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Gonorrhea
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Gonorrhea
Classification and external
resources

ICD-10 A54

ICD-9 098

Gonorrhea (also gonorrhoea), caused by the bacteria Neisseria gonorrhoeae, is a


common sexually transmitted disease. In the US, its incidence is second[1] only to
chlamydia.[2]

Non-genital sites in which it thrives are in the rectum, the throat (oropharynx), and the
eyes (conjunctiva). 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 typically spreads during sexual intercourse. It can also be vertically
transmitted, where infected mothers can pass gonorrhea to their newborn infants during
delivery. This causes conjunctivitis (eye infections) which, if left untreated, can lead to
blindness. As prophylaxis against this, many countries routinely treat infants with
eyedrops of erythromycin at birth. [3]

Contents
[hide]

• 1 Symptoms
• 2 Complications
• 3 Treatment
o 3.1 Antibiotics
o 3.2 United States recommendations
o 3.3 United Kingdom recommendations
o 3.4 Historically
• 4 Prevalence
• 5 Slang terms

• 6 References

Symptoms
The incubation period is 10 to 20 days with most symptoms occurring between the
fifteenth and twentieth days after being infected. A small number of people may be
asymptomatic for up to a lifetime. Between 30 and 60% of people with gonorrhea are
asymptomatic or have subclinical disease.[4] Women may complain of vaginal discharge,
difficulty urinating (dysuria), projectile urination, 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, though
transmission occurs rarely with "safe sex" practices of condom usage with lubrication.

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 childbirth, a condition known as ophthalmia
neonatorum.[5]

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. Instances of blurred vision in one eye may
occur in adults.

Complications
In men, inflammation of the epididymis (epididymitis), prostate gland (prostatitis) and
urethral structure (urethritis) can result from untreated gonorrhea[5].

In women, the most common result of untreated gonorrhea is pelvic inflammatory


disease, a serious infection of the uterus that can lead to infertility. Further on,
perihepatitis may develop[5]. This rare complication is associated with Fitz-Hugh-Curtis
syndrome. Additionally, septic arthritis in the fingers, wrists, toes, and ankles is also
common. 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.

Treatment
Antibiotics

This section does not cite any references or sources.


Please help improve this article by adding citations to reliable sources. Unverifiable material
may be challenged and removed. (August 2008)

Antibiotics that may be used to treat gonorrhea include:

• Amoxicillin 2 g plus probenecid 1 g orally


• Ampicillin 2 to 3 g plus probenecid 1 g orally
• Azithromycin 2 g orally
• Cefixime 400 mg orally
• Cefotaxime 500 mg by intramuscular injection
• Cefoxitin 2 g by intramuscular injection, plus probenecid 1 g orally
• Cefpodoxime (Vantin) 400 mg orally
• Ceftriaxone (Rocephin) 125 to 250 mg by intramuscular injection
• Ciprofloxacin 500 mg orally
• Levofloxacin 250 mg orally
• Ofloxacin 400 mg orally
• Spectinomycin 2 g by intramuscular injection

These drugs are all given as a single dose.

The level of tetracycline resistance in Neisseria gonorrhœae 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, doctors 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 β-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 five to seven 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.

United States recommendations

The United States 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.

Since 1993, fluoroquinolones (i.e., ciprofloxacin, ofloxacin, or levofloxacin) have been


used frequently in the treatment of gonorrhea because of their high efficacy, ready
availability, and convenience as a single-dose, oral therapy. Beginning in 2000,
fluoroquinolones were no longer recommended for gonorrhea treatment in persons who
acquired their infections in Asia or the Pacific Islands (including Hawaii); in 2002, this
recommendation was extended to California (2). In 2004, CDC recommended that
fluoroquinolones not be used in the United States to treat gonorrhea in men who have sex
with men (MSM). On the basis of the most recent evidence, CDC no longer recommends
the use of fluoroquinolones for the treatment of gonococcal infections and associated
conditions such as pelvic inflammatory disease (PID).[6] Consequently, only one class of
drugs, the cephalosporins, is still recommended and available for the treatment of
gonorrhea.[citation needed] The Center for Disease Control has recently (April 2007) updated
treatment guidelines.[7]

Antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-
resistant strains of gonorrhea are increasing in many areas of the world, including the
United States, and successful treatment of gonorrhea is becoming more difficult. Because
many people with gonorrhea also have chlamydia, another sexually transmitted disease,
antibiotics for both infections are usually given together. Persons with gonorrhea should
be tested for other STDs. It is important to take all of the medication prescribed to cure
gonorrhea. Although medication will stop the infection, it will not repair any permanent
damage done by the disease. People who have had gonorrhea and have been treated can
get the disease again if they have sexual contact with persons infected with gonorrhea. If
a person's symptoms continue even after receiving treatment, he or she should return to a
doctor to be reevaluated.

United Kingdom recommendations


In the United Kingdom, 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) has been recommended if there is concurrent


infection with chlamydia. However, since 2000, the Gonococcal Resistance to
Antimicrobials Surveillance Programme (GRASP) has gathered data on drug resistant
strains of gonorrhoea in the UK. In 2005, 2.2% of cases were azithromycin resistant and
in some regions of the UK this extended to 5% of cases. The mainstay of treatment now
is a cephalosporin with azithromycin (to cover 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).[8]

Historically

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 urinary meatus into any
unfortunate crewman suffering from gonorrhea. Silver nitrate was one of the widely used
drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün
invented this type of colloidal silver which was marketed by Bayer from 1897 on. The
silver-based treatment was used until the first antibiotics came into use in the 1940s.[9][10]

The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be


accurately determined from the historical record. One of the first reliable notations occur
in the Acts of the (English) Parliament, In 1161 this body passed a law to reduce the
spread of "...the perilous infirmity of burning."[11] The symptoms described are consistent
with, but not diagnostic of, gonorrhea. A similar decree was passed by Louis IX in France
in 1256, replacing regulation with banishment. [12] Similar symptoms were noted at the
siege of Acre by Crusaders.

Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several


changes occurred in European Medieval Society . Cities hired public health doctors to
treat afflicted patients without right of refusal. Pope Boniface rescinded the requirement
that physicians complete studies for the lower orders of the Catholic priesthood. It was
also at this time that a female foot fetish emerged as a safe-sex technique.

Medieval public health physicians in the employ of their cities were required to treat
prostitutes infected with the "burning ", as well as lepers and other epidemic victims.[13]
After Pope Boniface completely secularized the practice of medicine physicians were
more willing to treat a sexually-transmitted disease. Municipalities would hire an official
to regulate the examination of infected patients and check the spread of this sexually
transmitted contagion. In Paris, this official was popularly known as the "King of
Whores". Also, during this time-period the female foot was sexualized, for the first time,
on a popular basis. In 1220 Bertold of Regensburg listed those anatomotical parts of
women's bodies he considered sexually sinful. For the first time a surviving Medieval
manuscript listed womens feet as an erotic focus He warned that, "...you must all send
your feet to Hell by special torments".[14] This sexual emphasis on feet was noted again in
the syphilis epidemics of the Sixteenth and Nineteenth Century and the AIDS epidemic of
the Twentieth Century.[15]

Prevalence
"Gonorrhea is a very common infectious disease. The CDC estimates that more than
700,000 persons in the United States 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 the CDC. After the implementation of a national gonorrhea control program in
the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. 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."[16]

Slang terms
Gonorrhea is also commonly known by the slang term the clap.

Suggested etymology:

• Reference 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.[citation needed]
• Reference 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.
• From the old French word "clapoir", meaning sexual sore. This word was derived
from the old French word "clapier", meaning "brothel".

The term the clap was replaced with the similar sounding the jack in the 1975 AC/DC
song The Jack, which used the metaphor of playing cards and poker as sexual innuendo
in the original LP version. However, live recordings of the song make direct references to
the disease.

References
1. ^ "CDC - STD Surveillance - Gonorrhea". Retrieved on 2008-08-21.
2. ^ "CDC Fact Sheet - Chlamydia". Retrieved on 2008-08-21.
3. ^ "Erythromycin ointment for ocular prophylaxis of neonatal chlamydial
infection". Retrieved on 2008-07-14.
4. ^ YT van Duynhoven (1999). "The epidemiology of Neisseria gonorrheae in
Europe". Microbes and Infection 1 (6): 455–464. doi:10.1016/S1286-
4579(99)80049-5. PMID 10602678.
5. ^ a b c Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N.
(2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 705-706 ISBN
978-1-4160-2973-1
6. ^ "CDC Update to Sexually Transmitted Treatment Guidelines". Retrieved on
2008-08-21.
7. ^ "CDC STD Treatment Regimens". Retrieved on 2008-08-21.
8. ^ Health Protection Agency. "The gonococcal resistance to antimicrobials
surveillance programme: Annual report 2005" (PDF). Retrieved on 2006-10-28.
9. ^ Max Bender (1898). "Ueber neuere Antigonorrhoica (insbes. Argonin und
Protargol)". Archives of Dermatological Research 43 (1): 31–36.
doi:10.1007/BF01986890.
10. ^ "MedlinePlus - Neonatal Conjunctivitis". Retrieved on 2008-08-28.
11. ^ W Sanger. History of Prostitution. NY,Harper, 1910 .
12. ^ P. LaCroix. The History of Prostitution--Vol. 2. NY,MacMillan, 1931.
13. ^ WE Leiky . History of European Morals. NY, MacMillan, 1926.
14. ^ L Coultan. Life in the Middle Ages. Cambridge, Cambridge U. Press, 1925.
15. ^ Giannini AJ, Colapietro G, Slaby AE, Melemis SM, Bowman RK (October
1998). "Sexualization of the female foot as a response to sexually transmitted
epidemics: a preliminary study". Psychological reports 83 (2): 491–8. PMID
9819924.
16. ^ "Gonorrhea - CDC Fact Sheet". Retrieved on 2008-07-31.

Wikimedia Commons has media related to:


Gonorrhea
[hide]
v•d•e
Sexually transmitted diseases and infections (STD/STI) (primarily A50-
A64, 090-099)

Chancroid (Haemophilus ducreyi) • Chlamydia (Chlamydia


trachomatis) • Donovanosis (Granuloma Inguinale) •
Bacterial Lymphogranuloma venereum (LGV) •
Gonorrhea (Neisseria gonorrhoeae) • Syphilis (Treponema
pallidum) • Ureaplasma urealyticum

Protozoal Trichomoniasis (Trichomonas vaginalis)

Parasitic Crab louse/crabs • Scabies

AIDS (HIV-1/HIV-2) • Cervical cancer &


Genital warts (condyloma) (Human papillomavirus (HPV)) •
Viral
Hepatitis B • Herpes simplex virus (HSV1/HSV2) •
Molluscum contagiosum (MCV)

female: Cervicitis • Pelvic inflammatory disease (PID)

male: Epididymitis • Prostatitis


General inflammation
either: Proctitis • Urethritis/Non-
gonococcal urethritis (NGU)

Ectopic pregnancy • Premature birth • Infertility • Reactive


Other
arthritis
Retrieved from "http://en.wikipedia.org/wiki/Gonorrhea"
Categories: Sexually transmitted diseases and infections
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