Gonorrhea is one of the most common sexually transmitted infections (STIs), or STDs, as they’re commonly called. Once referred to as “the clap,” gonorrhea has historically been very easily treated and cured, but many health officials are increasingly concerned about strains of the bacteria that have developed drug resistance.

Learn more about what gonorrhea is, what it does to your body, how prevalent it is where you live and what you can do to prevent it.

In This Section

Gonorrhea Symptoms

Gonorrhea is caused by the bacteria Neisseria gonorrhoeae, which can infect the cervix, uterus, urethra, mouth, throat, eyes and rectum. While it infects both men and women, men are more likely than women to display symptoms.

While not all people will show obvious physical signs, those who do generally will begin displaying symptoms within about one week after exposure and infection. About 8 in 10 women who are infected with gonorrhea show no obvious physical signs of the disease, while a much smaller proportion of men (about 15%) can say the same.

Symptoms are similar between the sexes, but it can take as long as 30 days for some men to show signs of infection. Here are the symptoms for both males and females:

Male

  • Painful urination
  • Burning sensation when urinating
  • Discharge from the penis that’s yellow, white or green in color
  • Painful, swollen testicles
  • Sore throat
  • Anal itching or discharge

Female

  • Painful or burning urination
  • Abnormal vaginal discharge that could be bloody or yellow in color
  • Bleeding between periods
  • Sore throat
  • Anal itching or discharge

Gonorrhea Transmission

Gonorrhea, or the clap, as it’s often called, is spread through sexual contact with an infected person. This includes contact with the penis, vagina, mouth or anus, and because of the nature of the bacteria, it is not necessary for full penetration or even ejaculation to occur for the disease to be spread.

In some cases, gonorrhea can also infect a person’s eyes or throat if an infected person’s bodily fluids contact either part of the body.

The bacteria also can be spread from a pregnant woman to her baby during childbirth, but it can’t be spread through casual contact like sharing food or shaking hands or through more intimate contact like kissing or holding hands.

Gonorrhea Prevalence

Gonorrhea is among the most common sexually transmitted infections that are tracked nationally by federal health officials, impacting hundreds of thousands of Americans per year. While chlamydia, a disease that often has similar symptoms to gonorrhea, is more common, the clap has seen the number of cases and the population-adjusted rate rise dramatically in recent decades.

In 2018, the Centers for Disease Control and Prevention estimate that nearly 600,000 gonorrhea infections took place in the U.S., compared to 115,000 syphilis cases and 1.8 million cases of chlamydia.

Cases of gonorrhea in the U.S. have climbed every year since 2013, though numbers are down from the historic high recorded in 1978. Since 1994, the population-adjusted gonorrhea rate is up by only about 10%, but it’s climbed more than 80% over just the past 10 years.

Gonorrhea infections per 100,000 people by year

1994 163.9
1995 147.5
1996 121.8
1997 120.2
1998 129.2
1999 129.3
2000 128.7
2001 126.8
2002 122
2003 115.2
2004 112.4
2005 114.6
2006 119.7
2007 118
2008 110.7
2009 98.1
2010 100.2
2011 103.3
2012 106.7
2013 105.3
2014 109.8
2015 123
2016 145
2017 170.6
2018 179.1

Mississippi has the highest prevalence of gonorrhea among the states with a population-adjusted rate of 326.7 per 100,000 compared to the national rate of 179.1. That’s followed by Alaska (303.7) and South Carolina (274.7). Vermont’s rate is the lowest, just 43 per 100,000. Less than half the states have rates higher than the overall U.S. gonorrhea rate.

