Causes of Gonorrhea
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, a Gram-negative diplococcus that is transmitted through sexual contact with an infected person. 1
Pathogen Characteristics
- Causative organism: Neisseria gonorrhoeae (gonococcus)
- Classification: Gram-negative diplococcus (appears as pairs of bacteria under microscope)
- Identification: Can be visualized on Gram stain as intracellular Gram-negative diplococci, particularly in male urethral specimens 1
Transmission
Gonorrhea is exclusively transmitted through:
- Sexual contact with the genitals, rectum, or mouth of an infected person
- Vertical transmission from mother to infant during childbirth 1
The infection cannot be acquired from toilet seats, towels, or other inanimate objects.
Epidemiology
- Estimated 600,000 new N. gonorrhoeae infections occur annually in the United States 1
- Globally, an estimated 86.9 million adults are infected annually 2
- Gonorrhea is the second most commonly reported bacterial sexually transmitted disease 1
- Women aged <25 years are at highest risk for gonorrhea infection 1
Risk Factors
Several factors increase the risk of acquiring gonorrheal infection:
- Previous gonorrhea infection
- Presence of other sexually transmitted infections
- New or multiple sexual partners
- Inconsistent condom use
- Commercial sex work
- Drug use
- Men who have sex with men (MSM) have higher rates of antimicrobial resistance 3
Clinical Presentation
The presentation varies by anatomical site and gender:
- Men: Typically symptomatic with urethritis (dysuria and penile discharge)
- Women: Often asymptomatic or may present with mild vaginal discharge, severe pelvic pain, or no symptoms 4
- Extragenital sites: Can infect pharynx, rectum, and conjunctiva 2
Diagnostic Considerations
Diagnosis requires laboratory confirmation through:
Microscopy: Gram-stained smears showing polymorphonuclear leukocytes with intracellular Gram-negative diplococci (highly specific in symptomatic men) 1
Culture: Gold standard for extragenital sites (rectum and pharynx) 1
Nucleic Acid Amplification Tests (NAATs): Considered the standard for screening and diagnosis with high sensitivity and specificity 5
Complications
If left untreated, gonorrhea can lead to serious complications:
- Women: Pelvic inflammatory disease (PID), tubal scarring, infertility, ectopic pregnancy 1
- Men: Epididymitis, urethral stricture
- Both sexes: Disseminated gonococcal infection affecting joints and skin 4
- Neonates: Ophthalmia neonatorum (conjunctivitis) 1
Prevention
Prevention strategies include:
- Consistent and correct use of condoms
- Regular screening of high-risk individuals
- Partner notification and treatment
- Reducing stigma associated with STI testing and treatment 2
Treatment Challenges
A major public health concern is the increasing antimicrobial resistance in N. gonorrhoeae:
- Resistance has developed to nearly all antibiotics historically used for treatment 6
- Current recommended treatment is ceftriaxone plus azithromycin 7
- Ongoing surveillance for antimicrobial resistance is critical 2
Understanding that gonorrhea is caused by a specific bacterium transmitted through sexual contact is essential for effective prevention, diagnosis, and treatment strategies.