Gonorrhea is a sexually transmitted disease (commonly known as "the clap") caused by the bacterium Neisseria gonorrhea.

See also: Disseminated gonococcemia

Gonorrhea is one of the most common infectious diseases. Anyone who has any type of sex can catch gonorrhea. The infection can be spread through the mouth, vagina, penis, or anus.

The bacteria grow in warm, moist areas of the body, including the tubes that carry urine out of the body (urethra). In women, the bacteria may be found in the fallopian tubes, uterus, and cervix. The bacteria can even grow in the eyes.

Every state in the United States requires that health care providers tell their State Board of Health about any diagnosed cases of gonorrhea. This is done to make sure the patient gets proper follow up care and that anyone who had sexual contact with the patient is found and tested.

More than 700,000 persons in the United States get gonorrhea every year, according to the Centers for Disease Control and Prevention (CDC). In general, gonorrhea is most common in people 20 to 24 years old.

Gonorrhea is more common in large cities, inner-city areas, populations with lower overall levels of education and people with lower socioeconomic status.

Risk factors include having multiple sexual partners, having a partner with a past history of any sexually transmitted disease, and having sex without using a condom.

Symptoms of gonorrhea usually appear 2 - 5 days after infection, however, in men, symptoms may take up to a month to appear. Some people do not have symptoms. They may be completely unaware that they have caught the disease, and therefore do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person.

Symptoms in men include:

• Burning and pain while urinating
• Increased urinary frequency or urgency
• Discharge from the penis (white, yellow, or green in color)
• Red or swollen opening of penis (urethra)
• Tender or swollen testicles
• Sore throat

Symptoms in women can be very mild or non-specific, and may be mistaken for another type of infection. They include:

• Vaginal discharge
• Burning and pain while urinating
• Increased urination
• Sore throat
• Painful sexual intercourse
• Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area)
• Fever (if the infection spreads to the fallopian tubes and stomach area)

Tests used to diagnose gonorrhea in women include:

• Cervical gram stain
• Endocervical culture for gonorrhea

Tests used to diagnose gonorrhea in men include:

• Gram stain of urethral discharge
• Urethral discharge culture for gonorrhea

Tests used to diagnose gonorrhea in both men and women:

• Throat swab culture
• Rectal culture
• Ligase chain reaction (LCR) test

Gonorrhea can be quickly identified by staining a sample of tissue or discharge from the infected and then looking at it under the microscope. This is called a gram stain. Although this method is the fastest, it is not the most certain.

Cultures (cells that grow in a lab dish) provide absolute proof of infection. Generally, samples for a culture are taken from the cervix, vagina, urethra, anus, or throat. Cultures can provide a preliminary diagnosis often within 24 hours and a confirmed diagnosis within 72 hours.

DNA tests for the gonorrhea have been developed. They are especially useful as a screening test because they are quicker than cultures. Such tests can also be performed on urine samples, which are a lot easier to collect than samples from the genital area.

There are two goals in treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first is to cure the infection in the patient. The second is to locate and test all of the other people the person had sexual contact with and treat them to prevent further spread of the disease.

Penicillin used to be given to patients with gonorrhea. But it is not often used anymore because some types of the gonorrhea bacteria no longer respond to the drug. This is called antibiotic resistance. Antibiotic resistance is major public health threat in which bacteria cannot be killed with the usual antibiotic medicines.

The bacteria responsible for gonorrhea is growing increasingly resistant to another class of antibiotics called fluoroquinolones, which includes ciprofloxacin, ofloxacin, or levofloxacin. The U.S. Centers for Disease Control and Prevention now recommendeds against using these medicines to treat gonorrhea.

Antibiotics called cephalosporins, including Ceftriaxone (Rocephin), are recommended for persons with gonorrhea. A medicine called Azithromycin (Zithromax) may be given to persons with uncomplicated infections.

A follow-up visit 7 days after treatment is important, especially for women who may not have symptoms associated with the infection.

Complications in women may include:

• Salpingitis (scarring of the fallopian tubes), which can lead to problems getting pregnant
• Pelvic inflammatory disease
• Vulvovaginitis
• Sterility (inability to become pregnant)
• Painful intercourse (dyspareunia)

Complications in men may include:

• Periurethral abscess (collection of pus around the urethra)
• Narrowing of the urethra caused by scarring (urethral stricture)
• Urination problems
• Urinary tract infection
• Kidney failure

Complications in both men and women may include:

• Disseminated infection, which can be very serious
• Infection or inflammation of the reproductive system
• Peritonitis
• Bacteremia (gonococcemia)
• Gonococcal arthritis (joint infection)
• Gonococcal pharyngitis (throat infection)
• Ophthalmia neonatorum (gonococcal conjunctivitis)

If you have symptoms suggestive of gonorrhea, you should call your health care provider immediately. Most state-sponsored clinics will diagnose and treat sexually transmitted diseases (STDs) without charge.

Not having sexual intercourse (abstinence) is the only absolute method of preventing gonorrhea. A monogamous sexual relationship with an individual known to be free of any STD can reduce risk. Monogamous means you and your partner do not have sex with any other persons.

You can greatly lower your risk of catching an STD by using a condom every time you have sex. Condoms are available for both men and women, but are most commonly worn by the man. A condom must be used properly every time. (For instructions on how to use a condom, see safe sex.)

To further prevent the spread of infection, treatment of all sexual partners is important.

Gonorrhea is often associated with the presence of other sexually transmitted diseases. About half of the women with gonorrhea are also infected with chlamydia, another very common STD that can result in sterility. If you have gonorrhea, you should request testing for other sexually transmitted diseases, including AIDS.

Centers for Disease Control and Prevention (CDC). Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006: Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections. MMWR. 2007; 56(14);332-336.

U.S. Preventive Services Task Force. Screening for Gonorrhea: Recommendation Statement. Am Fam Physician. Nov. 1, 2005; 72(9); 1783-1786.

Cohen J, Powderly WG. Infectious Diseases. 2nd ed. New York, NY: Elsevier; 2004:2173-2186.

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2004. Atlanta, GA: U.S. Department of Health and Human Service, September 2005.

Weinstock H, Berman S, Cates W. Sexually transmitted disease among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004; 36: 6-10.

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2002. MMWR. 2002;51(no. RR-6).