View source for Gonorrhea

{{short description|Sexually transmitted infection}}
{{Redirect|The clap|other uses|Clap (disambiguation){{!}}Clap}}
{{for|the Lil Wayne song|Gonorrhea (song)}}
{{pp-vandalism|small=yes}}
{{Use dmy dates|date=March 2020}}
{{Infobox medical condition (new)
| name            = Gonorrhea
| synonyms        = Gonorrhoea, gonococcal infection, gonococcal urethritis, the clap
| image           = Gonococcal lesion on the skin PHIL 2038 lores.jpg
| caption         = Gonococcal lesion on the skin
| pronounce       = {{IPAc-en|ˌ|ɡ|ɒ|n|.|ə|ˈ|ɹ|i|.|ə}}
| field           = [[Infectious disease (medical specialty)|Infectious disease]]
| symptoms        = None, [[Dysuria|burning with urination]], [[vaginal discharge]], discharge from the [[Human penis|penis]], [[pelvic pain]], [[testicular pain]]<ref name=CDC2014/>
| complications   = [[Pelvic inflammatory disease]], [[epididymitis|inflammation of the epididymis]], [[septic arthritis]], [[endocarditis]]<ref name=CDC2014/><ref name=Mor2016>{{cite journal | vauthors = Morgan MK, Decker CF | title = Gonorrhea | journal = Disease-a-Month | volume = 62 | issue = 8 | pages = 260–268 | date = August 2016 | pmid = 27107780 | doi = 10.1016/j.disamonth.2016.03.009 }}</ref>
| onset           =
| duration        =
| types           =
| causes          = ''[[Neisseria gonorrhoeae]]'' typically [[sexually transmitted infection|sexually transmitted]]<ref name=CDC2014/>
| risks           =
| diagnosis       = Testing the urine, [[urethra]] in males; [[vagina]] or [[cervix]] in females, throat, or rectum<ref name=CDC2014/>
| differential    =
| prevention      = [[Condom]]s, having sex with only one person who is uninfected, [[sexual abstinence|not having sex]]<ref name=CDC2014/><ref name=STI2015/>
| treatment       = [[Ceftriaxone]] by injection and [[azithromycin]] by mouth<ref name=CDC2016Tx/><ref name=Un2015/>
| medication      =
| prognosis       =
| frequency       = 0.8% (women), 0.6% (men)<ref name=New2012/>
| deaths          =
}}

'''Gonorrhoea''' or '''gonorrhea''', colloquially known as '''the clap''',<ref>
    {{cite web
    | title = Clap
    | website = Cambridge Dictionary
    | url = https://dictionary.cambridge.org/dictionary/english/clap#:~:text=slang%20for%20gonorrhoea
    | access-date = 2024-12-08
    | publisher = Cambridge University Press
    }}
</ref> is a [[sexually transmitted infection]] (STI) caused by the bacterium ''[[Neisseria gonorrhoeae]]''.<ref>{{Cite web |title=Gonorrhoea (Neisseria gonorrhoeae infection) |url=https://www.who.int/news-room/fact-sheets/detail/gonorrhoea-(neisseria-gonorrhoeae-infection)#:~:text=Gonorrhoea%20is%20a%20preventable%20and%20curable%20sexually%20transmitted%20infection%20caused%20by%20the%20bacterium%20Neisseria%20gonorrhoeae |access-date=2024-12-08 |website=www.who.int |language=en}}</ref> Infection may involve the [[genitals]], mouth, or [[rectum]].<ref>{{cite book| vauthors = Delong L, Burkhart N |title=General and Oral Pathology for the Dental Hygienist|url=https://books.google.com/books?id=jmhADwAAQBAJ&pg=PT787|date=2017-11-27|publisher=Wolters Kluwer Health|isbn=978-1-4963-5453-2|page=787}}</ref> 

Gonorrhea is spread through sexual contact with an infected person,<ref name="CDC2014" /> or from a [[vertical transmission|mother to a child during birth]].<ref name="CDC2014" />  Infected males may experience [[Dysuria|pain or burning with urination]], discharge from the [[Human penis|penis]], or [[testicular pain]].<ref name=CDC2014/> Infected females may experience burning with urination, [[vaginal discharge]], vaginal bleeding between [[Menstruation|periods]], or [[pelvic pain]].<ref name=CDC2014/> Complications in females include [[pelvic inflammatory disease]] and in males include [[epididymitis|inflammation of the epididymis]].<ref name=CDC2014/> Many of those infected, however, have no symptoms.<ref name=CDC2014/> If untreated, gonorrhea can spread to [[septic arthritis|joints]] or [[endocarditis|heart valves]].<ref name=CDC2014/><ref name=Mor2016/> Globally, gonorrhea affects about 0.8% of women and 0.6% of men.<ref name=New2012>{{cite journal | vauthors = Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, Stevens G, Gottlieb S, Kiarie J, Temmerman M | display-authors = 6 | title = Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting | journal = PLOS ONE | volume = 10 | issue = 12 | pages = e0143304 | date = 8 December 2015 | pmid = 26646541 | pmc = 4672879 | doi = 10.1371/journal.pone.0143304 | doi-access = free | bibcode = 2015PLoSO..1043304N }}</ref> An estimated 33 to 106 million new cases occur each year.<ref>{{cite journal | vauthors = Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, etal | collaboration = Global Burden of Disease Study 2013 Collaborators | title = Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 386 | issue = 9995 | pages = 743–800 | date = August 2015 | pmid = 26063472 | pmc = 4561509 | doi = 10.1016/s0140-6736(15)60692-4 }}</ref><ref name=WHOEpi14>{{cite report|title=Emergence of multi-drug resistant Neisseria gonorrhoeae|publisher=World Health Organization|date=2012|url=http://apps.who.int/iris/bitstream/10665/70603/1/WHO_RHR_11.14_eng.pdf|archive-url=https://web.archive.org/web/20130613030128/http://whqlibdoc.who.int/hq/2011/WHO_RHR_11.14_eng.pdf|archive-date=13 June 2013|pages=2|url-status=dead}}</ref> In 2015, it caused about 700 deaths.<ref name=GBD2015De>{{cite journal | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 | last1 = Wang | first1 = Haidong | last2 = Naghavi | first2 = Mohsen | last3 = Allen | first3 = Christine | last4 = Barber | first4 = Ryan M. | last5 = Bhutta | first5 = Zulfiqar A. | last6 = Carter | first6 = Austin | last7 = Casey | first7 = Daniel C. | last8 = Charlson | first8 = Fiona J. | last9 = Chen | first9 = Alan Zian | last10 = Coates | first10 = Matthew M. | last11 = Coggeshall | first11 = Megan | last12 = Dandona | first12 = Lalit | last13 = Dicker | first13 = Daniel J. | last14 = Erskine | first14 = Holly E. | last15 = Ferrari | first15 = Alize J. | last16 = Fitzmaurice | first16 = Christina | last17 = Foreman | first17 = Kyle | last18 = Forouzanfar | first18 = Mohammad H. | last19 = Fraser | first19 = Maya S. | last20 = Fullman | first20 = Nancy | last21 = Gething | first21 = Peter W. | last22 = Goldberg | first22 = Ellen M. | last23 = Graetz | first23 = Nicholas | last24 = Haagsma | first24 = Juanita A. | last25 = Hay | first25 = Simon I. | last26 = Huynh | first26 = Chantal | last27 = Johnson | first27 = Catherine O. | last28 = Kassebaum | first28 = Nicholas J. | last29 = Kinfu | first29 = Yohannes | last30 = Kulikoff | first30 = Xie Rachel | display-authors = 1 }}</ref>

