gonorrhea gonorrhea gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (sti) caused by the bacterium neisseria gonorrhoeae. infection may involve the genitals, mouth, or rectum. infected men may experience pain or burning with urination, discharge from the penis, or testicular pain. infected women may experience burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. many of those infected, however, have no symptoms. if untreated, gonorrhea can spread to joints or heart valves. gonorrheaother namesgonorrhoea, gonococcal infection, gonococcal urethritis, the clapgonococcal lesion on the skinpronunciation/ˌɡɒn.əˈri.ə/ specialtyinfectious diseasesymptomsnone, burning with urination, vaginal discharge, discharge from the penis, pelvic pain, testicular paincomplicationspelvic inflammatory disease, inflammation of the epididymis, septic arthritis, endocarditiscausesneisseria gonorrhoeae typically sexually transmitteddiagnostic methodtesting the urine, urethra in males, or cervix in femalespreventioncondoms, having sex with only one person who is uninfected, not having sextreatmentceftriaxone by injection and azithromycin by mouthfrequency0.8% (women), 0.6% (men) gonorrhea is spread through sexual contact with an infected person. this includes oral, anal, and vaginal sex. it can also spread from a mother to a child during birth. diagnosis is by testing the urine, urethra in males, or cervix in females. testing all women who are sexually active and less than 25 years of age each year as well as those with new sexual partners is recommended; the same recommendation applies in men who have sex with men (msm). gonorrhea can be prevented with the use of condoms, having sex with only one person who is uninfected, and by not having sex. treatment is usually with ceftriaxone by injection and azithromycin by mouth. resistance has developed to many previously used antibiotics and higher doses of ceftriaxone are occasionally required. retesting is recommended three months after treatment. sexual partners from the last two months should also be treated. gonorrhea affects about 0.8% of women and 0.6% of men. an estimated 33 to 106 million new cases occur each year, out of the 498 million new cases of curable sti – which also includes syphilis, chlamydia, and trichomoniasis. infections in women most commonly occur when they are young adults. in 2015, it caused about 700 deaths. descriptions of the disease date back to before the common era within the hebrew bible/old testament (leviticus 15:2-3). the current name was first used by the greek physician galen before ad 200 who referred to it as "an unwanted discharge of semen". signs and symptoms gonorrhea infections of mucosal membranes can cause swelling, itching, pain, and the formation of pus. the time from exposure to symptoms is usually between two and 14 days, with most symptoms appearing between four and six days after infection, if they appear at all. both men and women with infections of the throat may experience a sore throat, though such infection does not produce symptoms in 90% of cases. other symptoms may include swollen lymph nodes around the neck. either sex can become infected in the eyes or rectum if these tissues are exposed to the bacterium. women half of women with gonorrhea are asymptomatic but the other half experience vaginal discharge, lower abdominal pain, or pain with sexual intercourse associated with inflammation of the uterine cervix. common medical complications of untreated gonorrhea in women include pelvic inflammatory disease which can cause scars to the fallopian tubes and result in later ectopic pregnancy among those women who become pregnant. men most infected men with symptoms have inflammation of the penile urethra associated with a burning sensation during urination and discharge from the penis. in men, discharge with or without burning occurs in half of all cases and is the most common symptom of the infection. this pain is caused by a narrowing and stiffening of the urethral lumen. the most common medical complication of gonorrhea in men is inflammation of the epididymis. gonorrhea is also associated with increased risk of prostate cancer. infants an infant with gonorrhea of the eyes if not treated, gonococcal ophthalmia neonatorum will develop in 28% of infants born to women with gonorrhea. spread if left untreated, gonorrhea can spread from the original site of infection and infect and damage the joints, skin, and other organs. indications of this can include fever, skin rashes, sores, and joint pain and swelling. in advanced cases, gonorrhea may cause a general feeling of tiredness similar to other infections. it is also possible for an individual to have an allergic reaction to the bacteria, in which case any appearing symptoms will be greatly intensified. very rarely it may settle in the heart, causing endocarditis, or in the spinal column, causing meningitis. both are more likely among individuals with suppressed immune systems, however. cause neisseria gonorrhoeae in pus from a case of gonorrhoea in a man (gram stain) gram-stained pus from a urethral discharge showing gram-negative, intracellular diplococci gonorrhea is caused by the bacterium neisseria gonorrhoeae. previous infection does not confer immunity – a person who has been infected can become infected again by exposure to someone who is infected. infected persons may be able to infect others repeatedly without having any signs or symptoms of their own. spread the infection is usually spread from one person to another through vaginal, oral, or anal sex. men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. the risk for men who have sex with men (msm) is higher. insertive msm may get a penile