Coming to terms with Sexually Transmitted Disease: Gonorrhea page 8

This is the oldest known sexually transmitted disease. In the 14th century it became known as the clap, a name we still use today. It is also referred to as “the drip” or “the dose.”

Until 1991, gonorrhea was the most commonly reported STD in the United States, even though rates have been steadily decreasing since the mid 1970s. The number of cases reported to the Centers for Disease Control and Prevention in 1992 was 433,949; by the end of November 1993, the number of cases was 336,169. Some experts believe many cases go unreported, and they estimate the actual number to be about two million a year.

• Risk factors: You are more likely to get gonorrhea if you or your partner have casual sexual contacts with others and if you are under the age of 20. From 1981 to 1991, adolescents were the only group of Americans showing an increase in the number of cases; people aged 15 to 19 have twice the number of infections as those aged 20 to 24. People living in the South Atlantic region of the U.S. (from Delaware down the eastern seaboard) may be at higher risk because this region has the highest number of reported cases.

People with limited access to health care also seem to have a higher risk for getting gonorrhea. Other groups at high risk of this or any other STD include people living in large cities, singles, those who have had past gonorrhea infections, drug users, and prostitutes.

A man having unprotected sex once with a woman infected with gonorrhea has a 20 percent to 25 percent chance of catching the disease. A woman having unprotected sex once with an infected man has an 80 percent to 90 percent chance of catching it.

• Signs and symptoms: The symptoms of gonorrhea are similar to those of chlamydia. Women with symptoms usually experience increased vaginal discharge. Other symptoms include pain when urinating, lower abdominal or rectal pain, intermittent vaginal bleeding, pain or bleeding during intercourse, and fever. Half of all women with gonorrhea infections also have a gonococcal rectal infection and may have discomfort in the anal area.

Up to 70 percent of infected women are asymptomatic. Only 10 percent of infected men are without symptoms. Therefore, your first warning of infection may be from your partner. He will experience painful urination and have a milky discharge from his penis. He may feel the need to urinate frequently.

• Cause: Gonorrhea infections are caused by a kidney bean-shaped bacteria scientists call Neisseria gonorrhea. These germs live in the cervix in women and inside the urethra (the tube that carries urine) in men.

• Incubation period: Symptoms usually develop within 10 days of infection.

• Possible health affects: Untreated infections can lead to Pelvic Inflammatory Disease (PID), which increases by 40 percent your chance of having a tubal (ectopic) pregnancy or becoming infertile. You also become susceptible to septicemia (blood poisoning), arthritis, or problems related to the skin, heart, or brain.

• Diagnosis: For men, a simple test called a gram stain is sufficient for diagnosis, but for women a tissue culture is often needed, since many organisms in the cervix look similar to the gonorrhea bacteria. A blood sample may be taken to test for syphilis, and a test for chlamydia may be done. Your tissue culture should be ready within 48 hours.

• Treatments: Many strains of gonorrhea are now resistant to standard drugs such as penicillin and tetracycline. However, two new types of drugs, the cephalosporins and the quinolones, are highly effective in treating gonorrhea. The cephalosporins include ceftriaxone (Rocephin) in a single 125-milligram intramuscular injection, and cefixime (Suprax) 400 milligrams orally in a single dose. The quinolones include ciprofloxacin (Cipro) 500 milligrams orally in a single dose, and ofloxacin (Floxin) 400 milligrams orally in a single dose. Ceftriaxone is expensive but offers higher and more sustained activity against infection than does cefixime. Ciprofloxacin is less expensive than ceftriaxone and has proven to be highly effective.

For those who are allergic to or who can not tolerate the cephalosporins and the quinolones, an injection of spectinomycin (Trobicin), is given in a single 2-gram intramuscular injection. Though spectinomycin is expensive, it will cure gonorrhea infections of the throat.

Your doctor may also suggest treatment for chlamydia since the two infections frequently occur together and chlamydia is often asymptomatic. For information on chlamydia treatment, see the previous section.

There are many other drugs available to treat gonorrhea. You can discuss them with your doctor.

• Follow-up: You won't need to be retested for gonorrhea after you have finished your medication unless your symptoms continue or you have been re-exposed to the disease.

If you received treatment because you had symptoms, all sex partners from the prior 30 days should also get treatment. If your infection was found incidentally, all sex partners from the last 60 days should be treated.

• Prevention: Latex condoms can protect you from the gonorrhea bacteria. Other methods, such as the diaphragm, cervical cap and spermicides also offer some protection. It is advisable to abstain from sex during your treatment, and until all tests are negative.

• Pregnancy: Pregnant women with gonorrhea can not be treated with quinolones or tetracyclines. If you are pregnant, you may be given a cephalosporin or a single injection of spectinomycin.

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