Diagnosis is by testing the urine, [[urethra]] in males, [[vagina]] or [[cervix]] in females. It can be diagnosed by testing a sample collected from the throat or rectum of individuals who have had oral or anal sex, respectively.<ref name="CDC2014">{{cite web|title=Gonorrhea – CDC Fact Sheet (Detailed Version)|url=https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm|website=CDC|access-date=27 August 2016|date=17 November 2015|url-status=live|archive-url=https://web.archive.org/web/20160902004117/http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm|archive-date=2 September 2016}}</ref> 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;<ref name="STI2015" /> the same recommendation applies in [[men who have sex with men]] (MSM).<ref name="STI2015" />
Gonorrhea can be prevented with the use of [[condom]]s, having sex with only one person who is uninfected, and by [[sexual abstinence|not having sex]].<ref name=CDC2014/><ref name=STI2015>{{cite journal | vauthors = Workowski KA, Bolan GA | title = Sexually transmitted diseases treatment guidelines, 2015 | journal = MMWR. Recommendations and Reports | volume = 64 | issue = RR-03 | pages = 1–137 | date = June 2015 | pmid = 26042815 | pmc = 5885289 }}</ref> Treatment is usually with [[ceftriaxone]] by injection and [[azithromycin]] by mouth.<ref name=CDC2016Tx/><ref name=Un2015/> [[antibiotic resistance|Resistance]] has developed to many previously used [[antibiotic]]s and higher doses of ceftriaxone are occasionally required.<ref name=CDC2016Tx>{{cite web|title=Antibiotic-Resistant Gonorrhea Basic Information|url=https://www.cdc.gov/std/gonorrhea/arg/basic.htm|website=CDC|access-date=27 August 2016|date=13 June 2016|url-status=live|archive-url=https://web.archive.org/web/20160908222601/http://www.cdc.gov/std/gonorrhea/arg/basic.htm|archive-date=8 September 2016}}</ref><ref name=Un2015>{{cite journal | vauthors = Unemo M | title = Current and future antimicrobial treatment of gonorrhoea - the rapidly evolving Neisseria gonorrhoeae continues to challenge | journal = BMC Infectious Diseases | volume = 15 | pages = 364 | date = August 2015 | pmid = 26293005 | pmc = 4546108 | doi = 10.1186/s12879-015-1029-2 | doi-access = free }}</ref>

==Signs and symptoms==
Gonorrhea infections of [[mucosal membrane]]s can cause swelling, itching, pain, and the formation of [[pus]].<ref name=":0" /> The [[incubation period|time from exposure to symptoms]] is usually between two and 14 days, with most symptoms appearing between four and six days after infection, if they appear at all.  Both men and women with infections of the throat may experience a [[sore throat]], though such infection does not produce symptoms in 90% of cases.<ref name=Zakher>{{cite journal | vauthors = Zakher B, Cantor AG, Pappas M, Daeges M, Nelson HD | title = Screening for gonorrhea and Chlamydia: a systematic review for the U.S. Preventive Services Task Force | journal = Annals of Internal Medicine | volume = 161 | issue = 12 | pages = 884–893 | date = December 2014 | pmid = 25244000 | doi = 10.7326/M14-1022 | s2cid = 207538182 | citeseerx = 10.1.1.691.6232 }}</ref><ref name=marr>{{Cite book|title=Sexually Transmitted Diseases: A Physician Tells You What You Need to Know| vauthors = Marr L |edition=Second|year=2007|orig-year=1998|publisher=Johns Hopkins University|place=Baltimore, Maryland|url=https://books.google.com/books?id=aywGiP9w-u8C&q=gonorrhea+throat&pg=PT150|isbn=978-0-8018-8658-4}}</ref> Other symptoms may include swollen lymph nodes around the neck.<ref name=":0">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774|title=Gonorrhea - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2019-08-06}}</ref> Either sex can become infected in the eyes or rectum if these tissues are exposed to the bacterium,<ref>{{Cite web |date=2022-04-05 |title=Detailed STD Facts - Gonorrhea |url=https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm |access-date=2022-04-23 |website=www.cdc.gov |language=en-us}}</ref> which can lead to pain with bowel movements, rectal discharge, or constipation.<ref>{{cite journal |last1=Keshvani |first1=Neil |last2=Gupta |first2=Arjun |last3=Incze |first3=Michael A. |title=I Am Worried About Gonorrhea: What Do I Need to Know? |journal=JAMA Internal Medicine |date=1 January 2019 |volume=179 |issue=1 |pages=132 |doi=10.1001/jamainternmed.2018.4345 |pmid=30398526 |doi-access=free }}</ref>

===Women===
Half of women with gonorrhea are [[asymptomatic]] but the other half experience [[vaginal discharge]], lower abdominal pain, or [[dyspareunia|pain with sexual intercourse]] associated with [[Cervicitis|inflammation of the uterine cervix]].<ref name="Smith2015">{{cite journal | vauthors = Smith L, Angarone MP | title = Sexually Transmitted Infections | journal = The Urologic Clinics of North America | volume = 42 | issue = 4 | pages = 507–518 | date = November 2015 | pmid = 26475947 | doi = 10.1016/j.ucl.2015.06.004 | citeseerx = 10.1.1.590.3827 | s2cid = 37727850 }}</ref><ref name=CE07/><ref name=Sternak2014/> Common medical complications of untreated gonorrhea in women include [[pelvic inflammatory disease]] which can cause scars to the [[fallopian tubes]] and result in later [[ectopic pregnancy]] among those women who become pregnant.<ref name=webmd/>

