.
Myrrh Gum (Commiphora myrrha) Powder, 4 oz. Bulk
Myrrh Oil (Gum Myrrh Bush), NOW Foods, 100% Pure Essential Oil, 1 fl. oz.
Myrrh Tincture, 100% Organic, 2 fl. oz.
Myrrh, as with calendula, reduce vaginal discharge and inflammation when used as a tea or douche.
HERBAL & HOLISTIC RECOMMENDATIONS - GONORRHEA & CHLAMYDIA
HERBS
Andiroba & Copaiba Oil. Apply to irritated area as needed. Relieves vaginal and rectal inflammation.
Arjuna Capsules. Take 500 mg every 8 hours. Contains luteolin, which kills gonorrhea and chlamydia bacteria. Arjun (Terminalia arjuna), 485 mg, 120 Vcaps
Astragalus Tincture. Use as directed on label. Helps to protect the immune system. and aids in healing. Astragalus Root Tincture, 100% Organic, 2 fl. oz.
Barberry, Coptis, Goldenseal or Oregon Grape root Tincture. Take 15-30 drops in 1/4 cup water 3 times daily. Contains berberine, which kills gonorrhea and chlamydia bacteria. Do not use barberry, coptis, goldenseal or Oregon grape root if you are pregnant or have gallbladder disease. Do not take these herbs with supplemental vitamin B-6 or with protein supplements containing the amino acid histidine. Do not take goldenseal on a daily basis for more than one week at a time, and DO NOT USE IT DURING PREGNANCY. Use it only under a health care provider's supervision. Do not use goldenseal if you have cardiovascular disease or glaucoma. Barberry Tincture, 100% Organic, 2 fl. oz., Goldenseal Root (Hydrastis canadensis) Tincture, 100% Organic, 2 fl. oz., Oregon Grape Root (Wild) Tincture, 100% Organic, 2 fl. oz.
Epimedium Tablets or Extract. Take as directed on the label or by dispensing herbalist. Use after suspected exposure. Antibacterial. Stimulates urination to keep bacteria from attaching to lining of urethra. Do not use epimedium if you have any kind of prostate disorder. Horny Goat Weed (Epimedium) Express Liquid Extract, 2 fl. oz.
Scutellaria Capsules. Take 1,000-2,000 mg 3 times daily. May act against antibiotic-resistant strains of gonorrhea and chlamydia. Do not use scutellaria if you have diarrhea. Blue Scullcap (Scutellaria lateriflora), Standardized, Nature's Way, 100 mg, 60 Vcaps, Scullcap Tincture, 100% Organic, 2 fl. oz.
Echinacea, pau d'arco and red clover aid in healing. Take in capsule, tincture or extract form or drink as tea. Take as directed on label. Echinacea Purpurea, Nature's Way, 400 mg, 100 Caps, Echinacea Tincture (Children), Orange Flavor, Alcohol Free, 100% Organic, 1 fl. oz., Echinacea Immune Support Tea, Yogi Tea, Certified Organic, 16 Tea Bags, Pau D'Arco (Purple Lapacho) Tincture, 100% Organic, 2 fl. oz., Pau D'Arco Tea, Incan Purple Lapacho, 48 Tea Bags, Pau D'Arco Extract, Incan Lapacho, 100% Natural Herbal, 4 fl. oz., Red Clover (Trifolium pratense) Herb Powder, 4 oz. Bulk, Red Clover Blossom & Herb, Nature's Way, 500 mg, 100 Caps, Red Clover Tincture, 100% Organic, 2 fl. oz.
TRADITIONAL CHINESE MEDICINE (TCM) FORMULAS
Dong Quai, Gentiana Longdancao, and Aloe Pill: A traditional Chinese herbal formula that treats gonorrhea and chlamydia with accompanying herpes infection. Do not use these herbs if you are trying to become pregnant.
Eight-Ingredient Pill with Rehmannia (Rehmannia-Eight Combination): A traditional Chinese herbal formula that increases urination, effectively flushing bacteria out of the genitourinary tract before they can cause damage. Use after suspected exposure.
Peony and Licorice Decoction: A traditional Chinese herbal formula that treats gonorrhea and chlamydia complicated by cramping and abdominal pain or pain around the anus. Do not use Peony and Licorice Decoction if you have an estrogen-sensitive disease, such as breast cancer, endometriosis, or fibrocystic breasts.
Note: Bulk herbs are available through Mountain Rose Herbs. See link below.
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Mountain Rose Herbs, Aromatherapy Oils A-B
Mountain Rose Herbs, Aromatherapy Oils C-E
Mountain Rose Herbs, Aromatherapy Oils F-L
Mountain Rose Herbs, Aromatherapy Oils M-P
Mountain Rose Herbs, Aromatherapy Oils Q-Z
Mountain Rose Herbs, Aromatherapy Oils: Oil Blends & Resins
Mountain Rose Herbs, Aromatherapy Oils: Diffusers, Nebulizers, & Burners
Mountain Rose Herbs, Aromatherapy Oils: Oil Kits
Click Here To Visit Herbal Remedies Product Page
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Gonorrhea causes no long-term problems if treated early in the course of the infection before any complications develop. Untreated gonorrhea can lead to many complications.
