Gonorrhea (the “clap” or “drip”) is caused by the bacterium Neisseria gonorrhoeae, which can survive only in the mucous membranes of the body. These areas, such as the cervix, urethra, mouth, throat, rectum, and even the eyes, provide moisture and warmth that help the bacterium survive. Neisseria gonorrhoeae is actually very fragile and can be de­stroyed by exposure to light, air, soap, water, or a change in temperature, and so it is nearly impossible to transmit gonorrhea nonsexually. The only exception to this is the transmission of gonorrhea from a mother to her baby as the baby passes through the vagina during delivery. Transmission of gonorrhea occurs when mucous membranes come into contact with each other; this can occur during sexual intercourse, oral sex, vulva-to-vulva sex, and anal sex.

Incidence Gonorrhea is the second most commonly reported infectious disease in the United States (chlamydia, which we will discuss shortly, is the first). Gonorrhea rates have dropped significantly over the last 30 years. In fact, there were over 1 million new cases of gonorrhea each year from 1976 to 1980 but only 330,000 cases in 2004 (Centers for Disease Control and Prevention, 2005d). Each year, there are between 600,000 and 1 million new cases. Overall, U. S. gonorrhea rates have been declining, and today the highest rates of gonorrhea are among those 25 years old and younger (Fortenberry,

2002) . Racial differences have been found, and African Americans account for close to 80% of all gonorrhea cases (Maldonado, 1999). There have also been differences in gon­orrhea rates in different parts of the United States. For example, rates are highest in parts of the South and lowest in the North (see Figure 15.2).

Symptoms The majority of women who are infected with gonorrhea are asymp­tomatic and do not know that they are carrying the disease; however, they are still able to infect their partners. In women, the cervix is the most common site of infec­tion, and a pus-filled cervical discharge may develop. If there are any symptoms, they develop within 3 to 5 days and include an increase in urinary frequency, abnormal uterine bleeding, and bleeding after sexual intercourse, which results from an irrita­tion of the cervix. The cervical discharge can irritate the vaginal lining, causing pain and discomfort. Urination can be difficult and painful. (This is dif­ferent from the pain caused by a urinary tract infection—see Chapter 4). If left untreated, gonorrhea can move up into the uterus and Fallopian tubes, and may lead to pelvic inflammatory disease (PID, which we’ll discuss later in this chapter).

Approximately 25% of infected men are asymptomatic, although they are still able to transmit the disease to their partners (Cates, 2004). When a man experiences symptoms, these would include epi­didymitis (epp-pih-did-ee-MITE-us), urethral discharge, painful uri­nation, and an increase in the frequency and urgency of urination. Symptoms usually appear between 2 and 6 days after infection.

Rectal gonorrhea, which can be transmitted to men and women during anal intercourse, may cause bloody stools and a puslike dis­charge. If left untreated, gonorrhea can move throughout the body and settle in various areas, including the joints, causing swelling, pain, and pus-filled infections.


Figure 15.2

Gonorrhea rates per 100,000 population by state, United States and outlying areas, 2004.

Source: Centers for Disease Control and Prevention, 2005d.


Figure 15.3

Gonorrhea rates by age and sex, United States, 2004.

Source: Centers for Disease Control and Prevention, 2005d.



750 600




600 750
























Figure 15.4

Gonorrhea rates by race/ethnicity and sex, United States, 2004.

Source: Centers for Disease Control and Prevention, 2005d.




Rate (per 100,000 population)




0 150 300 450 600 750









Pacific Islander


American Indian/ Alaskan Native



Diagnosis Testing for gonorrhea involves collecting a sample of the discharge from the cervix, urethra, or another infected area with a cotton swab. The discharge is incubated to allow the bacteria to multiply. It is then put on a slide and examined un­der a microscope for the presence of the gonococcus bacterium. Recently DNA testing using a person’s urine has become the gold standard for gonorrhea testing (Hawthorne, Farber, & Bibbo, 2005).


gonococcus bacterium

The bacterium that causes gonorrhea (Neisseria gonorrhoeae).




Explain the incidence, symptoms, diagnosis, and treatment of gonorrhea.


Treatment Gonorrhea can be treated effectively with antibiotics, either orally or via injection. However, some strains of gonorrhea have become resistant to certain an­tibiotics and other drugs must be used (Schwebke, 1991). Many sex partners of persons who test positive for gonorrhea are not treated, which can lead to reinfection and fur­ther infection of others (Golden et al., 2005).

