American Medical Association Family Medical Guide - American Medical Association [251]
In men, untreated gonorrhea can spread up the urethra and cause painful inflammation of the prostate gland and the epididymis, which, if not treated promptly, can lead to infertility. In some men, gonorrhea can lead to a painful condition called urethral stricture (see page 837), in which scar tissue forms in the urethra, making urination difficult.
In women, untreated gonorrhea can cause pelvic inflammatory disease (see page 871), a condition that can damage the lining of the fallopian tubes or the uterus, causing infertility. The bacteria can also spread to the uterus and the abdominal cavity, causing abscesses (collections of pus) to form around the fallopian tubes and the ovaries. If the abscesses are not treated, they can rupture and spill into the abdomen, causing inflammation of the lining of the abdominal cavity (peritonitis; see page 759). If not treated, gonorrhea can increase the risk of ectopic pregnancy (see page 523) or miscarriage (see page 522). A pregnant woman with gonorrhea can pass the infection to her baby during delivery, causing the eye infection conjunctivitis (see page 1038).
In rare cases, untreated gonorrhea can spread through the bloodstream and cause inflammation in other parts of the body, such as the joints, heart valves, or brain. In some people, the condition causes skin lesions.
People who have gonorrhea have an increased risk of becoming infected with HIV, the virus that causes AIDS (see page 909). Gonorrhea can cause CD4 cells (the infection-fighting white blood cells that are targeted by HIV) to go to the infected area to fight the infection. If HIV is present in the infected area, it will target and infect the CD4 cells, which can then spread HIV throughout the body.
Symptoms
The symptoms of gonorrhea usually develop about 2 to 5 days after sexual contact with an infected person, but can take as long as 30 days. In the early stages of the infection, the symptoms are often mild and may go unnoticed. Frequently, women with gonorrhea have no symptoms, but some women develop symptoms about 2 to 8 days after sexual contact with an infected person or at the beginning of their next period. Possible symptoms include a mild fever, burning or pain during urination, cloudy discharge from the vagina, discomfort or pain in the lower abdomen, or abnormal bleeding from the vagina. In some cases, a woman with gonorrhea experiences painful urination, inflammation of the bladder (cystitis; see page 877), or vaginal bleeding with sexual intercourse. If gonorrhea has led to pelvic inflammatory disease, symptoms can include abdominal cramps and pain, bleeding between periods, vomiting, or fever.
Men who have gonorrhea often have no symptoms, or they may urinate more often than usual or have severe pain and burning during urination or a cloudy, pus-filled discharge from the penis.
When gonorrhea infects the rectum, a person may experience anal itching, a cloudy discharge from the anus, and painful, bloody bowel movements. When gonorrhea infects the throat, most people have no symptoms, but some can have a sore throat.
Diagnosis
A diagnosis of gonorrhea is based on the symptoms, a physical examination, the results of blood and urine tests, and laboratory analysis of the discharge. The doctor uses a swab to obtain a sample of discharge from the man’s urethra or the woman’s cervix for examination under a microscope.
Treatment
Gonorrhea can be treated with antibiotics such as cefixime (taken orally) or ceftriaxone (injected directly into a muscle). Because people who have gonorrhea often also have an STD called chlamydia (see page 477), doctors usually prescribe a combination of antibiotics to treat both infections at the same time. If gonorrhea has spread through the bloodstream, a doctor will admit the person to a hospital and prescribe intravenous antibiotics.
To prevent conjunctivitis in a newborn whose mother has gonorrhea, a doctor will apply medication such as silver nitrate to the infant’s eyes immediately after delivery. If untreated, gonorrhea in an infant