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Gonorrhea, also spelled gonorrhoea, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae.[1] Many people have no symptoms.[1] Men may have burning with urination, discharge from the penis, or testicular pain.[1] Women may have burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain.[1]Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis.[1] If untreated, gonorrhea can spread to joints or heart valves.[1][2]

Gonorrhea is spread through sexual contact with an infected person.[1] This includes oral, anal, and vaginal sex.[1] It can also spread from a mother to a child during birth.[1] Diagnosis is by testing the urine, urethra in males, or cervix in females.[1] 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;[3] the same recommendation applies in men who have sex with men (MSM).[3]

Gonorrhea can be prevented with the use of condoms, having sex with only one person who is uninfected, and by not having sex.[1][3] Treatment is usually with ceftriaxone by injection and azithromycin by mouth.[4][5] Resistance has developed to many previously used antibiotics and higher doses of ceftriaxone are occasionally required.[4][5] Retesting is recommended three months after treatment.[3] Sexual partners from the last 2 months should also be treated.[1]

Gonorrhea affects about 0.8% of women and 0.6% of men.[6] 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.[7][8] Infections in women most commonly occur when they are young adults.[3] In 2015, it caused about 700 deaths.[9] Descriptions of the disease date as far back as the Old Testament.[2]

Contents
[hide]
 * 1Signs and symptoms
 * 2Cause
 * 2.1Spread
 * 3Diagnosis
 * 4Screening
 * 5Prevention
 * 6Treatment
 * 6.1Antibiotics
 * 6.2Sexual partners
 * 6.3Antibiotic resistance
 * 7Prognosis
 * 8Epidemiology
 * 9History
 * 10Research
 * 11References
 * 12External links

Signs and symptoms
Half of women with gonorrhea do not have symptoms, whereas others have vaginal discharge, lower abdominal pain, or pain with sexual intercourse associated with inflammation of the uterine cervix.[10][11][12] Most infected men with symptoms have inflammation of the penile urethra associated with a burning sensation during urination and discharge from the penis.[11] In men, discharge with or without burning occurs in half of all cases and is the most common symptom of the infection.[13] Men and women can acquire gonorrhea of the throat from performing oral sex on an infected partner, usually a male partner. Such infection does not produce symptoms in 90% of cases, and produces a sore throat in the remaining 10%.[14][15] In advanced cases, gonorrhea may cause a general feeling of tiredness similar to other infections.[13] 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.[13]

The incubation period is 2 to 14 days, with most symptoms appearing between 4 and 6 days after infection. Rarely, gonorrhea may cause skin lesions and joint infection (pain and swelling in the joints) after traveling through the blood stream (see below). 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).[15]

Having a case of gonorrhea is associated with an increased risk of developing prostate cancer.[16]

Cause
Multiple views of a Neisseria gonorrhoeae bacterium, which causes gonorrhea.

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae.[11] Also, previous infection does not confer immunity, and a person who has been infected can become infected again by exposure to someone who is infected, whether or not that person has any infectious signs or symptoms of their own.

Spread
The infection is usually spread from one person to another through vaginal, oral, or anal sex.[11][17] Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for men that have sex with men (MSM) is higher.[18] Active MSM may get a penile infection, while passive MSM may get anorectal gonorrhea.[19] Women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with an infected man.[20] A pregnant women can pass on the infection to her unborn infant.[citation needed]

A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum.[11]

Among children it has been noted to spread through methods other than sex such as through contaminated objects.[21] These objects have included baths, clothing, and towels.[21] This however is very uncommon.[22] The bacteria typically does not survive outside the body and usually will rapidly die within minutes to hours.[23]

Diagnosis
Traditionally, gonorrhea was diagnosed with gram stain and culture; however, newer polymerase chain reaction (PCR)-based testing methods are becoming more common.[12][24] In those failing initial treatment, culture should be done to determine sensitivity to antibiotics.[25]All people testing positive for gonorrhea should be tested for other sexually transmitted diseases such as chlamydia, syphilis, and human immunodeficiency virus.[25]

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).[26] 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.[10]

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.[27]

Prevention
See also: Safe sex

As with most sexually transmitted diseases, the risk of infection can be reduced significantly by the correct use of condoms and can be removed almost entirely by limiting sexual activities to a mutually monogamous relationship with an uninfected person.[28][29]

Those previously infected are encouraged to return for follow up care to make sure that the infection has been eliminated. In addition to the use of phone contact, the use of email and text messaging have been found to improve the re-testing for infection.[30]

Treatment
Penicillin entered mass production in 1944 and revolutionized the treatment of several venereal diseases.

Antibiotics
As of 2010, injectable ceftriaxone is one of the few effective antibiotics.[25] This is typically given in combination with either azithromycin or doxycycline.[31] As of 2015 and 2016 the CDC and WHO only recommends both ceftriaxone and azithromycin.[4][32] Because of increasing rates of antibiotic resistance local susceptibility patterns must be taken into account when deciding on treatment.[25][33]

Sexual partners
It is recommended that sexual partners be tested and potentially treated.[25] One option for treating sexual partners of people infected is patient-delivered partner therapy (PDPT), which involves providing prescriptions or medications to the person to take to his/her partner without the health care provider's first examining him/her.[34]

The United States' Centers for Disease Control and Prevention (CDC) currently recommend that individuals who have been diagnosed and treated for gonorrhea avoid sexual contact with others until at least one week past the final day of treatment in order to prevent the spread of the bacterium.[35]

Antibiotic resistance
Many antibiotics that were once effective including penicillin, tetracycline, and fluoroquinolones are no longer recommended because of high rates of resistance.[25] Resistance to cefixime has reached a level such that it is no longer recommended as a first-line agent in the United States, and if it is used a person should be tested again after a week to determine whether the infection still persists.[31] Cases of resistance to ceftriaxone have been reported but are still rare,[5][25] though public health officials are concerned that an emerging pattern of resistance may predict a global epidemic.[36] The UK's Health Protection Agency reported that 2011 saw a slight drop in gonorrhea antibiotic resistance, the first in 5 years.[37]