infection from anal intercourse, while receptive msm may get anorectal gonorrhea. women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with an infected man. a mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum. it may be able to spread through the objects contaminated with body fluid from an infected person. the bacteria typically does not survive long outside the body, typically dying within minutes to hours. risk factors it is discovered that sexually active women younger than 25 and men who have sex with men are at increased risk of getting gonorrhea. other risk factors include: having a new sex partner having a sex partner who has other partners having more than one sex partner having had gonorrhea or another sexually transmitted infection complications medically it has been said that untreated gonorrhea can lead to major complications, such as: infertility in women. gonorrhea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (pid). pid can result in scarring of the tubes, greater risk of pregnancy complications and infertility. pid requires immediate treatment. infertility in men. gonorrhea can cause a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis) to become inflamed (epididymitis). untreated epididymitis can lead to infertility. infection that spreads to the joints and other areas of the body. the bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of the body, including the joints. fever, rash, skin sores, joint pain, swelling and stiffness are possible results. increased risk of hiv/aids. having gonorrhea increases the susceptibility to infection with human immunodeficiency virus (hiv), the virus that leads to aids. people who have both gonorrhea and hiv (untreated by anti-retroviral therapy) are able to pass both diseases more readily to their partners. complications in babies. babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. diagnosis traditionally, gonorrhea was diagnosed with gram stain and culture; however, newer polymerase chain reaction (pcr)-based testing methods are becoming more common. in those failing initial treatment, culture should be done to determine sensitivity to antibiotics. tests that use pcr (aka nucleic acid amplification) to identify genes unique to n. gonorrhoeae are recommended for screening and diagnosis of gonorrhea infection. these pcr-based tests require a sample of urine, urethral swabs, or cervical/vaginal swabs. culture (growing colonies of bacteria in order to isolate and identify them) and gram-stain (staining of bacterial cell walls to reveal morphology) can also be used to detect the presence of n. gonorrhoeae in all specimen types except urine. the swab sample for gonorrhea infections does not show difference whether the sample was collected in home or in clinic in term of number patient treated. the implications in cured patient, reinfection, partner management, and safety are unknown. if gram-negative, oxidase-positive diplococci are visualized on direct gram stain of urethral pus (male genital infection), no further testing is needed to establish the diagnosis of gonorrhea infection. however, in the case of female infection direct gram stain of cervical swabs is not useful because the n. gonorrhoeae organisms are less concentrated in these samples. the chances of false positives are increased as gram-negative diplococci native to the normal vaginal flora cannot be distinguished from n. gonorrhoeae. thus, cervical swabs must be cultured under the conditions described above. if oxidase positive, gram-negative diplococci are isolated from a culture of a cervical/vaginal swab specimen, then the diagnosis is made. culture is especially useful for diagnosis of infections of the throat, rectum, eyes, blood, or joints—areas where pcr-based tests are not well established in all labs. culture is also useful for antimicrobial sensitivity testing, treatment failure, and epidemiological purposes (outbreaks, surveillance). in patients who may have disseminated gonococcal infection (dgi), all possible mucosal sites should be cultured (e.g., pharynx, cervix, urethra, rectum). three sets of blood cultures should also be obtained. synovial fluid should be collected in cases of septic arthritis. all people testing positive for gonorrhea should be tested for other sexually transmitted diseases such as chlamydia, syphilis, and human immunodeficiency virus. studies have found co-infection with chlamydia ranging from 46 to 54% in young people with gonorrhea. among persons in the united states between 14 and 39 years of age, 46% of people with gonorrheal infection also have chlamydial infection. for this reason, gonorrhea and chlamydia testing are often combined. people diagnosed with gonorrhea infection have a fivefold increase risk of hiv transmission. additionally, infected persons who are hiv positive are more likely to shed and transmit hiv to uninfected partners during an episode of gonorrhea. screening the united states preventive services task force (uspstf) recommends screening for gonorrhea in women at increased risk of infection, which includes all sexually active women younger than 25 years. extragenital gonorrhea and chlamydia are highest in men who have sex with men (msm). additionally, the uspstf also recommends routine screening in people who have previously tested positive for gonorrhea or have multiple sexual partners and individuals who use condoms inconsistently, provide sexual favors for money, or have sex while under the influence of alcohol or drugs. screening for gonorrhea in women who are (or intend to become) pregnant, and who are found to be at high risk for sexually transmitted diseases, is recommended as part of prenatal care in the united states. prevention