Gonorrhea infections per 100,000 people by state

Mississippi 326.7
Alaska 303.7
South Carolina 274.7
Alabama 261.4
Louisiana 257.1
New Mexico 252.3
Missouri 246.8
Arkansas 243
North Carolina 230.9
Oklahoma 228.9
Tennessee 217.8
Nevada 216
Ohio 215.7
California 200.3
Georgia 200.1
Illinois 198.6
South Dakota 194.2
New York 187.7
Arizona 183.4
Indiana 182.9
North Dakota 181.2
Kansas 180.4
Delaware 175.8
Maryland 170.3
Kentucky 167.7
Michigan 167.5
Texas 166.9
Colorado 158.6
Florida 155.6
Iowa 153.8
Washington 151.3
Oregon 142.7
Nebraska 140.4
Virginia 139
Connecticut 138.2
Wisconsin 136
Minnesota 135.2
Rhode Island 126.1
Pennsylvania 124.1
Massachusetts 117.7
Montana 112.4
Hawaii 104.7
New Jersey 100.7
Utah 93.3
Idaho 66
West Virginia 62.9
Wyoming 53.7
Maine 53.1
New Hampshire 44.2
Vermont 43

At-Risk Groups

While anybody who is sexually active and fails to use proper protection is at an increased risk of contracting gonorrhea, the disease is much more common among young people. That’s because that age group is less likely to use condoms consistently and more likely to have frequent but casual sexual partners.

The CDC estimates that as many as 1.1 million cases of gonorrhea occur in a given year, but only about half of those are actually reported. As many as 50% of new cases occur in people between 15 and 24, and men are more likely than women to have symptoms, so they are more likely to be diagnosed.

For both men and women, prevalence peaks in those who are between the ages of 20 and 24, but all those between 15 and 34 have rates that are higher than the overall rate for either sex. In two age groups (10-14 and 15-19), women have higher rates than men, but the opposite is true in every other age group.

Gonorrhea infections per 100,000 people by age and sex

Age group Male Female
10-14 4.8 21.3
15-19 320.5 548.1
20-24 720.9 702.6
25-29 674.0 427.2
30-34 481.2 248.3
35-39 316.1 139.1
40-44 200.5 74.3
45-54 120 28.6
55-64 51.3 7.7
65+ 9 1
Total 212.8 145.8

Among racial and ethnic groups, African-Americans have the highest rates of gonorrhea, while Asians have the lowest reported population-adjusted rates of the clap. Hispanics and Native Americans have similar rates behind African-Americans.

Gonorrhea infections per 100,000 people by race or ethnicity

African-Americans 548.90
Hispanics 392.6
Native Americans/Alaska Natives 329.5
Native Hawaiians/Pacific Islanders 181.4
Multirace 94.4
Whites 71.1
Asians 35.1

Gonorrhea Complications

Untreated gonorrhea can lead to major, long-term health issues for both women and men, including potentially impacting a person’s ability to have children. Here’s a look at some of the potential complications from gonorrhea:

  • Other STDs: Individuals with gonorrhea are at an elevated risk of having other sexually transmitted diseases and infections, including HIV, chlamydia and others.
  • PID: For women, untreated gonorrhea can spread to the fallopian tubes or uterus, causing pelvic inflammatory disease (PID), an infection of the female reproductive system. Potential complications from PID include uterine or ovarian abscesses, chronic pelvic pain, ectopic pregnancy, infertility and scar tissue in the reproductive system. Many women who develop PID don’t show obvious physical signs, but some will develop fever, chills, pelvic pain and bowel discomfort.
  • Pregnancy: Untreated gonorrhea can be passed to a fetus during birth and is linked to miscarriages, premature births and low birth weight, among other complications.
  • Epididymitis: In men who have untreated gonorrhea, a condition called epididymitis, which is an infection of the testicles and prostate gland, can occur, and in rare cases, this may lead to infertility.
  • Infection inside the body: In rare cases, Neisseria gonorrhoeae may enter the bloodstream and cause sepsis, a potentially life-threatening infection, in other parts of the body.

Gonorrhea & Pregnancy

In addition to the risk of passing gonorrhea to their babies during birth, women with untreated gonorrhea have a higher likelihood of other potential complications during their pregnancies. Gonorrhea infection during pregnancy has been linked to a higher rate of miscarriages, premature birth or low birth weight and an infection of the fetal membranes that can lead to prolonged labor, which raises the risk of medical danger to the mother and fetus.

