STD Awareness: Gonorrhea of the Throat

Pictured above: Gonococci can band together to attach themselves to a human cell. From: Dustin Higashi, University of Arizona http://uanews.org/node/33150

Editor’s note: For more information on oral gonorrhea, please see our post Why Should You Care About Oral Gonorrhea? For more information on whether a gonorrhea infection can go away without treatment, please see our post Will STDs Go Away on Their Own?

My fellow Generation Xers might remember an episode of Chicago Hope in which a very young Jessica Alba portrays a teenage girl with a gonorrhea infection in her throat — also called pharyngeal gonorrhea. The actress later reported being shunned by members of her church, disillusioning her from the religion she grew up with. It is a testament to the power of taboo that even a fictional association with a sexually transmitted disease (STD) can elicit such negative reactions.

Taboos can affect the ways we relate to one another sexually, as well. Many of us conceptualize of disease as “dirty,” and the flip side to that is to think of people without disease as “clean.” This kind of stigmatizing language can be found in phrases like “She looked clean” and “Don’t worry, I’m clean” — all to describe people who are perceived to be or who claim to be free of STDs. With all the baggage we put on STD status, it can be difficult to ask a partner to use a condom or dental dam during oral sex. Some people might think we don’t trust them or are underhandedly questioning their “cleanliness.” These sorts of fears can cloud our judgment when it comes to protecting our health, but there is nothing wrong with asking your partner to use protection during oral sex — especially if you don’t know one another’s STD status. There are many good reasons to use barrier methods when engaging in oral sex, and pharyngeal gonorrhea is just one of them.

Unprotected oral contact with a penis puts you at the most risk of acquiring pharyngeal gonorrhea.

Gonorrhea is most famous as an infection of the cervix or the urethra. But gonococci, the bacteria that cause gonorrhea, can thrive in other warm, moist areas of your body — not just the reproductive tract, but also the mouth, throat, eyes, and anus. Gonococci can be transmitted to your mouth or throat via oral sex — most likely via unprotected oral sex. Symptoms might include a sore throat, but 90 percent of the time there are no symptoms at all.

If you were to put everyone with gonorrhea into one giant room, you would be able to find gonococci in the throats of about:

• 3 to 7 percent of heterosexual men
• 10 to 20 percent of heterosexual women
• 10 to 25 percent of men who have sex with men (MSM)

As shown by the above numbers, people who perform fellatio (oral contact with a penis) are much more likely to wind up with pharyngeal gonorrhea than are those whose oral-sex repertoire includes only cunnilingus (oral contact with a vagina, clitoris, etc.). Interestingly, performing fellatio seems to be associated with symptoms of pharyngeal gonorrhea while performing cunnilingus does not. Perhaps there is something about fellatio that has the potential to irritate the throat, independently of a gonorrhea infection.

Although gonorrhea can be spread via cervical and vaginal secretions, the frequency of transmission by this route has not been well studied among women who have sex with women (WSW). Documentation of pharyngeal gonorrhea among exclusively lesbian populations is rare, although it certainly exists!

While transmission of gonorrhea from a penis to a mouth has been well documented, researchers aren’t quite sure how easy it is to transmit gonorrhea from a mouth to a urethra, vagina, or anus. Despite an unknown transmission rate, the fact remains that this mode of transmission is possible — therefore, during the time you have a pharyngeal gonorrhea infection, you can transmit the infection to your partner(s).

The good news about pharyngeal gonorrhea is that gonococci don’t seem very well suited to living in throats — they are much better adapted to the anus and genitals. A flurry of research on pharyngeal gonorrhea was performed in the 1970s and 1980s, when it was demonstrated that gonorrhea infections in the throat can clear up without medical intervention within three months — with possibly half of infections going away after just a week.

