Gonorrhea Testing

Gonorrhea is spread by sexual contact with the vagina, penis, mouth of anus of somebody who is already infected. Anybody who is sexually active can get gonorrhea.

Up to half of the cases of gonorrhea occur in the 15-24 year age group (1). Men who have sex with men are also at higher than average risk to have gonorrea.

Risk factors for gonorrhea include:

• Unprotected sex (without a condom)
• More than one sexual partner
• One or more sexual partners with an increased risk of contracting the disease

Anybody with symptoms of gonorrhea (see below) should be tested. Anybody with a sex partner who has an STD should also be tested.

Anybody with symptoms of gonorrhea (see below) should be tested. Anybody with a sex partner who has an STD should also be tested.
But gonorrhea frequently causes no symptoms at all. Up to 70% of women with gonorrhea of the cervix have no symptoms (4). Screening for a disease means getting tested even if no symptoms are present, for the purpose of detecting and treating the disease in the early stages.

Screening for gonorrhea is recommended for various groups below.

Screening is recommended for these nonpregnant women:

• Sexually active women younger than 25 (screen every year)
• Older women at high risk for gonorrhea due to new or multiple sex partners, or sex partner who has a STD (screen every year)

Screening is recommended for high risk pregnant women:

• In the first prenatal visit, and
• In the third trimester

Screening is recommended for these men:

• Sexually active young men who receive care in settings where the rate of gonorrhea is high, such correctional facilities, adolescent clinics, STD clinics
• Men who have sex with men (screen every year)

Screening in men:

• Sexually active young men who receive care in settings where the rate of chlamydia is high, such correctional facilities, adolescent clinics, STD clinics
• Men who have sex with men (screen every year)

In women with untreated gonorrhea, the infection can spread into the uterus and the fallopian tubes and cause PID. Approximately 10-20% of women with gonorrhea of the cervix have PID (4). Symptoms of PID include pelvic or lower abdominal pain, abnormal vaginal bleeding, pain during sexual intercourse, and fever.

Damage to reproductive organs from gonorrhea can cause infertility and can also increase the risk of ectopic pregnancy.

Gonorrhea in pregnant women can cause several types of problems:

• Chorioamnionitis – infection and inflammation of the membranes and fluid surrounding the fetus within the uterus
• Older women at high risk for gonorrhea due to new or multiple sex partners, or sex partner who has a STD (screen every year)
• Early labor and birth
• Low birth weight of the infant
• Spontaneous abortions

A pregnant woman can also transmit a gonorrhea infection to her infant during childbirth, potentially causing infection of the infant’s eyes. Conjunctivitis (inflammation of the membrane covering the white part of the eye and the inner lining of the eyelid) affects 30-50% of infants born to women who have gonorrhea cervicitis at the time of delivery (4,5). Fortunately, this complication has become rare in the U.S. due to widespread use of preventive measures wherein a topical antibiotic is applied to the infant’s eyes immediately after birth.

Men with untreated gonorrhea can develop epididymitis, which is infection and swelling of the epididymis (a tube that runs alongside the testicle). In rare instances, men with gonorrhea develop swelling of the penis, abscesses of the penis, or scarring along the inside of the urethra that make it difficult to pass urine.

Gonorrhea can spread through the bloodstream to infect joints, tendons, and skin. Other sites for widespread gonorrhea include the valves of the heart, membranes surrounding the brain, and the bones.

Antibiotic treatment of chlamydia is recommended for:

• Antibiotic treatment of chlamydia is recommended for:
• Persons who test positive for gonorrhea even if they have no symptoms
• Newborns of infected mothers

In some cases, it may be reasonable to treat recent sexual partners of those infected with gonorrhea without testing the sexual partners.

The purpose of treating is chlamydia is to:

• Relieve symptoms (if present)
• Prevent infections causing long term problems
• Decrease the risk of spreading the infection to others, such as sexual partners or infants (through childbirth)

Gonorrhea is treated with antibiotics. The full prescribed course of antibiotics should be taken even if the symptoms improve after a few days. The antibiotics, taken correctly, will cure gonorrhea unless the bacteria is resistant to the antibiotics. If antibiotics are not taken properly, the infection might not be eradicated.

Due to the rise of antibiotic-resistant strains of the gonorrhea bacteria, it is now recommended to treat gonorrhea of the genital tract, thorat, and eye with a combination of antibiotics (6):

• Ceftriaxone, given as a single 250 mg injection into the muscle, PLUS
• A single dose of azithromycin 1,000 mg, which may require taking two 500 mg tablets

For pregnant women, the recommended treatment for gonorrhea is the same as for nonpregnant women — ceftriaxone plus azithromycin.
In the case where gonorrhea is causing epididymitis or proctitis, the infection is treated with ceftriaxone plus doxycycline (not azithromycin). Treatment of gonorrhea that is causing PID or gonorrhea that has spread to other sites of the body is depending on the extent and severity of the infection.

To prevent spreading gonorrhea to others, it is important to avoid sexual activity until treatment is complete. Experts also recommend retesting in 3 months after treatment of a confirmed gonorrhea infection.

When chlamydia and gonorrhea are present at the same time, treatment includes antibiotics for both infections.

The only certain way to avoid getting gonorrhea is to not have vaginal, oral, or anal sex.

To prevent gonorrhea while you are sexually active, use a latex condom at all times and stay in a mutually monogamous relationship with a partner who does not have gonorrhea or other STDs. Mutually monogamous means that you and your partner have sex only with each other and not with other people.

