There are more than 60 nationally notifiable infectious diseases that state health departments report to the Centers for Disease Control and Prevention (CDC). While reporting these infectious diseases is not mandatory, all 50 states reported on the sexually transmitted infections (STIs) that are included in the list. Based on the data collected by the CDC, it has been observed that the reportable STIs are on the rise again in the United States. The reported Chlamydia infection rates have been increasing over the past 10 years. The reported syphilis infection rates have been increasing since 2001. Most recently, the CDC reported that the national gonorrhea infection rates began increasing in 2004. While there is no clear-cut explanation for this trend, the bottom line is that sexually active adults are at risk for infection.

Gonorrhea, or Neisseria gonorrhoeae, is the second-most frequently reported sexually transmitted infection after Chlamydia, or Chlamydia trachomatis. Back in 1975, the rate of gonorrhea infection was 464 cases per every 100,000 people. Due to the high rate of infection, a national gonorrhea control program was started in the mid-970s. Following the implementation of the national program, over the next 22 years the national rate of gonorrhea infection declined 74 percent to just 120 cases per every 100,000 people in 1997. In 1998, national rate increased slightly and then remained fairly stable through 2004.

Over 350,000 cases of gonorrhea were reported to the CDC in 2006. Based on this reported number of gonorrhea cases, the United States has a rate of almost 121 cases of reported gonorrhea per every 100,000 people. However, reported cases are only part of the story. It is estimated that approximately 600,000 men and women are actually infected with gonorrhea every year. These numbers demonstrate that gonorrhea, like other STIs, is diagnosed approximately half as often as it is occurring and is therefore under-reported. All the undiagnosed cases of gonorrhea mean that hundreds of thousands of Americans are unaware that they are carrying the infection and that they are capable of passing the infection on to their sex partners. 

Gonorrhea, also known as the clap, is a bacterial infection that can be passed between sex partners during intercourse. However, sex is not the only time that gonorrhea can be spread. It can be passed to new babies during delivery as well as between sex partners through contact with wet surfaces. Gonorrhea infections favor the urethra, the cervix, and the rectum in the genital region, as well as the oropharynx—the area behind the mouth including the base of the tongue, the tonsils and the uvula, and the conjunctiva—the tissue covering the white part of the eye and the insides of the eyelids. The conjunctiva is where newborns can become infected, and all newborns receive silver nitrate in their eyes to prevent infection during delivery. The transmission of gonorrhea is painless and no one knows that the infection is occurring.

Unfortunately, most women do not show any signs of infection and severe complications can arise regardless of having visual symptoms. If symptoms do show up, it is usually within 10 days of infection. Women may feel pain or burning during urination. They can have yellow or bloody vaginal discharge as well as bleeding between periods. Women may also experience pain during sexual intercourse.

Although gonorrhea can take up to 14 days to manifest symptoms in men, most men begin to show signs of infection sooner, usually within 2-5. Signs of gonorrhea infection in men may include clear, white or thick yellow discharge from the penis. Men may also experience pain or burning during urination. Some men, like women, do not have any symptoms.

Symptoms of an anal gonorrhea infection can affect both men and women in the same way.  Those infected may have sore rectums. They can also experience anal discharge, bleeding, itching, along with bowel movements that hurt. For men and women with gonorrheal throat infections, a severe sore throat is what they will notice. Adults and children with eye infections caused by gonorrhea may have red and itchy eyes as well as a discharge from the eyes.

There are three tests that are used to diagnose gonorrhea. Oftentimes, a doctor will do multiple tests so that they can be sure of an accurate diagnosis. The easiest test is a simple staining of a sample to look for the bacteria. This test may be conducted in the doctor’s office and is very accurate for diagnosing a gonorrhea infection in men. However, this will probably not be the only test that the doctor uses. The doctor will also want a urine sample or a cervical swab to test for bacterial genes. Cultures of the bacteria can also be taken; however, these are not as accurate. Yet cultures are good for detecting drug-resistant strains of the disease, or types of gonorrhea that do not respond to certain medications.  

Gonorrhea is treated with antibiotics. The type of antibiotic prescribed can vary depending on the opinion of your healthcare provider. It is suggested that someone who has tested positive for gonorrhea should also be treated for Chlamydia because often both infections occur together and one may not be detected.

It is important to finish all prescribed antibiotics, even if the symptoms have subsided. Not taking all of the prescribed antibiotics or skipping doses can cause antibiotic resistance to occur. Antibiotic resistance is the term used to describe what happens when a bacteria or other organism is able to survive and reproduce in the presence of antibiotics. When these bacteria reproduce, the offspring will also be able to resist antibiotics, thus creating antibiotic-resistant strains of bacteria such as gonorrhea.

However, if gonorrhea is not treated or not treated properly, the infection can cause permanent injury. Both gonorrhea and Chlamydia can cause pelvic inflammatory disease (PID), an infection of the female reproductive organs. PID can injure the tissue of the uterus, fallopian tubes and ovaries. If not treated, PID can result in infertility, an ectopic pregnancy, constant pain in the pelvic region or infection. An ectopic pregnancy is when a pregnancy occurs outside of the uterus, which commonly happens in the fallopian tubes. Both gonorrhea and Chlamydia are treatable infections and PID is completely preventable.

Taking preventive actions to avoid the transmission of gonorrhea is important. Gonorrhea, as well as other STIs, can be passed on to other people regardless of whether there are physical symptoms. Sexually active adults may be putting themselves at risk for infection when they have unprotected sexual intercourse. STIs are preventable through a variety of methods.

The most effective method of preventing the spread of gonorrhea and other STIs, aside from abstinence, is using latex condoms. Latex does not allow viruses or bacteria to pass through the barricade of the condom. Other condom materials, such as lambskin or polyurethane, are not considered as effective. Lambskin condoms are considered more porous and may not always keep microorganisms from crossing the barrier that condoms should provide. Polyurethane condoms, while effective at preventing transmission of STIs, are more prone to breaking and slipping off than latex condoms. 

Along with using condoms, another method of prevention is to have all potential sexual partners tested for STIs before engaging in sexual intercourse. Sexual partners need to be honest with each other about their past and current sexual history. All sexually active adults should get tested for STIs, including HIV, on a regular basis.    

Being infected with gonorrhea can make it easier for an HIV to infection to occur, as can any sexually transmitted infection. The STIs can cause sores to develop and swelling to occur, which provides opportunities for HIV to breach the skin and mucous membranes in the mouth, vaginal area or anus. With regular visits to a doctor, these symptoms can be caught early and treated before they turn into something worse.

Another opportunity for STI prevention is during a regular gynecologist appointment. Women should receive regular Pap tests once they turn 18 or within three years of becoming sexually active, to test for cervical cancer. While at the gynecologist appointment, women should ask to be tested for STIs, including Chlamydia and gonorrhea, since STI tests are not always a part of a gynecological appointment. Men should also have regular doctor appointments to discuss their sexual health and to have regular STI testing.

Gonorrhea is a preventable and treatable STI. Transmission of gonorrhea and other STIs can be avoided by taking precautions. Use condoms every time sexual and get yourself and your sex partners tested for STIs for a fulfilling and healthy sex life.