===Men===
Most infected men with symptoms have [[urethritis|inflammation of the penile urethra]] associated with a [[dysuria|burning sensation during urination]] and discharge from the penis.<ref name=CE07/> In men, discharge with or without burning occurs in half of all cases and is the most common symptom of the infection.<ref name="Shmaefsky2009p52">{{cite book | vauthors = Shmaefsky BR |title=Gonorrhea|url=https://books.google.com/books?id=3iS7tXxC_HQC&pg=PA49|date=1 January 2009|publisher=Infobase|isbn=978-1-4381-0142-2|page=52}}</ref> This pain is caused by a narrowing and stiffening of the urethral [[Lumen (anatomy)|lumen]].<ref name="ChengBostwick2014">{{cite book| vauthors = Cheng L, Bostwick DG |title=Urologic Surgical Pathology E-Book|url=https://books.google.com/books?id=wrHQAgAAQBAJ&pg=PA863|date=24 January 2014|publisher=Elsevier Health Sciences|isbn=978-0-323-08619-6|page=863}}</ref> The most common medical complication of gonorrhea in men is [[epididymitis|inflammation of the epididymis]].<ref name=webmd>{{cite web|title=What Complications Can Gonorrhea Cause?|work=WebMD|url=https://www.webmd.com/sexual-conditions/complications-gonorrhea-cause|date=2019}}</ref> Gonorrhea is also associated with increased risk of [[prostate cancer]].<ref name="CainiGandini2014">{{cite journal | vauthors = Caini S, Gandini S, Dudas M, Bremer V, Severi E, Gherasim A | title = Sexually transmitted infections and prostate cancer risk: a systematic review and meta-analysis | journal = Cancer Epidemiology | volume = 38 | issue = 4 | pages = 329–338 | date = August 2014 | pmid = 24986642 | doi = 10.1016/j.canep.2014.06.002 }}</ref>

===Infants===
[[File:Gonococcal ophthalmia neonatorum.jpg|thumb|right|An infant with gonorrhea of the eyes]]
If not treated, [[neonatal conjunctivitis|gonococcal ophthalmia neonatorum]] will develop in 28% of infants born to women with gonorrhea.<ref>{{cite web|url=http://www.phac-aspc.gc.ca/publicat/clinic-clinique/pdf/s1c16e.pdf|title=Prophylaxis for Gonococcal and Chlamydial Ophthalmia Neonatorum ''in'' the Canadian Guide to Clinical Preventative Health Care|publisher=Public Health Agency of Canada|url-status=dead|archive-url=https://web.archive.org/web/20100310075359/http://www.phac-aspc.gc.ca//publicat/clinic-clinique/pdf/s1c16e.pdf|archive-date=10 March 2010}}</ref>

===Spread===
If left untreated, gonorrhea can spread from the original site of infection and infect and damage the joints, skin, and other organs. Indications of this can include fever, skin rashes, sores, and joint pain and swelling.<ref name=webmd/> In advanced cases, gonorrhea may cause a general [[Fatigue (medical)|feeling of tiredness]] similar to other infections.<ref name="Complications from gonorrhea">{{Cite web |title=Complications from gonorrhea |url=https://stanfordhealthcare.org/medical-conditions/sexual-and-reproductive-health/gonorrhea/symptoms/complications.html |access-date=2022-04-25 |website=stanfordhealthcare.org |language=en}}</ref><ref name="Shmaefsky2009p52"/> It is also possible for an individual to have an [[allergy|allergic reaction]] to the bacteria, in which case any appearing symptoms will be greatly intensified.<ref name="Shmaefsky2009p52"/> 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.<ref name=marr/>

==Cause==
[[File:Gram-stain of gonorrhoea.jpg|thumb|''[[Neisseria gonorrhoeae]]'' in pus from a case of gonorrhoea in a man ([[Gram stain]])]]
[[File:Pus cells with intracellular gonococci.jpg|thumb|Gram-stained pus from a urethral discharge showing Gram-negative, intracellular diplococci]]
Gonorrhea is caused by the bacterium ''[[Neisseria gonorrhoeae]]''.<ref name=CE07/> Previous infection does not confer immunity – a person who has been infected can become infected again by exposure to someone who is infected. Infected persons may be able to infect others repeatedly without having any signs or symptoms of their own.<ref name="Gonorrhea - Symptoms and causes">{{Cite web |title=Gonorrhea - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774 |access-date=2022-04-23 |website=Mayo Clinic |language=en}}</ref>

===Spread===
The infection is usually spread from one person to another through [[Sexual intercourse|vaginal]], [[Oral sex|oral]], or [[anal sex]].<ref name=CE07/><ref name="TrebachChaulk2015">{{cite journal | vauthors = Trebach JD, Chaulk CP, Page KR, Tuddenham S, Ghanem KG | title = Neisseria gonorrhoeae and Chlamydia trachomatis among women reporting extragenital exposures | journal = Sexually Transmitted Diseases | volume = 42 | issue = 5 | pages = 233–239 | date = May 2015 | pmid = 25868133 | pmc = 4672628 | doi = 10.1097/OLQ.0000000000000248 }}</ref> Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for [[men who have sex with men]] (MSM) is higher.<ref name="Howard Brown">Howard Brown Health Center: STI Annual Report, 2009</ref> Insertive MSM may get a penile infection from anal intercourse, while receptive MSM may get anorectal gonorrhea. Women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with an infected man.<ref name="condomreport">National Institute of Allergy and Infectious Diseases; National Institutes of Health, Department of Health and Human Services (20 July 2001). "Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention". Hyatt Dulles Airport, Herndon, Virginia. pp14</ref>

A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as [[ophthalmia neonatorum]].<ref name=CE07/> It may be able to spread through the objects contaminated with body fluid from an infected person.<ref name="Good2007">{{cite journal | vauthors = Goodyear-Smith F | title = What is the evidence for non-sexual transmission of gonorrhoea in children after the neonatal period? A systematic review | journal = Journal of Forensic and Legal Medicine | volume = 14 | issue = 8 | pages = 489–502 | date = November 2007 | pmid = 17961874 | doi = 10.1016/j.jflm.2007.04.001 }}</ref> The bacteria typically does not survive long outside the body, typically dying within minutes to hours.<ref name="Shmaefsky2009p48">{{cite book| vauthors = Shmaefsky BR |title=Gonorrhea|url=https://books.google.com/books?id=3iS7tXxC_HQC&pg=PA48|date=1 January 2009|publisher=Infobase|isbn=978-1-4381-0142-2|page=48}}</ref>

====Risk factors====

It is discovered that sexually active women younger than 25 and men who have sex with men are at increased risk of getting gonorrhea.<ref>{{Cite book | vauthors = Holmes KK |url=http://worldcat.org/oclc/644578106 |title=Sexually transmitted diseases |date=1984 |publisher=McGraw-Hill |oclc=644578106}}</ref>

Other risk factors include:

* Having a new sex partner
* Having a sex partner who has other partners
* Having more than one sex partner
* Having had gonorrhea or another sexually transmitted infection<ref>{{Cite journal |date=May 2013 |title=A Randomized, Controlled Trial of inSPOT and Patient-Delivered Partner Therapy for Gonorrhea and Chlamydial Infection Among Men Who Have Sex With Men |journal=Sexually Transmitted Diseases |volume=40 |issue=5 |pages=432 |doi=10.1097/olq.0b013e31829349ec |issn=0148-5717|doi-access=free }}</ref>
*

== Complications ==
Untreated gonorrhea can lead to major complications, such as:

* '''Infertility in women.''' Gonorrhea can spread into the uterus and fallopian tubes, causing [[pelvic inflammatory disease]] (PID). <abbr>PID</abbr> can result in scarring of the tubes, greater risk of pregnancy complications and infertility, and can be fatal, particularly in the immunocompromised.{{citation needed|date=September 2023}} <abbr>PID</abbr> requires immediate treatment.
* '''Infertility in men.''' Gonorrhea can cause a small, coiled tube in the rear portion of the testicles where the sperm ducts are located ([[epididymis]]) to become inflamed ([[epididymitis]]). Untreated epididymitis can lead to infertility.
* '''Infection that spreads to the joints and other areas of the body.''' The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of the body, including the joints. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results.
* '''Increased risk of HIV/AIDS.''' Having gonorrhea increases the susceptibility to infection with [[HIV|human immunodeficiency virus]] (HIV), the virus that leads to <abbr>AIDS</abbr>. People who have both gonorrhea and <abbr>HIV</abbr> (untreated by anti-retroviral therapy) are able to pass both diseases more readily to their partners.
* '''Complications in babies.''' Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections.<ref name="Complications from gonorrhea"/><ref name="Gonorrhea - Symptoms and causes"/>

==Diagnosis==

Traditionally, gonorrhea was diagnosed with [[Gram stain]] and [[Cell culture|culture]]; however, newer [[polymerase chain reaction]] (PCR)-based testing methods are becoming more common.<ref name=Sternak2014>{{cite journal | vauthors = Ljubin-Sternak S, Meštrović T | title = Chlamydia trachomatis and Genital Mycoplasmas: Pathogens with an Impact on Human Reproductive Health | journal = Journal of Pathogens | volume = 2014 | issue = 183167 | pages = 183167 | date = 2014 | pmid = 25614838 | pmc = 4295611 | doi = 10.1155/2014/183167 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Barry PM, Klausner JD | title = The use of cephalosporins for gonorrhea: the impending problem of resistance | journal = Expert Opinion on Pharmacotherapy | volume = 10 | issue = 4 | pages = 555–577 | date = March 2009 | pmid = 19284360 | pmc = 2657229 | doi = 10.1517/14656560902731993 }}</ref> If initial treatment fails, a culture should be done to determine the sensitivity of the bacteria to antibiotics.<ref name=Japan10/>

Tests that use PCR (aka nucleic acid amplification) to identify genes unique to ''N. gonorrhoeae'' are recommended for screening and diagnosis of gonorrhea infection. These PCR-based tests require a sample of urine, urethral swabs, or cervical/vaginal swabs. Culture (growing colonies of bacteria in order to isolate and identify them) and Gram-stain (staining of bacterial cell walls to reveal morphology) can also be used to detect the presence of ''N. gonorrhoeae'' in all specimen types except urine.<ref name=":12">{{Cite web|url=https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening|title=Final Recommendation Statement: Chlamydia and Gonorrhea: Screening – US Preventive Services Task Force|website=uspreventiveservicestaskforce.org|language=en|access-date=2017-12-07}}</ref><ref name=":7">{{Cite web|url=https://www.cdc.gov/std/tg2015/gonorrhea.htm|title=Gonococcal Infections – 2015 STD Treatment Guidelines|website=cdc.gov|language=en-us|access-date=2017-12-07}}</ref> Studies of the swab sample method for gonorrhea infections have not shown any difference in the number of patients treated, whether the sample was collected at home or in the clinic. The implications for number of patients cured, reinfection rates, partner management, and safety are unknown.<ref>{{cite journal | vauthors = Fajardo-Bernal L, Aponte-Gonzalez J, Vigil P, Angel-Müller E, Rincon C, Gaitán HG, Low N | title = Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 9 | pages = CD011317 | date = September 2015 | pmid = 26418128 | pmc = 8666088 | doi = 10.1002/14651858.CD011317.pub2 | collaboration = Cochrane STI Group }}</ref>

If Gram-negative, oxidase-positive diplococci are visualized on direct Gram stain of urethral pus (male genital infection), no further testing is needed to establish the diagnosis of gonorrhea infection.<ref name=Lev13th>{{Cite book|title=Review of medical microbiology and immunology| vauthors = Levinson W |isbn=9780071818117|edition=Thirteenth |location=New York|oclc=871305336|date=2014-07-01}}</ref><ref name=":6" /> However, direct Gram stain of cervical swabs is not useful because the ''N. gonorrhoeae'' organisms are less concentrated in these samples. The chance of a false positive test is also higher for a cervical swab, as Gram-negative diplococci native to the normal vaginal flora cannot be distinguished from ''N. gonorrhoeae'' in that context. Thus, cervical swabs must be cultured under the conditions described above. If oxidase positive, Gram-negative diplococci are isolated from a culture of a cervical/vaginal swab specimen, then the diagnosis is made. Culture is especially useful for diagnosis of infections of the throat, rectum, eyes, blood, or joints—areas where PCR-based tests are not well established in all labs.<ref name=":6" /><ref name=":10" /> Culture is also useful for antimicrobial sensitivity testing, analyzing treatment failure, and epidemiological purposes (outbreaks, surveillance).<ref name=":6">{{cite journal | vauthors = Ng LK, Martin IE | title = The laboratory diagnosis of Neisseria gonorrhoeae | journal = The Canadian Journal of Infectious Diseases & Medical Microbiology | volume = 16 | issue = 1 | pages = 15–25 | date = January 2005 | pmid = 18159523 | pmc = 2095009 | doi = 10.1155/2005/323082 | doi-access = free }}</ref>

In patients who may have disseminated gonococcal infection (DGI), all possible mucosal sites should be cultured (e.g., pharynx, cervix, urethra, rectum).<ref name=":10">https://www.cdc.gov/std/tg2015/clinical.htm section on prevention methods</ref> Three sets of blood cultures should also be obtained.<ref>{{EMedicine|article|218059|Gonorrhea|overview}}</ref> [[Synovial fluid]] should be collected in cases of [[septic arthritis]].<ref name=":10" />