Many people with gonorrhea, especially women, have no symptoms. But even people without symptoms can still spread the infection to others through sex.

Symptoms in women include:

• Dysuria (burning or pain when urinating)
• Vaginal itching
• Bleeding and/or discharge from the cervix
• Bleeding between menstrual periods
• Heavy or prolonged menstrual periods
• Pain in the pelvis or lower abdomen
• Pain and swelling in the Bartholin glands along the opening of the vagina
• Painful intercourse

Symptoms in men include:

• Dysuria
• Green, yellow, or white discharge from the penis
• Pain and swelling of the scrotum

Symptoms that can occur in both men and women include:

• Rectal pain, discharge, itching, or bleeding (proctitis). Proctitis from gonorrhea is more common in men and women who have anal receptive intercourse. But women who do not have anal intercourse can become infected if the bacteria has spread to the vaginal region.
• Sore throat, white spots in the back of the throat, or swollen glands in the neck (pharyngitis)

Women at risk for gonorrhea or who have been diagnosed with gonorrhea should contact their health care provider immediately or go to the emergency room if they have any of these symptoms:

• Sudden onset of severe pain in the lower abdomen
• Lower abdominal pain associated with vaginal bleeding or vaginal discharge and a fever of 37.8 C or more
• Dysuria (burning sensation during urination) or frequent urination and a fever of 37.8 C or more
• Inability to urinate

Men at risk for gonorrhea or who have been diagnosed with gonorrhea should contact their health care provider immediately or go to the emergency room if they have any of these symptoms:

• Discharge from the penis and a fever of 37.8 C or more
• Dysuria (burning sensation during urination) or frequent urination and a fever of 37.8 C or more
• Inability to urinate
• Pain, swelling or tenderness of the scrotum and a fever of 37.8 C or more.

Up to 46% of people who are infected with gonorrhea have a chlamydia infection at the same time (6). Therefore, testing for both infections should be done at the same time.

There are several ways of collecting samples from the patient to test for gonorrhea:

• For men, the urine test is preferred. A swab of the opening of the penis (urethra) is also an option.
• For women, the preferred test is a vaginal swab, which can be collected by the woman herself. A urine sample is also acceptable. A swab from the cervix may be obtained if a pelvic exam is performed.
• Swabs of the rectal and throat are necessary to diagnose infections of those areas.

There are several ways to analyze samples after they are collected:

• The preferred way to analyze urine samples and the various swabs described above is to test for genetic material from the gonorrhea bacteria. This method is the most rapid and accurate test for gonorrhea.
• The urethral swab in a man who has gonorrhea symptoms can be analyzed on a slide, under a microscope, to identify the bacteria. However, using this method is not accurate for men without symptoms, women, or infections at other sites of the body
• A swab sample can be subjected to a culture test, which involves placing the sample in a special dish to allow bacteria to grow and multiply. The bacteria are tested to determine if they can be treated with an array of antibiotics. Culture tests are slow, but are necessary when health care providers become concerned about gonorrhea that are resistant to common antibiotics.

Antibiotic treatment of chamydia is recommended for:

• Persons who test positive for gonorrhea even if they have no symptoms
• Newborns of infected mothers

In some cases, it may be reasonable to treat recent sexual partners of those infected with gonorrhea without testing the sexual partners.

The prupose of treatin is chamydia is to:

• Relieve symptoms (if present)
• Prevent infections causing long term problems
• Decrease the risk of spreading the infection to others, such as sexual partners or infants (through childbirth)

Gonorrhea is treated with antibiotics. The full prescribed course of antibiotics should be taken even if the symptoms improve after a few days. The antibiotics, taken correctly, will cure gonorrhea unless the bacteria is resistant to the antibiotics. If antibiotics are not taken properly, the infection might not be eradicated.

Due to the rise of antibiotic-resistant strains of the gonorrhea bacteria, it is now recommended to treat gonorrhea of the genital tract, thorat, and eye with a combination of antibiotics (6):

• Ceftriaxone, given as a single 250 mg injection into the muscle, PLUS
• A single dose of azithromycin 1,000 mg, which may require taking two 500 mg tablets

For pregnant women, the recommended treatment for gonorrhea is the same as for nonpregnant women — ceftriaxone plus azithromycin.

In the case where gonorrhea is causing epididymitis or proctitis, the infection is treated with ceftriaxone plus doxycycline (not azithromycin).

Treatment of gonorrhea that is causing PID or gonorrhea that has spread to other sites of the body is depending on the extent and severity of the infection.

To prevent spreading gonorrhea to others, it is important to avoid sexual activity until treatment is complete. Experts also recommend retesting in 3 months after treatment of a confirmed gonorrhea infection.

When chlamydia and gonorrhea are present at the same time, treatment includes antibiotics for both infections.

Experts and researchers are investigating the following areas:

• Whether a higher dose of ceftriaxone is more effective for treating gonorrhea
• Whether to treat recent sex partners of someone with gonorrhea without testing the sex partners first. (Note that sex partners of people with gonorrhea should at least be tested for gonorrhea.)
• The effectiveness of a vaccine for gonorrhea.

IMPORTANT:

Question: Why do I still have symptoms after finishing treatment for gonorrhea?

Answer: If you had symptoms when you were diagnosed with gonorrhea (not everybody has symptoms) and the symptoms remain or come back again after you’ve finished the antibiotics, there are a few possible explanations. First, the gonorrhea may be resistant to the antibiotics that you received. Second, you may have become reinfected with a new, separate gonorrhea infection. Third, you may have another STD.