Gonorrhea
Neisseria gonorrhea is a bacterium that only infects humans. Gonorrhea is a common sexually transmitted infection (STI), especially among young people ages 15-24 years. It can cause infections in the throat, genitals and rectum, and it is often asymptomatic. Despite the lack of symptoms, it can cause problems later in life, such as infertility (in both men and women) and pelvic inflammatory disease. According to CDC data, in 2023, a total of 601,319 cases of gonorrhea were reported, making it the second most common nationally notifiable STI in the United States for that year.
Signs & symptoms
Symptoms depend upon the site of infection. Gonorrhea is more often asymptomatic in women. In men and women, urethritis can cause dysuria and discharge. Women can experience vaginal discharge or spotting, and men can experience painful or swollen testicles. Rectal infections can cause anal discharge and itching, pain, bleeding and painful bowel movements. Throat infections cause typical pharyngitis symptoms–sore throat and lymphadenopathy. Disseminated gonorrhea, or infection away from sites of sexual activity (e.g., blood stream, joints) is rare but does occur.
Perinatal exposure to endocervical infection may result in gonococcal conjunctivitis in newborns, which can lead to complications like blindness or systemic infections, including meningitis, if left untreated.
Diagnosis
Physicians can diagnose gonorrhea with a PCR test of the infected area. It is important that physicians ask their patients about sexual activity and offer testing of all possibly infected areas. With instructions, patients can self-collect posterior oropharyngeal, rectal and vaginal samples if preferred, while urine samples can also be sent. Treatment can be given after testing is done, rather than waiting for a diagnosis, especially in patients for whom it may not be easy to return for a second appointment.
Prevention strategies
Treatment
Neisseria gonorrhea is treated and cured with antibiotics. The only CDC-recommended treatment of uncomplicated gonorrhea is a single dose of ceftriaxone 500 mg given intramuscularly. If injectable treatment is not possible one dose of oral cefixime 800 mg can be considered. Concurrent treatment of Chlamydia trachomatis with oral doxycycline 100 mg daily for 7 days should be given if tests have not ruled it out.
Expedited Partner Therapy (EPT) has been shown to be effective in reducing reinfection. While referring the partner for testing and treatment with ceftriaxone is ideal, for those who cannot come for evaluation giving the patient a prescription for their partner for cefixime is recommended EPT has been shown to be effective in heterosexual partners; in MSM shared-decision making is recommended.
Prevention
Using condoms prevents the spread of gonorrhea. Once a patient has been treated for gonorrhea, they should wait seven days before resuming sexual activity or risk spreading the infection to their partner.
Reporting
Gonorrhea is a nationally notifiable disease and is a reportable condition in every state. Notify state, tribal, local or territorial health departments (24-hour Epi On Call contact list) of any suspected case of gonorrhea to help ensure partner notification and treatment.