All people testing positive for gonorrhea should be tested for other sexually transmitted infections such as [[Chlamydia infection|chlamydia]], [[syphilis]], and [[human immunodeficiency virus]].<ref name=Japan10>{{cite journal | vauthors = Deguchi T, Nakane K, Yasuda M, Maeda S | title = Emergence and spread of drug resistant Neisseria gonorrhoeae | journal = The Journal of Urology | volume = 184 | issue = 3 | pages = 851–8; quiz 1235 | date = September 2010 | pmid = 20643433 | doi = 10.1016/j.juro.2010.04.078 }}</ref> Studies have found co-infection with chlamydia ranging from 46 to 54% in young people with gonorrhea.<ref>{{cite journal | vauthors = Kahn RH, Mosure DJ, Blank S, Kent CK, Chow JM, Boudov MR, Brock J, Tulloch S | display-authors = 6 | title = Chlamydia trachomatis and Neisseria gonorrhoeae prevalence and coinfection in adolescents entering selected US juvenile detention centers, 1997-2002 | journal = Sexually Transmitted Diseases | volume = 32 | issue = 4 | pages = 255–259 | date = April 2005 | pmid = 15788927 | doi = 10.1097/01.olq.0000158496.00315.04 | s2cid = 20864079 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Dicker LW, Mosure DJ, Berman SM, Levine WC | title = Gonorrhea prevalence and coinfection with chlamydia in women in the United States, 2000 | journal = Sexually Transmitted Diseases | volume = 30 | issue = 5 | pages = 472–476 | date = May 2003 | pmid = 12916141 | doi = 10.1097/00007435-200305000-00016 | s2cid = 39361152 | doi-access = free }}</ref> Among persons in the United States between 14 and 39 years of age, 46% of people with gonorrheal infection also have chlamydial infection.<ref>{{cite journal | vauthors = Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G, Weinstock H | title = Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002 | journal = Annals of Internal Medicine | volume = 147 | issue = 2 | pages = 89–96 | date = July 2007 | pmid = 17638719 | doi = 10.7326/0003-4819-147-2-200707170-00007 | s2cid = 16507728 | doi-access =  }}</ref> For this reason, gonorrhea and chlamydia testing are often combined.<ref name=":12" /><ref name=":14">{{Cite web | url=https://www.cdc.gov/std/tg2015/gonorrhea.htm | title=Gonococcal Infections - 2015 STD Treatment Guidelines| date=2018-01-04}}</ref><ref name="Sherris">{{cite book | veditors = Ryan KJ, Ray CG |title=Sherris Medical Microbiology | edition = 4th | publisher = McGraw Hill | year = 2004 | isbn = 978-0-8385-8529-0 }}{{page needed|date=February 2015}}</ref> People diagnosed with gonorrhea infection have a fivefold increase risk of HIV transmission.<ref>{{cite web|url=http://whqlibdoc.who.int/hq/2011/WHO_RHR_11.14_eng.pdf|title=Emergence of multi-drug resistant Neisseria gonorrhoeae – Threat of global rise in untreatable sexually transmitted infections|author=Department of Reproductive Health and Research|date=2011|work=FactSheet WHO/RHR/11.14|publisher=World Health Organization}}</ref> Additionally, infected persons who are HIV positive are more likely to shed and transmit HIV to uninfected partners during an episode of gonorrhea.<ref>{{Cite web|url=https://www.cdc.gov/std/gonorrhea/default.htm|title=Gonorrhea – STD information from CDC|date=2017-10-06|website=cdc.gov|language=en-us|access-date=2017-12-05}}</ref>

== 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).<ref>{{cite journal | vauthors = Meyers D, Wolff T, Gregory K, Marion L, Moyer V, Nelson H, Petitti D, Sawaya GF | display-authors = 6 | title = USPSTF recommendations for STI screening | journal = American Family Physician | volume = 77 | issue = 6 | pages = 819–824 | date = March 2008 | pmid = 18386598 }}</ref> <!--Gonorrheal infections in young women are missed with genital-only testing.--><!-- does not appear to be discussed in the source -->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.<ref name="Smith2015"/>

Screening for gonorrhea in women who are (or intend to become) pregnant, and who are found to be at high risk for [[sexually transmitted infection]]s, is recommended as part of [[prenatal care in the United States]].<ref>[http://www.icsi.org/prenatal_care_4/prenatal_care__routine__full_version__2.html Health Care Guideline: Routine Prenatal Care. Fourteenth Edition.] {{webarchive|url=https://web.archive.org/web/20080705032759/http://www.icsi.org/prenatal_care_4/prenatal_care__routine__full_version__2.html |date=5 July 2008 }} By the Institute for Clinical Systems Improvement July 2010.</ref>

== Prevention ==
{{see also|Safe sex}}

As with most sexually transmitted infections, the risk of infection can be reduced significantly by the correct use of [[condom]]s, [[sexual abstinence|not having sex]], or can be removed almost entirely by limiting sexual activities to a mutually monogamous relationship with an uninfected person.<ref>[https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004526/ section: Prevention] {{webarchive|url=https://web.archive.org/web/20130720041540/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004526/ |date=20 July 2013 }}</ref><ref>[https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm section: How can gonorrhea be prevented?] {{webarchive|url=https://web.archive.org/web/20161216052928/http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm |date=16 December 2016 }}</ref>

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.<ref name="DesaiWoodhall2015">{{cite journal | vauthors = Desai M, Woodhall SC, Nardone A, Burns F, Mercey D, Gilson R | title = Active recall to increase HIV and STI testing: a systematic review | journal = Sexually Transmitted Infections | volume = 91 | issue = 5 | pages = 314–323 | date = August 2015 | pmid = 25759476 | doi = 10.1136/sextrans-2014-051930 | doi-access = free }}</ref>

Newborn babies coming through the birth canal are given [[erythromycin]] ointment in the eyes to prevent blindness from infection. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.<ref name=Sad2016/>

== Treatment ==

===Antibiotics===
[[File:PenicillinPSAedit.jpg|thumb|[[Penicillin]] entered mass production in 1944 and revolutionized the treatment of several venereal diseases.]]
Antibiotics are used to treat gonorrhea infections. As of 2016, both [[ceftriaxone]] by injection and [[azithromycin]] by mouth are most effective.<ref name=CDC2016Tx/><ref name="MMWR2012" /><ref name=WHO2017Res>{{cite web|title=Antibiotic-resistant gonorrhoea on the rise, new drugs needed|url=https://www.who.int/mediacentre/news/releases/2017/Antibiotic-resistant-gonorrhoea/en/|website=World Health Organization|access-date=10 July 2017|date=7 July 2017|url-status=live|archive-url=https://web.archive.org/web/20170709050132/http://www.who.int/mediacentre/news/releases/2017/Antibiotic-resistant-gonorrhoea/en/|archive-date=9 July 2017}}</ref><ref>{{cite journal | vauthors = Sánchez-Busó L, Golparian D, Corander J, Grad YH, Ohnishi M, Flemming R, Parkhill J, Bentley SD, Unemo M, Harris SR | display-authors = 6 | title = The impact of antimicrobials on gonococcal evolution | journal = Nature Microbiology | volume = 4 | issue = 11 | pages = 1941–1950 | date = November 2019 | pmid = 31358980 | pmc = 6817357 | doi = 10.1038/s41564-019-0501-y }}</ref> However, due to increasing rates of [[antibiotic resistance]], local susceptibility patterns must be taken into account when deciding on treatment.<ref name=Japan10/><ref name="BaardaSikora2015"/> [[Ertapenem]] is a potential effective alternative treatment for ceftriaxone-resistant gonorrhea.<ref>{{cite journal | vauthors = de Vries HJ, de Laat M, Jongen VW, Heijman T, Wind CM, Boyd A, de Korne-Elenbaas J, van Dam AP, Schim van der Loeff MF | display-authors = 6 | title = Efficacy of ertapenem, gentamicin, fosfomycin, and ceftriaxone for the treatment of anogenital gonorrhoea (NABOGO): a randomised, non-inferiority trial | journal = The Lancet. Infectious Diseases | volume = 22 | issue = 5 | pages = 706–717 | date = May 2022 | pmid = 35065063 | doi = 10.1016/S1473-3099(21)00625-3 | s2cid = 246129045 }}</ref><ref>{{cite web |title=Antibiotic Ertapenem is alternative drug in treatment of gonorrhea |url=https://www.amsterdamumc.org/en/research/institutes/amsterdam-institute-for-infection-and-immunity/news/antibiotic-ertapenem-is-alternative-drug-in-treatment-of-gonorrhea.htm |website=Amsterdam UMC |access-date=8 July 2022 |date=20 January 2022}}</ref>