This shouldn’t lull you into complacency, however — during the time you have a pharyngeal gonorrhea infection, you have the potential to infect others, and some experts fear that these symptom-free, under-the-radar infections might perpetuate strains of antibiotic-resistant gonorrhea. Furthermore, depending on your other sexual activities you might have gonorrhea in your genital or anal area as well, and infections in those sites are often asymptomatic. Additionally (and rarely), someone with untreated gonorrhea can develop a form of infective arthritis called disseminated gonococcal infection (DGI), which can cause joint pain, rashes, lesions, or fever. It seems likely that someone with a pharyngeal gonorrhea infection might also be at increased risk for DGI, despite the ability of a throat infection to clear up on its own. DGI can be treated, but if it is ignored for too long it can cause permanent joint damage.

It’s unfortunate that so many people are under the impression that barrier methods aren’t necessary during oral sex (at least when we don’t know our partners’ STD status) — this leaves them more vulnerable to preventable infections. Furthermore, pharyngeal gonorrhea is more difficult to treat than gonorrhea in the genital or anal areas. Throat infections are treated most effectively with a single shot of ceftriaxone and an oral antibiotic. While genital and anal gonorrhea infections are usually treated this way as well, they can also be treated with a wider range of antibiotics — but these other antibiotics aren’t as effective against pharyngeal infections. And, since there are strains of antibiotic-resistant gonorrhea out there, you don’t want your choice of antibiotics to be further limited.

Pharyngeal gonorrhea is diagnosed by taking a swab of the throat. You can receive testing and treatment at a Planned Parenthood health center, as well as other clinics, health departments, and private health care providers. Infected individuals should also make sure their sexual partners receive treatment to ensure that they won’t be reinfected.

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Can gargling with Listerine treat gonorrhea of the mouth?

Gut Check looks at health claims made by studies, newsmakers, or conventional wisdom. We ask: Should you believe this?

The claim:

Gargling with Listerine can eliminate gonorrhea throat infection, scientists reported on Tuesday in the journal Sexually Transmitted Infections.

Tell me more:

When Listerine was concocted in 1879, inventor Dr. Joseph Lawrence asserted that it could fight gonorrhea (and also clean floors). In all that time there have been no published studies of the claim. So scientists in Australia stepped up, partly because gonorrhea has become increasingly common: In Australia, rates have risen from 62 cases per 100,000 men in 2010 to 99 in 2015; in the US, from 98 cases per 100,000 in 2009 to 124 in 2015.

Scientists led by Dr. Eric Chow of the Melbourne Sexual Health Center ran two experiments. First they added Listerine Cool Mint or Total Care to lab dishes full of Neisseria gonorrhoeae bacteria (fun fact: also discovered in 1879). Undiluted, both flavors left zero bacteria alive in the dishes after a minute of exposure. Even diluted 4-to-1 they killed most of the microbes.

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Then the researchers enrolled men who have sex with men, and who tested positive for gonorrhea in their mouth or throat, in a randomized clinical trial: 104 rinsed and gargled once with Cool Mint, 92 did so with saline. The men also received antibiotics, but “antibiotics don’t do as good a job of curing gonorrhea of the throat as at other sites of infection,” said Dr. Edward Hook of the University of Alabama, Birmingham, an advisor of the American Sexual Health Association, and an expert on sexually transmitted infections who was not involved in the study.

Related:

Syphilis and gonorrhea rates have risen sharply in US, CDC says

Five minutes later, 84 percent of the saline group still tested positive for gonorrhea on a throat culture. Only 52 percent of the Listerine users did. Testing negative “means there is no viable N. gonorrhoeae present on the swab,” Chow said.

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Listerine was much more effective at eliminating gonorrhea bacteria around the tonsils than further back, possibly because more of it reached the former: gargling well takes practice. “It was possible that not all men gargle[d] enough,” he said.

Listerine contains alcohol, but the researchers aren’t sure which ingredient was responsible for killing N. gonorrhoeae.

Really?

There’s a remote possibility that there were viable bacteria on the throat culture, but in amounts too small to detect. And testing people five minutes after they gargled doesn’t show whether Listerine had more than a short-lived effect.

On the other hand, in the lab bench study the microbes, once gone, stayed gone. And the finding that a single gargle eliminated gonorrhea bacteria in the throats of nearly half the men raises the possibility that doing it regularly might keep the microbes away and prevent gonorrhea transmission through oral sex.

