Gonorrhea: Causative Agent, Symptoms, Treatment and Prevention
What is Gonorrhea?
One of the most common STIs in men and women is gonorrhea.
Importantly, the ability to treat gonorrhea infections with antibiotics might soon become more challenging.
Causative Agent and Epidemiology of Gonorrhea
The agent of gonorrhea is Neisseria gonorrhoeae, a small, unencapsulated, nonmotile, gram-negative diplococcus named for Albert Neisser, who isolated it in 1879.
The organism, commonly known as the gonococcus, has a characteristic double-bean shape.
The great majority of cases of gonorrhea are transmitted during sexual intercourse.
(Gonorrhea is sometimes called “the clap,” from the French “clappoir” for “brothel.”) The organism is found only in humans, where it can infect the cervix, uterus, fallopian tubes, and urethra, as well as the mouth, throat, and anus.
Gonorrhea is the second most frequently reported nationally notifiable infectious disease in the United States with the highest percentage of infections being in persons 15 to 24 years of age.
The CDC estimates that 3 to 4 million cases go undetected or unreported each year.
Globally, the World Health Organization (WHO) believes there are more than 78 million infections annually.
Clinical Symptoms of Gonorrhea
Following attachment of N. gonorrhoeae by pili to the genital tract, the incubation period for gonorrhea ranges from 2 to 6 days.
In females, the cervix becomes reddened, and a discharge might be expressed by pressure against the pubic area.
Patients often report abdominal pain and a burning sensation on urination, and the normal menstrual cycle might be interrupted.
In some females, gonorrhea also spreads to the fallopian tubes. As these thin passage ways become riddled with pouches and adhesions, salpingitis and PID might occur.
Sterility can result from scar tissue remaining after the disease has been treated, or a woman might experience an ectopic pregnancy.
It should be noted that symptoms are not universally observed in females, and an estimated 50% of affected women remain asymptomatic but can spread the disease unknowingly through sexual intercourse.
Gonorrhea is particularly dangerous to an infant born to an infected woman.
The infant can contract gonococci during passage through the birth canal and develop neonatal conjunctivitis.
Symptoms of gonorrhea tend to be more acute in males than in females, and males thus tend to seek diagnosis and treatment more readily.
When gonococci infect the mucus membranes of the urethra, symptoms include a tingling sensation in the penis, followed in a few days by pain when urinating.
There is also a thin, watery discharge at first, followed later by more obvious yellow, thick fluid resembling semen.
Frequent urination and an urge to urinate develop as the disease spreads further into the urethra.
The lymph nodes of the groin can swell, and sharp pain might be felt in the testicles.
Unchecked infection of the epididymis can lead to sterility.
Like chlamydia, gonorrhea does not restrict itself to the urogenital organs.
Gonococcal pharyngitis can develop in the pharynx if bacterial cells are transmitted by oral–genital contact; patients complain of sore throat or difficulty in swallowing.
Infection of the rectum, or gonococcal proctitis, also can occur, especially in individuals performing anal intercourse.
Treatment and Prevention of Gonorrhea
Historically, gonorrhea has been treated effectively with antibiotics.
However, today N. gonorrhoeae is becoming resistant to most all antibiotics used for treatment, and it might be only a matter of time before treatment failures occur.
Such changes are transforming N. gonorrhoeae into a major superbug and a potential global public health threat.