Gonorrhea (also gonorrhoea), caused by the bacteria Neisseria gonorrhoeae, is a common sexually transmitted disease. In the US, its incidence is second only to chlamydia.

Non-genital sites in which it thrives are in the rectum, the throat (oropharynx), and the eyes (conjunctiva). The vulva and vagina in women are usually spared because they are lined by stratified epithelial cells—in women the cervix is the usual first site of infection. Gonorrhea typically spreads during sexual intercourse. It can also be vertically transmitted, where infected mothers can pass gonorrhea to their newborn infants during delivery. This causes conjunctivitis (eye infections) which, if left untreated, can lead to blindness. As prophylaxis against this, many countries routinely treat infants with eyedrops of erythromycin at birth.

Symptoms

The incubation period is 10 to 20 days with most symptoms occurring between the fifteenth and twentieth days after being infected. A small number of people may be asymptomatic for up to a lifetime. Between 30 and 60% of people with gonorrhea are asymptomatic or have subclinical disease.

Men have a 20% chance of getting the infection by having sexual relations with a woman infected with gonorrhea. Women have a 50% chance of getting the infection by having sexual relations with a man infected with gonorrhea. An infected mother may transmit gonorrhea to her newborn during childbirth, a condition known as ophthalmia neonatorum. Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 705-706 ISBN 978-1-4160-2973-1

Less advanced symptoms, which may indicate development of pelvic inflammatory disease (PID), include cramps and pain, bleeding between menstrual periods, vomiting, or fever. It is not unusual for men to have asymptomatic gonorrhea. Men may complain of pain on urinating and thick, copious, urethral pus discharge (also known as gleet) is the most common presentation. Examination may show a reddened external urethral meatus. Ascending infection may involve the epididymis, testicles or prostate gland causing symptoms such as scrotal pain or swelling. Instances of blurred vision in one eye may occur in adults.

Complications

In men, inflammation of the epididymis (epididymitis), prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea.

In women, the most common result of untreated gonorrhea is pelvic inflammatory disease, a serious infection of the uterus that can lead to infertility. Further on, perihepatitis may develop. This rare complication is associated with Fitz-Hugh-Curtis syndrome. Additionally, septic arthritis in the fingers, wrists, toes, and ankles is also common. This should be evaluated promptly with a culture of the synovial fluid, blood, cervix, urethra, rectum, skin lesion fluid, or pharynx. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.