“Their experiments suggest that the contents of Listerine do kill [gonorrhea] bacteria,” Hook said. “That’s quite interesting.”

Related:

Gonorrhea may become resistant to all antibiotics sooner than anticipated

Also important: Gonorrhea infections of the throat almost never produce symptoms, Hook said, not even a sore throat. Doctors rarely test for it, so people don’t know they have it. But, through unprotected oral sex, gonorrhea can cause genital and urethral infections, which do have symptoms, such as pain and discharge. That makes pharyngeal gonorrhea “a real public health problem,” Hook said.

The verdict:

The in vitro experiment plus the clinical trial make a strong case that Listerine can kill gonorrhea. To nail that down, a larger study will have to test people for longer to be sure infections are gone and to see what gargling technique is most effective.

A guide to oral gonorrhea: how it’s caused, symptoms, and more – Blog

Medically reviewed by Rosanna Sutherby, PharmD on February 3, 2020. Written by Laura Kleist. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

In this quick overview, we’ll highlight some key points to know about oral gonorrhea—so keep reading to learn what it is, symptoms it can cause, health risks it’s linked to, and more.

Oral gonorrhea: what it is

Gonorrhea is a sexually transmitted infection caused by the Neisseria gonorrhoeae bacterium. In the United States, approximately 820,000 new gonorrhea cases are reported to the Centers for Disease Control and Prevention (CDC) each year.

Oral gonorrhea (also known as pharyngeal gonorrhea) is when the infection affects the tissues of the throat—instead of the genitals or rectum, for example.

Oral gonorrhea is most commonly transmitted through oral sex. Either giving oral sex to a person with infected genitals or receiving oral sex from a person with an infected oral cavity may transmit the bacteria (recent research has also suggested the possibility that kissing can transmit oral gonorrhea from one partner to another). Significantly, transmission can occur even if no symptoms are present in the person who first had the infection.

Oral gonorrhea symptoms

In most cases, oral gonorrhea produces no noticeable symptoms. Among people who do experience symptoms, however, the most prevalent sign is a persistent sore throat. Other possible symptoms include:

• Swollen, burning, or painful glands in your throat
• Difficulty swallowing
• Flu-like symptoms
• Visible irritation, redness, or lesions in the back of the throat

If you believe you’re suffering from symptoms of oral gonorrhea, talk with your healthcare provider so they can offer guidance on the next steps to take.

Disseminated gonorrhea: a health risk associated with untreated oral gonorrhea

If it isn’t treated promptly, oral gonorrhea may eventually spread to the bloodstream, where it can then infect other parts of the body. When gonorrhea spreads in this way, it’s referred to as a disseminated gonococcal infection (DGI) or disseminated gonorrhea. Skin sores, rashes, joint pain, joint swelling, fever, chills, and generally feeling unwell are among the common symptoms of this type of infection.

But disseminated gonorrhea does more than just trigger symptoms: left unchecked, it can cause serious harm to some of the body’s key systems. Gonococcal arthritis may develop, for instance—involving severe inflammation of one or more joints in the body—if gonorrhea bacteria infect that joint(s).

Gonococcal endocarditis is another possible (though quite rare) complication of disseminated gonorrhea. This condition develops when gonorrhea infects the endocardium, an important part of the heart. The infection can lead to significant damage to other parts of the heart, as well, like heart valves. Tachycardia and—more severely—heart failure may develop due to this damage.

Fortunately, disseminated gonorrhea isn’t all that common: studies suggest that it occurs in just 0.5% to 3% of gonorrhea cases. But due to its severe nature, immediate medical treatment is recommended if someone does have disseminated gonorrhea.

Though oral gonorrhea affects the mouth and throat in someone who has it, the infection can spread to other areas of a partner’s body (like their genitals) through sexual contact. If that happens, one’s partner may be at risk of several health conditions, such as the following.