Call your health care provider immediately for medical evaluation if you have the following symptoms.
In Women:
- Sudden, severe pain in the lower abdomen.
- Lower abdominal pain with vaginal bleeding or discharge and a fever of 100°F (37.78°C) or higher.
- Urinary burning, frequent urination, or inability to urinate and a fever of 100°F (37.78°C) or higher.
- New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
In Men:
- Discharge from the penis and a fever of 100°F (37.78°C) or higher.
- Urinary burning, frequent urination, or inability to urinate and a fever of 100°F (37.78°C) or higher.
- Pain, swelling, or tenderness in the scrotum and a fever of 100°F (37.78°C) or higher.
- New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Call your health care provider to determine when an evaluation is needed if you have the following symptoms.
In women:
- Vaginal discharge that has become yellowish, thicker, or bad-smelling.
- Bleeding between periods that occurs more than once when periods are usually regular.
- Pain during sexual intercourse.
- Bleeding after sexual intercourse or douching.
- Sores, bumps, rashes, blisters, or warts on or around the genital or anal area.
- Burning, pain, or itching with urination or frequent urination lasting longer than 24 hours.
- Pelvic or lower abdominal pain occurs without a known cause, such as diarrhea or menstrual cramps.
- Pink eye (conjunctivitis).
- Suspected exposure to a sexually transmitted disease.
In men
- Sores, bumps, rashes, blisters, or warts on or around the genital or anal areas.
- Burning, pain, or itching with urination or frequent urination lasting longer than 24 hours.
- Suspected exposure to a sexually transmitted disease.
- Abnormal discharge from the penis.
- Pink eye (conjunctivitis).
Watchful waiting is a period of time during which you and your health care provider observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate for a gonorrhea infection. Gonorrhea causes no long-term problems if treated early in the course of the infection before any complications develop, but untreated gonorrhea can lead to many complications. Avoid sexual contact until you have been examined by your health professional to prevent transmitting an infection.
If you know you have been exposed to gonorrhea, both you and your sex partner(s) need to be treated. You need to be treated even if you don't have symptoms. You should notify all sex partners with whom you have had sex within 60 days of noticing symptoms or receiving a diagnosis of an infection.
If you are unable or uncomfortable contacting your sex partners, health departments and sexually transmitted disease (STD) clinics can help with this process. Low-cost diagnosis and treatment of gonorrhea is usually available at local health departments and family planning clinics, such as Planned Parenthood. If you are unable or uncomfortable contacting your sex partners, health departments and sexually transmitted disease (STD) clinics can help with this process. Some people are not comfortable seeing their usual health professional for sexually transmitted diseases. Most counties have confidential clinics for diagnosing and treating gonorrhea and other sexually transmitted diseases.
FOR MORE HELPFUL INFORMATION:
Sexuality Information and Education Council of the U.S. (SIECUS)
130 West 42nd Street
Suite 350
New York, NY 10036-7802
Phone: (212) 819-9770
Fax: (212) 819-9776
E-mail: siecus@siecus.org
Web Address: http://www.siecus.org
SIECUS develops, collects, and disseminates information; promotes comprehensive education about sexuality, including sexually transmitted diseases; and advocates the right of individuals to make responsible sexual choices.
Planned Parenthood Federation of America
810 Seventh Avenue
New York, NY 10019
Phone: 1-800-669-0156
Phone: (212) 541-7800
Fax: (212) 245-1845
Web Address: http://www.plannedparenthood.org
This organization provides comprehensive reproductive health care and consumer information about family planning, sexual health, and sexually transmitted diseases (STDs).
STD National Hotline
Phone: 1-800-227-8922
The hot line is available Monday through Friday, 8 a.m. to 11 p.m., Eastern standard time. It provides education, research, and public policy on sexually transmitted diseases (STDs), including minor and major STD infections. Referrals, information on prevention, and free pamphlets are available.
LINKS
Gonorrhea Information & Pictures.
WebMD: Gonorrhea
NIH Factsheets: Gonorrhea
CDC: Gonorrhea/Neisseria
Puberty101: Gonorrhea
Nonsexual Transmission of Gonorrhea
Pediatrics: Gonorrhea in Prepubertal Children
Gonorrhea Information
Portable Guide: Sexually Transmitted Diseases & Child Sexual Abuse
IPT Journal: Medical Examination for Sexual Abuse - Have We Been Misled?
IPT Journal: Medical Findings & Child Sexual Abuse
CDC: Neisseria Microbiology
CDC: Identification of Neisseria and related species
BaceriaMuseum.org: Neisseria gonorrhoeae
Gonorrhea.net
eMedicine: Pediatrics, Child Sexual Abuse
Manual For BioSafety in Laboratories
Stability & Viability of N.gonorrhoeae in various solutions and buffers
MSDS Safety Sheet: N. Gonorrhoeae
MoonDragon's Obgyn Information: Sexually Transmitted Diseases (STDs)
