Content Information
Disease Information
Gonorrhea is a common sexually transmitted disease (STD) caused by Neisseria gonorrhoeae.
Overview
Also known as: Gonorrhea Gonococcal Infection (GC), Neisseria gonorrhoeae, Clap, Drip, Dose
Responsibilities
- Hospital: Report cases by IDSS, fax, phone, or mail
- Lab: Report positive lab results by IDSS, fax, phone, or mail
- Physician: Report cases by fax, phone, or mail
Local Public Health Agency (LPHA): Follow-up conducted by Iowa Department of Public Health or by Black Hawk, Linn, Polk or Scott County Health Departments
Iowa HHS
Sexually Transmitted Disease Reporting Hotline: (515) 281-3031
A. Agent
Gonorrhea is a common sexually transmitted disease (STD) caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist environment of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and in the urethra in women and men. The bacterium can also grow in the oropharynx, anorectum, and eyes.
B. Clinical Description
Symptoms: Men may have some signs or symptoms that appear 2 – 5 days after infection, but the symptoms can take as long as 30 days to appear. There may also be no signs or symptoms as this infection is often asymptomatic. Signs and symptoms may include a burning sensation when urinating, or a white, yellow, or green discharge from the penis, but these are often mild. Sometimes men with gonorrhea have painful or swollen testicles.
In women, symptoms are often mild. Many who are infected have no symptoms. Even when a woman has symptoms, they can be non-specific and mistaken for a bladder or vaginal infection. Initial signs and symptoms in women can include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods or during or after intercourse. Women with mild or no symptoms are still at risk of developing serious complications.
Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or sometimes painful bowel movements. Rectal infection can sometimes have no symptoms. Infections in the throat may cause a sore throat, but usually there are no symptoms.
Onset: If symptoms are present, a range of 0 - 30 days, with 2 - 7 days being the most common. Often there are no symptoms; 10% - 15% of men and about 80% of women have no symptoms. People with no symptoms are at increased risk for developing complications, because they receive no treatment. Asymptomatic individuals may spread the infection unknowingly.
Complications: Untreated gonorrhea can cause serious and permanent health problems in both women and men.
- In men, gonorrhea can cause epididymitis, a painful condition of the testicles that can lead to infertility if untreated. Without prompt treatment, gonorrhea can also affect the prostate, and lead to scarring inside the urethra, making urination difficult.
- In women, gonorrhea is a common cause of pelvic inflammatory disease (PID). About one million women in the United States develop PID each year. Women with PID do not necessarily have symptoms. When symptoms are present, they can be very severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled “pockets” that are hard to cure) and long lasting, chronic pelvic pain. PID can cause infertility, or damage the fallopian tubes enough to increase the risk of ectopic pregnancy. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube.
- If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby. Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult a healthcare provider for appropriate examination, testing, and treatment, if necessary.
- Gonorrhea can spread to the blood or joints. This condition, called Disseminated Gonococcal Infection, can be life threatening. People with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are more likely to transmit HIV to someone else.
C. Reservoirs
Common reservoirs: Humans
D. Modes of Transmission
Person-to-person: Gonorrhea is spread through contact between the penis, vagina, mouth, and anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during birth.
Gonorrhea can spread to other unlikely parts of the body. For example, a person can get an eye infection after touching infected genitals and then the eyes. People who have had gonorrhea and received treatment may get infected again if they have sexual contact with a person infected with gonorrhea.
Any sexually active person can be infected with gonorrhea. The greater the number of sex partners, the greater the risk of infection. Because the cervixes of teenage girls and young women are not fully matured, they are at particularly high risk for infection if sexually active. Since gonorrhea can be transmitted by oral or anal sex, men who have sex with men are also at risk for gonorrheal infection.
E. Incubation period
The average incubation period is 2 - 5 days, but may range from 0 - 30 days. Men who are infected may have no symptoms, and may not believe that they are infected. Most women who are infected have no symptoms. Most women who develop local symptoms do so within 10 days of infection.
F. Period of Communicability or Infectious Period
A person who is infected with gonorrhea can spread disease from the time he or she is infected until properly treated. Reinfection is common if partners are not adequately treated in a timely manner.
G. Epidemiology
Gonorrhea is the second most commonly reported notifiable disease in the United States. It is estimated that approximately 800,000 people in the United States are infected with gonorrhea each year. Only about ½ of these infections are reported to CDC. In 2011, 321,849 cases of gonorrhea were reported in the U.S. to CDC. In 2011, the rate of reported gonorrhea infections was 104.2 per 100,000 persons. In Iowa, there were 1,966 cases reported in 2011 (Rate: 65 per 100,000). Rates are highest among persons 15 to 29 years of age. People in this age range account for 81% of diagnoses. In addition, rates among African Americans remain markedly higher than among other racial and ethnic groups.
H. Bioterrorism Potential
None.
I. Additional Information
The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions should not affect the investigation or reporting of a case that fulfills the criteria in this chapter. (CSTE case definitions are used by the state health department and the CDC to maintain uniform standards for national reporting.)
Fact Sheets and Forms
Treatment Information
N. gonorrhoeae can be treated and cured with antibiotics. For uncomplicated gonococcal infections of the cervix, urethra, and rectum: 250 mg ceftriaxone, delivered in a single dose by intramuscular injection plus 1 gram of azithromycin, given orally in a single dose. Pregnant women should be treated with the same regimen. HIV-positive persons with N. gonorrhoeae should also receive the same treatment as those who are HIV-negative. Refer to the 2010 CDC Sexually Transmitted Diseases Treatment Guidelines for complete treatment guidelines.
Treatment failure has occurred among individuals with gonococcal infections who were treated with oral cephalosporins. Although antimicrobial resistant strains of N. gonorrhoeae are most common in Asian countries, treatment failures with oral cephalosporins have been documented in North America. Decreasing susceptibility to cephalosporins has been observed throughout the United States, occurring more frequently on the West Coast. People diagnosed with N. gonorrhoeae should tell their healthcare provider if they or their sex partners have recently traveled to areas in which resistance appears to be developing more rapidly (e.g., Southeast Asia), to ensure proper treatment.
References
Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2010. MMWR 2010; 59, RR-12
Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections – MMWR August 10, 2012
CDC. Sexually Transmitted Disease Statistics, 2011.
Heymann, D.L., ed. Control of Communicable Diseases Manual, 20th Edition. Washington, DC, American Public Health Association, 2015.
CDC. Case Definitions for Infectious Conditions under Public Health Surveillance, 1996:
Notification And Surveillance of Reportable Communicable and Infectious Diseases, Poisonings and Conditions. Iowa Code 2010 Section 139A.
Additional Resources
STD Program web site, Iowa HHS
American Sexual Health Association