Pelvic inflammatory disease

Pelvic inflammatory disease is a painful condition characterized by inflammation of the organs of the female reproductive system. In most cases, PID stems from an active infection of the female reproductive organs. Lower abdominal pain, pelvic pain, heavy vaginal discharge, foul-smelling discharge, abnormal vaginal bleeding, pain during intercourse, and difficult or painful urination are common symptoms of the condition.

Female and male infertility

Urogenital gonorrhea infections can cause infertility in both women and men. In women, the infection can spread to the uterus and fallopian tubes, where it often causes pelvic inflammatory disease. Because PID is strongly associated with fallopian tube scarring, the condition can greatly increase your risk of infertility, as well as complications during pregnancy. .

In men, the infection can cause inflammation of the epididymis (the tube that connects the testicles to the sperm duct). If left untreated, epididymal inflammation affects the sperm’s ability to mature, which can lead to infertility.

Seeking medical treatment for oral gonorrhea

If you believe you may have contracted oral gonorrhea, early detection of a potential infection is key to keeping your health safe. Your healthcare provider may recommend an oral gonorrhea test, which involves a quick swab of your mouth or throat. They may also suggest testing for gonorrhea in other sites of the body—like the genitals and rectum. Additionally, because gonorrhea and chlamydia often infect someone at the same time, your healthcare provider may recommend a chlamydia test.

In most cases, antibiotics—often taken orally—can effectively treat a gonorrhea infection.

You can conveniently test for urogenital gonorrhea and chlamydia (the most common kind of infection they cause) with the Everlywell at-home Chlamydia & Gonorrhea Test. Note that this test cannot detect oral gonorrhea.

Preventing oral gonorrhea

There are a few steps you can take that may help reduce the risk of getting or transmitting oral gonorrhea, including:

• Practice safe oral sex by consistently using condoms or dental dams
• Regularly test for STDs, and encourage your partner to do the same (the at-home STD Test for men and women makes routine testing easy).

Common questions about oral gonorrhea

What does oral gonorrhea look like?

Though visible symptoms are uncommon, when gonorrhea infects the throat, it can produce symptoms that bear a striking resemblance to those of strep throat. If you notice unusual redness, white spotting, or pale-colored discharge in your throat, this may be an indication of oral gonorrhea—and it’s a good idea to see your healthcare provider for an evaluation.

Can you get gonorrhea from oral sex?

Yes, you can contract gonorrhea through oral sex. Transmission of the bacteria can occur either by giving oral sex to a partner with infected genitals or receiving oral sex from someone with an oral infection.

References

1. Gonococcal Infections. Centers for Disease Control and Prevention. URL. Accessed February 3, 2020.

2. Chow EP, Fairley CK. The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission. J Int AIDS Soc. 2019;22 Suppl 6(Suppl Suppl 6):e25354. doi:10.1002/jia2.25354

3. de Campos FP, Kawabata VS, Bittencourt MS, Lovisolo SM, Felipe-Silva A, de Lemos AP. Gonococcal endocarditis: an ever-present threat. Autops Case Rep. 2016;6(2):19-25. doi:10.4322/acr.2016.037Title.

4. Health Alert Template for Disseminated Gonococcal Infection (DGI). Centers for Disease Control and Prevention. URL. Accessed February 3, 2020.

5. Pelvic inflammatory disease (PID). Mayo Clinic. URL. Accessed February 3, 2020.

6. Gonorrhea. Mayo Clinic. URL. Accessed February 3, 2020.

7. Gonorrhea – diagnosis & treatment. Mayo Clinic. URL. Accessed February 3, 2020.

Yes, You can get Throat Gonorrhea

On Thursday, the Food and Drug Administration cleared the first diagnostic tests for extragenital testing for chlamydia and gonorrhea. In other words, these are the first gonorrhea and chlamydia tests where doctors can swab for samples somewhere other than your genitals. Options are great, but you might wonder why a doctor would choose to go looking for sexually transmitted infections in the throat or rectum when a urine sample is all you need to detect them. The answer, friends, is that your genitals are not the only places you can get sexually transmitted infections. Yes, it’s that time of year again: the time of year when Rachel Ann Feltman logs on to remind you that throat gonorrhea is a thing.