Adults may have eyes infected with gonorrhoea and require proper personal hygiene and medications.<ref name=Sad2016>{{cite journal | vauthors = Sadowska-Przytocka A, Czarnecka-Operacz M, Jenerowicz D, Grzybowski A | title = Ocular manifestations of infectious skin diseases | journal = Clinics in Dermatology | volume = 34 | issue = 2 | pages = 124–128 | date = 2016 | pmid = 26903179 | doi = 10.1016/j.clindermatol.2015.11.010 }}</ref> Addition of topical antibiotics have not been shown to improve cure rates compared to oral antibiotics alone in treatment of eye infected gonorrhea.<ref>{{cite journal | vauthors = Epling J | title = Bacterial conjunctivitis | journal = BMJ Clinical Evidence | volume = 2012 | date = February 2012 | pmid = 22348418 | pmc = 3635545 }}</ref> For newborns, [[erythromycin]] ointment is recommended as a preventative measure for gonococcal infant [[conjunctivitis]].<ref>{{cite journal | vauthors = Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB | display-authors = 6 | title = Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: US Preventive Services Task Force Reaffirmation Recommendation Statement | journal = JAMA | volume = 321 | issue = 4 | pages = 394–398 | date = January 2019 | pmid = 30694327 | doi = 10.1001/jama.2018.21367 | doi-access = free }}</ref>

Infections of the throat can be especially problematic, as antibiotics have difficulty becoming sufficiently concentrated there to destroy the bacteria. This is amplified by the fact that pharyngeal gonorrhoea is mostly asymptomatic, and gonococci and commensal ''Neisseria'' species can coexist for long time periods in the pharynx and share anti-microbial resistance genes. Accordingly, an enhanced focus on early detection (i.e., screening of high-risk populations, such as men who have sex with men, [[polymerase chain reaction|PCR testing]] should be considered) and appropriate treatment of pharyngeal gonorrhoea is important.<ref name=CDC2016Tx/>

===Sexual partners===
It is recommended that sexual partners be tested and potentially treated.<ref name=Japan10/> 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.<ref name=EPTFinalReport2006>[https://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf "Expedited partner therapy in the management of sexually transmitted diseases"] {{webarchive|url=https://web.archive.org/web/20091102171329/http://cdc.gov/std/treatment/EPTFinalReport2006.pdf |date=2 November 2009 }}. February 2006. Centers for Disease Control and Prevention (CDC).</ref>

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.<ref>{{cite web|title=Gonorrhea – CDC Fact Sheet| work = U.S. Centers for Disease Control and Prevention |url=https://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm|access-date=17 October 2014|date=14 July 2014|url-status=live|archive-url=https://web.archive.org/web/20161216052928/http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm|archive-date=16 December 2016}}</ref>

===Antibiotic resistance===
{{Main|Antibiotic resistance in gonorrhea}}
Many antibiotics that were once effective including [[penicillin]], [[tetracycline]], and [[fluoroquinolones]] are no longer recommended because of high rates of resistance.<ref name=Japan10/> 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.<ref name=MMWR2012>{{cite journal | title = Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 61 | issue = 31 | pages = 590–594 | date = August 2012 | pmid = 22874837 | author1 = Centers for Disease Control Prevention (CDC) }}</ref> Public health officials are concerned that an emerging pattern of resistance may predict a global epidemic.<ref name=Groopman>{{cite magazine | title = Sex and the Superbug | magazine = The New Yorker | date = 2012-10-01 | vauthors = Groopman J | volume = LXXXVIII | issue = 30 | pages = 26–31 | url = http://www.newyorker.com/reporting/2012/10/01/121001fa_fact_groopman | access-date = 2012-10-13 | quote = ...public-health experts [see]...the emergence of a strain of gonorrhea that is resistant to the last drug available against it, and the harbinger of a sexually transmitted global epidemic. | url-status = live | archive-url = https://web.archive.org/web/20121009062727/http://www.newyorker.com/reporting/2012/10/01/121001fa_fact_groopman | archive-date = 9 October 2012}}</ref><ref>{{cite journal | vauthors = Pleininger S, Indra A, Golparian D, Heger F, Schindler S, Jacobsson S, Heidler S, Unemo M | display-authors = 6 | title = Extensively drug-resistant (XDR) ''Neisseria gonorrhoeae'' causing possible gonorrhoea treatment failure with ceftriaxone plus azithromycin in Austria, April 2022 | journal = Euro Surveillance | volume = 27 | issue = 24 | date = June 2022 | pmid = 35713023 | pmc = 9205165 | doi = 10.2807/1560-7917.ES.2022.27.24.2200455 | s2cid = 249747652 }}</ref> In 2016, the [[World Health Organization|WHO]] published new guidelines for treatment, stating "There is an urgent need to update treatment recommendations for gonococcal infections to respond to changing antimicrobial resistance (AMR) patterns of ''N. gonorrhoeae''. High-level resistance to previously recommended quinolones is widespread and decreased susceptibility to the extended-spectrum (third-generation) cephalosporins, another recommended first-line treatment in the 2003 guidelines, is increasing and several countries have reported treatment failures."<ref>{{cite web |url=https://www.who.int/reproductivehealth/publications/rtis/gonorrhoea-treatment-guidelines/en/ |title=WHO guidelines for the treatment of ''Neisseria gonorrhoeae'' |publisher=World Health Organization |date=2016 |access-date=24 September 2020 }}</ref>

==Prognosis==
[[File:Gonorrhoea world map - DALY - WHO2004.svg|thumb|[[Disability-adjusted life year]] for gonorrhea per 100,000&nbsp;inhabitants
{{Col-begin}}
{{Col-break}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|<13}}
{{legend|#fff200|13–26}}
{{legend|#ffdc00|26–39}}
{{legend|#ffc600|39–52}}
{{legend|#ffb000|52–65}}
{{legend|#ff9a00|65–78}}
{{Col-break}}
{{legend|#ff8400|78–91}}
{{legend|#ff6e00|91–104}}
{{legend|#ff5800|104–117}}
{{legend|#ff4200|117–130}}
{{legend|#ff2c00|130–143}}
{{legend|#cb0000|>143}}
{{col-end}}]]
Gonorrhea if left untreated may last for weeks or months with higher risks of complications.<ref name=CE07/> One of the complications of gonorrhea is systemic dissemination resulting in skin [[pustule]]s or [[petechia]], [[septic arthritis]], [[meningitis]], or [[endocarditis]].<ref name=CE07/> This occurs in between 0.6 and 3% of infected women and 0.4 and 0.7% of infected men.<ref name=CE07/>

