Gonorrhea is a highly contagious sexually transmitted bacterial infection, sometimes referred to as the ‘clap’.
The U.S. Centers for Disease Control and Prevention’s latest tracking suggests that resistance went down between 2011 and 2013 to the antibiotic treatment cefixime for treating gonorrhea but it has started to climb back up in 2014. However, cefixime isn’t typically the first drug of choice for treating gonorrhea infections. The CDC’s most recent guidelines for gonorrhea treatment, issued in 2012, recommend only using cefixime when the preferred option — ceftriaxone-based combination therapy — isn’t available.
However, this increase in resistance is of concern and indicates a need for ongoing vigilance in efficacy studies.
Any sexually active person can get gonorrhea through unprotected vaginal, anal, or oral sex.
Gonorrhea spreads through semen or vaginal fluids during unprotected sexual contact, heterosexual or homosexual, with an infected partner including touching an infected body part with fingers. Gonorrhea can be passed from a mother to her baby at birth and most commonly affects the baby’s eyes.
The infection is not spread from simple kissing, sharing towels, toilet seats, etc.
The incubation period is 1-14 days.
Most women with gonorrhea have no symptoms, and when they do the symptoms are often mild and may be mistaken as a bladder or vaginal infection.
However, they are at risk for developing serious complications if untreated.
Symptoms can include:
Painful or burning sensation during urination
Increase in vaginal discharge; strong smelling, may be thin and watery or thick and yellow/green
Vaginal bleeding between periods
Possibly some low abdominal or pelvic tenderness/pain, sometimes with nausea
Men may also show no symptoms, but those who do may experience
Burning sensation with urination
White, yellow or green discharge from the penis
Painful or swollen testicles
Rectal infections may either cause no symptoms, or symptoms in both men and women may include:
Painful bowel movements
Gonorrhea that affects the eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes.
A throat infection may include a sore throat and swollen lymph nodes in the neck.
A urine test can be used. For those who have had oral and/or anal sex, samples may be collected from the throat and/or rectum by swab. A swab can also be used to collect a specimen from the male urethra or female cervix.
A genital examination by a doctor or nurse and an internal examination for women may also be done.
New Treatment Guidelines on Dual antibiotic therapy for gonococcal infections by the American College of Obstetricians and Gynecologists as reported in the November, 2015 article in Medscape are as follows:
Neisseria gonorrhoeae has developed resistance to the sulfonamides, the tetracyclines, and penicillin. Dual therapy with ceftriaxone and azithromycin remains the only recommended first-line regimen for the treatment of gonorrhea in the United States.
Dual therapy with ceftriaxone and azithromycin should be administered together on the same day, preferably simultaneously, and under direct observation.
The preferred first-line regimen for uncomplicated gonococcal infections of the cervix, urethra, and rectum is ceftriaxone, 250 mg, in a single intramuscular dose plus azithromycin, 1 g, in a single oral dose.
Second-line regimens include oral cefixime plus oral azithromycin and, in cases of severe penicillin allergy, oral gemifloxacin plus azithromycin or gentamicin (intramuscularly) plus azithromycin.
Pregnant women who are infected with N gonorrhoeae should be treated with the recommended dual therapy.
A test-of-cure is not needed for individuals diagnosed with uncomplicated urogenital or rectal gonorrhea who are treated with the recommended or alternative regimens.
Repeat N gonorrhoeae infection is prevalent among patients who have been diagnosed with and treated for gonorrhea in the preceding several months. Most of these infections result from reinfection; therefore, clinicians should advise patients with gonorrhea to be retested 3 months after treatment. Pregnant women with antenatal gonococcal infection should be retested in the third trimester unless recently treated.
Women with pharyngeal gonorrhea treated with an alternative regimen should return 14 days after treatment for a test-of-cure using either culture or nucleic acid amplification test.
Recent sex partners within 60 days of a patient’s diagnosis should seek evaluation and presumptive treatment for N gonorrhoeae and Chlamydia trachomatis infections.
After both the individual and their partner have completed treatment a waiting period of seven days is recommended before having sex. Reinfection is possible by having unprotected sex with a person who is infected.
References for this information were taken from:
Swift D. ACOG advocates dual therapy for gonococcal infections. Medscape Medical News. WebMD Inc. October 22, 2015.
Committee opinion 645 summary: dual therapy for gonococcal infections. Obstet Gynecol. 2015 Nov;126(5):1126.
In women untreated gonorrhea can cause PID (pelvic inflammatory disease), the formation of scar tissue that can block fallopian tubes, ectopic pregnancy, infertility, and long-term pelvic and abdominal pain.
For men the tube attaching to the testicles (epididymis) can be painful and lead to sterility.
Untreated gonorrhea can also increase susceptibility to contracting HIV.
In rare cases, gonorrhea can spread to the joints and blood causing life threatening conditions. If one or more joints become infected the joint(s) may be warm, red, swollen and painful especially with movement.
Free CDC Fact Sheet — http://www.cdc.gov/std/gonorrhea/gon-factsheet-july-2014.pdf
Information for this article was taken from:
For additional references, see Fact Sheet.
[Heartbeat International Fact Sheet, Susan Dammann, RN, LAS ]