All pregnant women under 25 should be tested for gonorrhea at their first prenatal visit, along with being tested for chlamydia. Pregnant women older than 25 should be tested if they are at an elevated risk of having gonorrhea; this includes women who currently have or have previously had other STDs and those who engage in high-risk sexual activities. Women at high risk should be re-tested in their third trimester.

Gonorrhea Testing

Because most people who become infected with gonorrhea won’t display any obvious physical signs, anybody who has ever had sexual contact with another person should be screened at least once. Anybody who has had sex or sexual contact with someone they later learned is infected with gonorrhea should speak with their doctor about getting screened for gonorrhea.

Here are the federal recommendations for gonorrhea testing:

  • Women: All sexually active women under 25 should be screened, as should those who are over 25 but are at higher risk of STDs. All those who test positive should be rechecked three months after treatment.
  • Pregnant women: Pregnant women under 25 should be screened at their first prenatal visit, and those who are older than that should be screened if they are at an elevated risk of STIs. Those who test positive should be rechecked three months after treatment.
  • Men: Annual screening is necessary for all men who have sex with men even if they use condoms. These men should be screened at all sites of contact (urethra, rectum, throat).
  • HIV-positive individuals: People with HIV should be screened at their initial HIV evaluation and at least yearly after that. More frequent gonorrhea testing may be necessary, and individuals should check with their healthcare providers to be sure.

Because it’s common not to show obvious physical signs of gonorrhea, few cases can be diagnosed with a visual examination alone. And even for people who do have some physical signs, many STIs have symptoms that can be mistaken for other STIs or urinary tract infections, including gonorrhea.

The good news is that many people can be tested for gonorrhea simply by providing a urine sample, while others may need to provide a quick swab from their penis, anus, cervix, urethra or throat.

Several options are out there for safe, confidential STI screenings, including for gonorrhea, such as:

  • Pharmacy clinic
  • Planned Parenthood
  • Doctor’s office
  • Urgent care center
  • Campus health clinic
  • Community health clinics
  • At-home test kits

Gonorrhea Treatment

While gonorrhea for decades has been easily treated and cured through antibiotics, gonorrhea is developing a resistance to the drugs used to treat it. There currently is only one remaining antibiotic class to which the bacteria hasn’t yet developed resistance — cephalosporins, which includes brand names like Ancef, Ceftin and Ceclor. Few other antibiotics have been well-studied and determined to be effective against gonorrhea.

Still, a gonorrhea infection can be cured either with a shot/pill combination or a week-long course of pills. It’s crucial that people complete their entire course of medication to ensure the bacteria leaves their body and so they do not contribute to antibiotic-resistant gonorrhea.

Those who are undergoing treatment should refrain from having sex for at least a week, and they should get tested again in a few months to ensure the infection is gone completely. While it’s possible to rid yourself of an active gonorrhea infection, antibiotics cannot undo the damage that’s been done, and the treatment doesn’t protect you from any future exposure or infection.

Gonorrhea Prevention

It’s true that gonorrhea is usually easily treated and cured, the best protection against gonorrhea and other STDs is prevention. The only way to ensure you aren’t at risk of contracting any STIs, including gonorrhea, is to completely abstain from sex, but condoms and dental dams are the best ways to engage in safer sex and reduce your risk of contracting or spreading gonorrhea.

But remember that even if you use safer sex practices, it may still be possible to spread or contract gonorrhea, even if you don’t have penetrative sex to completion.

That’s why everyone who is part of a higher-risk group — men who have sex with men, everybody who has frequent new sex partners and those who are HIV-positive — should get tested for gonorrhea once a year or on a schedule that’s recommended by their healthcare provider.

Conclusion

While gonorrhea may not seem as scary as some other STDs like HIV or syphilis, the truth is that prevalence has roared back in recent years and the bacteria has proven to be a very dangerous one that’s developing drug resistance. When you add to that the possibility of gonorrhea doing very real long-term damage to your body, it’s clear gonorrhea should not be taken lightly.

Additional References

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by AtHomeSTDKit

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