In men, [[Epididymitis|inflammation of the epididymis]], [[Prostatitis|prostate gland]], and [[Urethritis|urethra]] can result from untreated gonorrhea.<ref name=Robbins>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}}</ref> In women, the most common result of untreated gonorrhea is [[pelvic inflammatory disease]]. Other complications include [[perihepatitis|inflammation of the tissue surrounding the liver]],<ref name=Robbins/> a rare complication associated with [[Fitz-Hugh–Curtis syndrome]]; [[septic arthritis]] in the fingers, wrists, toes, and ankles; [[septic abortion]]; [[chorioamnionitis]] during pregnancy; neonatal or adult blindness from [[conjunctivitis]]; and [[infertility]]. Men who have had a gonorrhea infection have an increased risk of getting [[prostate cancer]].<ref name="CainiGandini2014"/>

==Epidemiology==
{{Main|Epidemiology of gonorrhoea}}
[[File:Chart of gonorrhea infection rates (USA, 1941-2007).png|thumb|Gonorrhea rates, United States, 1941–2007]]
About 88 million cases of gonorrhea occur each year, out of the 448 million new cases of curable STI each year – that also includes syphilis, chlamydia and [[trichomoniasis]].<ref name=WHOEpi14/> The prevalence was highest in the [[Africa]]n region, the [[Americas]], and Western [[Pacific Ocean|Pacific]], and lowest in [[Europe]].<ref>{{cite journal | vauthors = Kirkcaldy RD, Weston E, Segurado AC, Hughes G | title = Epidemiology of gonorrhoea: a global perspective | journal = Sexual Health | volume = 16 | issue = 5 | pages = 401–411 | date = September 2019 | pmid = 31505159 | pmc = 7064409 | doi = 10.1071/SH19061 | publisher = [[United States National Library of Medicine]] }}</ref> In 2013, it caused about 3,200 deaths, up from 2,300 in 1990.<ref name=GBD2013Death>{{cite journal | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–171 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/s0140-6736(14)61682-2 | author1 = GBD 2013 Mortality and Causes of Death Collaborators }}</ref>

In the United Kingdom, 196 per 100,000 males 20 to 24 years old and 133 per 100,000 females 16 to 19 years old were diagnosed in 2005.<ref name=CE07>{{cite journal | vauthors = Moran JS | title = Gonorrhoea | journal = BMJ Clinical Evidence | volume = 2007 | date = March 2007 | pmid = 19454057 | pmc = 2943790 }}</ref> In 2013, the CDC estimated that more than 820,000 people in the United States get a new gonorrheal infection each year. Fewer than half of these infections are reported to CDC. In 2011, 321,849 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113. 5 per 100,000 persons.<ref>{{cite web|url=https://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm|title=Gonorrhea – CDC Fact Sheet|publisher=CDC|date=29 May 2012|access-date=2013-12-20|url-status=live|archive-url=https://web.archive.org/web/20161216052928/http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm|archive-date=16 December 2016}}</ref>

In the US, it is the second-most-common bacterial [[sexually transmitted infections]]; [[Chlamydia infection|chlamydia]] remains first.<ref name=cdcgonorrhea>{{cite web|title=CDC – STD Surveillance – Gonorrhea|url=https://www.cdc.gov/std/stats/gonorrhea.htm|access-date=2008-08-21 |archive-url = https://web.archive.org/web/20080306085420/http://www.cdc.gov/std/stats/gonorrhea.htm |archive-date = 2008-03-06}}</ref><ref name=cdcchlamydia>{{cite web|title=CDC Fact Sheet – Chlamydia|url=https://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm|access-date=2008-08-21|url-status=live|archive-url=https://web.archive.org/web/20161216052855/http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm|archive-date=16 December 2016}}</ref> According to the CDC [[African American]]s are most affected by gonorrhea, accounting for 69% of all gonorrhea cases in 2010.<ref>{{cite web|title=STD Trends in the United States: 2010 National Data for Gonorrhea, Chlamydia, and Syphilis|url=https://www.cdc.gov/std/stats10/tables/trends-table.htm|publisher=[[Centers for Disease Control and Prevention]] (CDC)|date=22 November 2010|url-status=live|archive-url=https://web.archive.org/web/20120124104622/http://www.cdc.gov/std/stats10/tables/trends-table.htm|archive-date=24 January 2012}}</ref>

The World Health Organization warned in 2017 of the spread of untreatable strains of gonorrhea, following analysis of at least three cases in Japan, France and Spain, which survived all antibiotic treatment.<ref>{{cite news|url=https://www.theguardian.com/society/2017/jul/07/untreatable-gonorrhoea-superbug-spreading-around-world-who-warns|title=Untreatable gonorrhoea 'superbug' spreading around world, WHO warns|newspaper=The Daily Telegraph|date=7 July 2017|url-status=live|archive-url=https://web.archive.org/web/20170707065204/https://www.theguardian.com/society/2017/jul/07/untreatable-gonorrhoea-superbug-spreading-around-world-who-warns|archive-date=7 July 2017}}</ref>

==History==
[[File:SheMayLookCleanBut.jpg|thumb|left|During World War II, the U.S. government used posters to warn military personnel about the dangers of gonorrhea and other [[sexually transmitted infections]].]]

Some scholars translate the biblical terms {{lang|he-Latn|zav}} (for a male, {{langx|he|זָב}}) and {{lang|he-Latn|zavah}} (for a female, {{lang|he|זָבָה}}) as gonorrhea.<ref>{{cite web |url=http://www.biu.ac.il/JH/Parasha/eng/metzora/nitzan.html |title=Daf Parashat Hashavua |access-date=2012-11-02 |url-status=live |archive-url=https://web.archive.org/web/20121003062653/http://www.biu.ac.il/JH/Parasha/eng/metzora/nitzan.html |archive-date=3 October 2012}}</ref>

It has been suggested{{By whom|date=July 2022}} that [[mercury (element)|mercury]] was used as a treatment for gonorrhea.{{When|reason=During or until what period in history?|date=July 2022}} Surgeons' tools on board the recovered English warship the ''[[Mary Rose]]'' included a [[syringe]] that, according to some, was used to inject the mercury via the [[urinary meatus]] into crewmen with gonorrhea. The name "the clap", in reference to the disease, is recorded as early as the sixteenth century, referring to a medieval [[red-light district]] in Paris, Les Clapiers. Translating to "The rabbit holes", it was so named for the small huts in which prostitutes worked.<ref name=firstuseprimary>{{Cite book |title= The Mirror for Magistrates |year= 1587 | vauthors = Higgins J |title-link= The Mirror for Magistrates }} as cited in the ''Oxford English Dictionary'' entry for "clap".</ref><ref name="BaardaSikora2015">{{cite journal | vauthors = Baarda BI, Sikora AE | title = Proteomics of Neisseria gonorrhoeae: the treasure hunt for countermeasures against an old disease | journal = Frontiers in Microbiology | volume = 6 | pages = 1190 | year = 2015 | pmid = 26579097 | pmc = 4620152 | doi = 10.3389/fmicb.2015.01190 | doi-access = free }}</ref>

