Can gonorrhea remain asymptomatic and still be transmitted to others?

From the Guidelines

Yes, gonorrhea can absolutely remain asymptomatic and still be transmitted to others. Many infected individuals, especially women (up to 80%) and some men (10-15%), show no symptoms at all while carrying the infection 1. Despite the absence of symptoms, these individuals can still spread the bacteria during sexual contact. This silent transmission is one of the main reasons gonorrhea remains prevalent worldwide. The bacterium Neisseria gonorrhoeae can live in the genital tract, rectum, or throat without causing noticeable symptoms while remaining infectious.

Key Points to Consider

• Testing is the only reliable way to identify asymptomatic infections, which is why regular STI screening is recommended for sexually active individuals, especially those with new or multiple partners 1.
• If diagnosed, gonorrhea requires prompt antibiotic treatment, typically with a single injection of ceftriaxone 500mg intramuscularly, sometimes combined with oral azithromycin 1g as a single dose 1.
• All sexual partners from the previous 60 days should also be notified, tested, and treated to prevent reinfection and further transmission of this silent but serious infection 1.
• The USPSTF recommends annual gonorrhea screening of all at-risk, sexually active females, and the CDC recommends urethral, rectal, and oropharyngeal gonorrhea testing at least annually for men who have sex with men (MSM) who engage in receptive anal or oral intercourse, respectively 1.

Prevention and Control

Prevention of gonorrhea transmission is crucial and can be achieved through regular screening, prompt treatment of infected individuals, and notification and treatment of sexual partners. Education on safe sex practices, including the use of condoms, is also vital in reducing the spread of the infection. Given the potential for asymptomatic transmission, a proactive approach to screening and treatment is necessary to control the spread of gonorrhea.

From the Research

Gonorrhea Transmission and Asymptomatic Cases

• Gonorrhea, caused by the bacterium Neisseria gonorrhoeae, can remain asymptomatic in individuals, particularly women, and still be transmitted to others 2.
• Asymptomatic gonorrhea is significantly common in both males and females, and individuals with one sexually transmitted disease (STD) are more likely to have an asymptomatic gonorrheal infection 2.
• The Centers for Disease Control and Prevention (CDC) recommends routine genital screening for all sexually active women at risk for infection, including women aged < 25 years and older women with one or more risk factors 3.

Risk of Transmission

• Gonorrhea can be transmitted through sexual contact, and asymptomatic individuals can still transmit the infection to their partners 3, 4.
• The pharynx has been implicated as a site for acquiring resistance through transformation with commensal Neisseria species or induced resistance through subtherapeutic antimicrobial levels, highlighting the importance of appropriate screening and treatment 5.
• Screening for asymptomatic infections, maintaining culture capacity to monitor antimicrobial resistance, and treating with effective regimens are crucial strategies to control gonorrhea 5.

Treatment and Prevention

• Effective treatment can prevent complications and transmission, but the emergence of antimicrobial resistance complicates treatment recommendations and control efforts 6, 4.
• The CDC recommends a single 500 mg IM dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea, and concurrent treatment with doxycycline if chlamydial infection has not been excluded 6.
• Promoting safe sexual behaviors, reducing STI-associated stigma, and improving global surveillance of antimicrobial resistance are essential to inform treatment guidelines and control gonorrhea 4.