The Glamorous Side of Gonorrhea

Before I describe all the gory details of gonorrhea, let me just say this: Many good people unknowingly get gonorrhea, then inadvertently pass it to others. I have treated just as many upper-class married folks as I have promiscuous teenagers. Gonorrhea does not discriminate, and we are all at risk if we are sexually active.

Now let me share with you what is decidedly unglamorous about gonorrhea: foul-smelling vaginal discharge, pus-like discharge from the tip of the penis, a painfully swollen testicle, burning and pain with urination, anal irritation and anal discharge, and painful sex. And I’m just getting started. The infection is spread by anal sex, vaginal sex, and oral sex and, contrary to urban legend, cannot be acquired from sitting on a toilet seat.

Untreated gonorrhea (caused by the bacterium Neisseria gonorrhoeae) is even more devastating.

In men, it can result in chronic, painful inflammation of the prostate gland and urethral strictures (narrowing of the urine canal inside the penis). In women, half of the infections will be asymptomatic, but this does not stop the bacteria from spreading inside their bodies and causing further damage. The most common result of untreated gonorrhea in women is pelvic inflammatory disease (PID), which can cause chronic pelvic pain and infertility. It is a sad fact that untreated gonorrhea, even when asymptomatic, can silently steal a woman’s ability to have children later in life. (So can untreated chlamydia, another sexually transmitted disease.) Since the majority of gonorrhea and chlamydia in the United States occurs in people ages 15-24, young people are especially at risk.

An under-discussed type of gonorrhea occurring in both sexes is gonorrhea of the throat. Infection in the throat is acquired through performing oral sex on an infected partner (usually male). As if gonorrhea of the throat weren’t ghastly enough, 90 percent of these cases are asymptomatic yet can still silently travel to other parts of the body via the bloodstream, a phenomenon known as dissemination. (The other 10 percent of throat gonorrhea cases will complain of a sore throat, usually 4-6 days after oral sex.) Disseminated gonorrhea wreaks havoc, causing swollen joints, painful skin lesions, infected heart valves, and even meningitis.

Gonorrhea is nicknamed “the clap,” an expression possibly referencing an old treatment. Before penicillin entered mass production in 1944, gonorrhea was difficult to treat and one method involved clearing gonorrhea pus from the urethra (the urine canal inside the penis). The penis was “clapped” on both sides simultaneously to expel the pus, a procedure which could either be done with one’s hands or with a heavy book slammed down on the penis against a table or other hard surface. Expulsion of the urethral pus restored normal urine flow. These days, we recommend a round of antibiotics over “the clap” approach (to the relief of our male patients).

In California, gonorrhea and chlamydia are on the rise. We saw a 56 percent increase in Santa Barbara County in 2011. So what are your chances of getting gonorrhea? In a single act of vaginal intercourse between an infected man and an uninfected woman, her chance of getting his gonorrhea is around 60-80 percent. If the woman is infected (and remember, half the time has no symptoms) and the man is not, his chance of getting her gonorrhea is 20 percent from that single act.

Playing the odds is for Vegas – not vaginas. There are important steps one can take to decrease risk. Using condoms has been shown to significantly decrease one’s risk of acquiring a sexually transmitted disease (STD). Being in a monogamous relationship with an uninfected partner is another option. Since so many infections are asymptomatic, but still easily spread, annual testing for at-risk people is critical.

The Centers for Disease Control and Prevention (CDC) recommends annual gonorrhea/chlamydia screening for the following groups: men who have sex with men, women in at-risk categories (age 25 or younger and sexually active, new or multiple sexual partners, pregnant), anyone with HIV, and anyone with symptoms of gonorrhea or chlamydia.

Gonorrhea and chlamydia are best friends and usually party together, so if you test positive for one, we treat you for both. The treatment is fairly simple and involves a shot in the arm and antibiotic pills. We recommend that sexual partners be treated as well, given the highly contagious nature of the bacteria. Doctors are now able to write prescriptions for the patient’s partner without ever seeing the partner. This is called patient-delivered partner therapy, or PDPT, and is just one of the creative tactics public health officials have taken to combat sexually transmitted diseases.

As if all of that weren’t enough to worry about, experts at the CDC have recently notified doctors of a new strain of gonorrhea that is resistant to typical antibiotics. Public health officials worry that this emerging pattern of resistance may predict a global epidemic of this new “super bug” of sex, making it more difficult to treat the infection.

One in five Americans has an STD. Look around the coffee shop (or bar) you’re sitting in right now. One in five. This is not a scare tactic but rather a motivation to get tested, get treated, and use prevention strategies for safer sex.