[[Silver nitrate]] was one of the widely used drugs in the 19th century. However, it became replaced by [[Protargol]]. [[Arthur Eichengrün]] invented this type of [[colloidal silver]], which was marketed by [[Bayer]] from 1897 onward. The silver-based treatment was used until the first antibiotics came into use in the 1940s.<ref>{{cite journal |vauthors=Bender M |title=Ueber neuere Antigonorrhoica (insbes. Argonin und Protargol) |journal=Archives of Dermatological Research |year=1898 |volume=43 |issue=1 |pages=31–36 |doi=10.1007/BF01986890 |s2cid=45492365 |url=https://zenodo.org/record/2135400 }}</ref><ref name=medlineneogono>{{MedlinePlusEncyclopedia|001606|Neonatal Conjunctivitis}}</ref>

The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record. One of the first reliable notations occurs in the Acts of the [[Parliament of England|English Parliament]] which, in 1161, passed a law to reduce the spread of "the perilous infirmity of burning".<ref>{{cite book | vauthors = Sanger W | title = History of Prostitution |location=New York |publisher=Harper |date=1910 }}</ref> The symptoms described are consistent with, but not diagnostic of, gonorrhea. A similar decree was passed by [[Louis IX]] in France in 1256, replacing regulation with banishment.<ref>{{cite book |vauthors=LaCroix P |title=The History of Prostitution |volume=2 |location=New York |publisher=MacMillan |date=1931 }}</ref> Similar symptoms were noted at the [[Siege of Acre (1291)|siege of Acre]] by [[Crusaders]].

Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several changes occurred in European medieval society. Cities hired [[public health]] doctors to treat affected patients without right of refusal. [[Pope Boniface VIII]] rescinded the requirement that physicians complete studies for the lower orders of the [[Catholic priesthood]].<ref name="Moen 2017">{{cite book |vauthors=Moen J, Bivens L |title=Basic Healthcare Studies: Sexually Transmitted Disease |publisher=Alpha Editions |year=2017 |url=https://books.google.com/books?id=iwU1DgAAQBAJ&pg=PT70 |isbn=9789386367570 }}</ref>

Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as [[leprosy|lepers]] and other epidemic patients.<ref>{{cite book |vauthors=Leiky WE |title=History of European Morals |location=New York |publisher=MacMillan |date=1926 }}</ref> After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted infection.<ref name="Moen 2017"/>

== Research ==
A vaccine for gonorrhea has been developed that is effective in mice.<ref>{{cite journal | vauthors = Jerse AE, Bash MC, Russell MW | title = Vaccines against gonorrhea: current status and future challenges | journal = Vaccine | volume = 32 | issue = 14 | pages = 1579–1587 | date = March 2014 | pmid = 24016806 | pmc = 4682887 | doi = 10.1016/j.vaccine.2013.08.067 }}</ref> It will not be available for human use until further studies have demonstrated that it is both safe and effective in the human population. Development of a vaccine has been complicated by the ongoing evolution of resistant strains and [[antigenic variation]] (the ability of ''N. gonorrhoeae'' to disguise itself with different surface markers to evade the immune system).<ref name="BaardaSikora2015" />

As ''[[N. gonorrhoeae]]'' is closely related to ''[[N. meningitidis]]'' and they have 80–90% homology in their genetic sequences some cross-protection by [[meningococcal vaccine]]s is plausible. A study published in 2017 showed that [[MeNZB]] group B meningococcal vaccine provided a partial protection against gonorrhea.<ref name=Gottlieb2017>{{cite journal | vauthors = Gottlieb SL, Johnston C | title = Future prospects for new vaccines against sexually transmitted infections | journal = Current Opinion in Infectious Diseases | volume = 30 | issue = 1 | pages = 77–86 | date = February 2017 | pmid = 27922851 | pmc = 5325242 | doi = 10.1097/QCO.0000000000000343 }}</ref> The vaccine efficiency was calculated to be 31%.<ref name="Petousis-Harris2017">{{cite journal | vauthors = Petousis-Harris H, Paynter J, Morgan J, Saxton P, McArdle B, Goodyear-Smith F, Black S | title = Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: a retrospective case-control study | journal = Lancet | volume = 390 | issue = 10102 | pages = 1603–1610 | date = September 2017 | pmid = 28705462 | doi = 10.1016/S0140-6736(17)31449-6 | s2cid = 4230156 }}</ref> In June 2023, [[GSK plc|GlaxoSmithKline]] won fast-track designation from the [[Food and Drug Administration]] for its vaccine candidate against gonorrhea.<ref>{{cite news |last= |first= |date=27 June 2023|title=GSK's gonorrhoea vaccine receives FDA's 'fast-track' designation|url=https://www.reuters.com/business/healthcare-pharmaceuticals/gsks-gonorrhoea-vaccine-receives-fdas-fast-track-designation-2023-06-27/|work=[[Reuters]]|location= |access-date=20 August 2023}}</ref> In 2025 the [[National Health Service|NHS]] approved a gonorrhoea vaccine programme for England starting on August based on 4CMenB a vaccine for [[Meningococcal disease|meningococcal B disease]] that also shows to offer up 40% protection against gonorrhea.<ref>{{Cite web |last=England |first=N. H. S. |date=2025-05-21 |title=NHS England » NHS and local government to roll out world-first vaccine programme to prevent gonorrhoea |url=https://www.england.nhs.uk/2025/05/nhs-and-local-government-to-roll-out-world-first-vaccine-programme-to-prevent-gonorrhoea/#:~:text=People%20who%20receive%20the%20jab,Security%20Agency%20(UKHSA)%20research. |access-date=2025-05-21 |website=www.england.nhs.uk |language=en-US}}</ref><ref>{{Cite web |date=2025-05-21 |title=Gonorrhoea vaccine to be rolled out in England from August |url=https://www.bbc.com/news/articles/cded26z16leo |access-date=2025-05-21 |website=www.bbc.com |language=en-GB}}</ref> 
{{Clear}}

== References ==
{{Reflist}}

== External links ==
{{Commons category|Gonorrhea}}
* [https://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm "Gonorrhea – CDC Fact Sheet"]
{{Medical resources
| DiseasesDB=8834
| ICD10 = A54
| ICD9 = {{ICD9|098}}
| ICDO =
| OMIM =
| MedlinePlus = 007267
| eMedicineSubj = article
| eMedicineTopic = 782913
| MeshID = D006069
}}
{{STD/STI}}
{{Gram-negative proteobacterial bacterial diseases}}
{{Bacterial cutaneous infections}}
{{Authority control}}

[[Category:Bacterium-related cutaneous conditions]]
[[Category:Gonorrhea]]
[[Category:Infectious causes of cancer]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia emergency medicine articles ready to translate]]