Every once in awhile the Centers for Disease Control and Prevention locate a few cases of drug-resistant gonorrhea in the United States. Most recently this occurred in Michigan, when several drug-resistant cases of gonorrhea were reported to the CDC (Macomber et al., 2005). This had also happened in the 1980s, when gonorrhea became resistant to penicillin (the most common drug treatment at the time). Although uncommon, it is not unheard of for strains of infectious diseases to mutate and become drug resistant over time.


sex byte

The human papillomavirus, trichomoniasis, and chlamydia account for 88% of all new STI cases among 15- to 24-year-olds (Weinstock, Berman, & Cates, 2004).



During a woman’s yearly visit, healthcare providers perform a Pap testing, which is designed to evaluate the cervical cells. Although it is possible that some STIs, such as cervical warts and herpes, may show up during Pap testing, many will not. If you think that you may have been exposed to any STIs, it is important for you to ask your healthcare provider to per­form specific tests to screen for these. Specific tests can be run for syphilis, gonorrhea, chlamydia, herpes, genital warts, or HIV. All sexually active young people (under the age of 25) should have a chlamydia test performed annually (Couldwell, 2005).



Syphilis is caused by an infection with the bacterium Treponema pallidum. Like Neisseria gonorrhoeae, these bacteria can live only in the mucous membranes of the body. The bac­teria enter the body through small tears in the skin and are able to replicate themselves.


I syphilis

A bacterial STI that is divided into primary, sec­ondary, and tertiary stages.



Rate (per 100,000 population)

Подпись: Figure 15.5 Primary and secondary syphilis rates by age and sex, United States, 2004. Source: Centers for Disease Control and Prevention, 2005d. Подпись:Подпись: Men 12.0 9.6 Подпись: 12.4GonorrheaGonorrheaAge

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-54 55-64 65+


Syphilis is transmitted during sexual contact, and it usually first infects the cervix, pe­nis, anus, lips, or nipples. Congenital syphilis may also be transmitted via the placenta congenital syphilis during the first or second trimester of pregnancy. A syphilis infection acquired by an infant from

the mother during pregnancy.

Incidence Syphilis rates decreased in 1990, and in 2000 were the lowest since re­porting began in 1941. However, rates began to increase again in 2002, mostly among men who were having sex with men (Centers for Disease Control and Prevention,

2005d). In 2004 there were 7,980 cases of primary and secondary syphilis reported (see Table 15.1 and Figure 15.5).

Gonorrhea Gonorrhea Подпись: Women 9.0 12.0 15.0

Like gonorrhea, syphilis rates differ geographically, with lower rates in the Midwest and higher rates in the South. There are also racial and ethnic variations, with higher rates in African Americans (see Figure 15.6 for more information on syphilis and race/ ethnic groups).

Figure 15.6

Primary and secondary syphilis rates by race/ethnicity and sex, United States, 2004.


Gonorrhea Подпись: Symptoms Infection with syphilis is divided into three stages. The first stage of infection, primary or early syphilis, occurs anywhere from 10 to 90 days after infection (typically this happens within 2 to 6 weeks). During this stage, there may be one or more small, red-brown sores, called chancres, that appear on the vulva, penis, vagina, cervix, anus, mouth, or lips. The chancre (SHANK-ker), which is a round sore with a hard raised edge and a sunken center, is usually painless and does not itch. If left untreated, the chancre will heal in 3 to 8 weeks. However, during this time the person can still transmit the disease to other sexual partners. Once the chancre disappears, the infected person enters into the second stage, secondary syphilis, which begins anywhere from 3 to 6 weeks after the chancre has healed. During this stage, the syphilis invades the central nervous system. The infected person develops reddish patches on the skin that look like a rash or hives. There may also be wartlike growths in the area of infection (Brown & Frank, 2003). If the rash develops on the scalp, hair loss can also occur. The lymph glands in the groin, armpit, neck, or other areas enlarge and become tender. Additional symptoms at this stage include headaches, fevers, anorexia, flulike symptoms, and fatigue. In the third and final stage of the disease, tertiary or late syphilis, the disease goes into remission. The rash, fever, and other symptoms go away, and the person usually feels fine. He or she is still able to transmit the disease for about 1 year, but after this time the person is no longer infectious. Left untreated, however, tertiary or late syphilis can cause neurological, sensory, muscular, and psychological difficulties and is eventually fatal. Syphilis causes more severe symptoms and progresses much more quickly in patients who have been diagnosed with HIV (Gregory et al., 1990). Diagnosis Anyone who develops a chancre should immediately go to a healthcare provider to be tested for the presence of the syphilis-causing bacteria. This diagnosis can be made in several ways. A culture can be taken from one of the lesions and microscop-

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