This isn’t meant to shame or embarrass anyone who had, has, and/or will have throat gonorrhea (or rectal gonorrhea, or good old-fashioned genital gonorrhea). Nay; the point is that so-called sexually transmitted infections can happen to anyone having any kind of sex, even if it involves a condom or doesn’t include penetration.

Here’s everything you need to know about these migrating microbes:

Wait, I can get gonorrhea in my throat?

Yes, and also in your butt. You can also get chlamydia in your throat and butt, but throat chlamydia just doesn’t have the same ring to it. The CDC has a helpful list of all the places on your body you might get an initial infection of various STIs, but the big takeaway is simple: Even people who always use condoms can get STIs, pretty much every STI can (at least in rare circumstances) be transmitted by unprotected oral sex, and STIs can show symptoms on parts of your body you wouldn’t expect.

Why is this important? Well, a lot of people assume STIs are gross—thanks, society—and part of that stigma is a misconception that all STIs produce gnarly and horrific symptoms. In reality, this is pretty rare! Herpes, for instance, is asymptomatic in almost everyone who has it, and gonorrhea and chlamydia can also infiltrate your body’s defenses without making much fuss. They can even go away on their own, but the problem is that they don’t always do so.

That means that you should not wait for an outbreak of oozing sores before getting tested for STIs. If you’re sexually active—and we’re talking about any kind of sex—you need to get tested two to three times a year.

Circling back to throat gonorrhea and the lessons we can learn from it: doctors are people too, and that means they’re influenced by the same STI stigma you are. Even if they’re up-to-date on all the ways STIs can and will present in a patient, they still might think it uncouth or downright unacceptable to suggest your sore throat might be the result of an STI. That’s why it’s crucial for you to know the facts. Don’t expect throat gonorrhea to strike at any moment (it won’t), but if you’ve recently had unprotected oral sex with someone whose STI status is unknown to you or likely to be in flux due to the existence of other partners, and you’ve got a mysterious throat infection, you should raise the possibility to your physician. There’s even a test for it now! They’ll be super impressed with your ability to self-advocate for good medical care. If they’re not, go find a doctor who is (and who will test you for throat gonorrhea).

How the heck does this happen?

A mucus membrane is a mucus membrane. STIs, like all infections, are caused by viral, bacterial, or fungal microbes. While many of these infections have particular parts of the body they’ve evolved to thrive in, most of them aren’t too picky. The risks vary between diseases—a 2016 article from the San Francisco AIDS Foundationreally hammers home the message that the bacteria Neisseria gonorrhoeae will take any opportunity to hop off your skin and onto someone else’s, but not all STIs are this industrious.

This doesn’t mean you should spend your next date in a hazmat suit. The solution is actually really simple.

Get tested

You can even order tests online. So convenient!

How do I know if I have throat gonorrhea?

You probably won’t. As previously mentioned, there often aren’t any symptoms, and if there are, it’s going to feel like any other sore throat. Don’t expect green pus to start oozing out of your tonsils (though if that does happen you should definitely see a doctor because you absolutely have something worse than throat gonorrhea). All you can do is understand the risks of the physical activities you participate in, enjoy them as safely as possible, and connect the dots if you, a person at risk of contracting gonorrhea or chlamydia, have a lingering sore throat.

Gonorrhea can cause life-threatening health problems, but only in rare cases, and only if it’s left untreated for a long time. Yes, it’s scary that an infection that’s unlikely to cause symptoms can really hurt you in the long run—how are you supposed to know if you have it? When it comes to genital infections, of course, the answer is simple: regular testing. If you engage in a lot of oral or anal sex, it could be worth insisting on getting one of the two new tests every once in awhile just to be sure you don’t have microbes making themselves at home in unexpected places. Antibiotic resistance is on the rise for these infections, but most cases will still clear up without any problems if they’re caught early. Take your antibiotics and make sure you’re actually cured before having sex with anyone.

One more time: Get tested

Since most cases of chlamydia and gonorrhea that aren’t in the genitals will be even less obtrusive than the genital infections themselves, the biggest reason to be proactive is so your throat gonorrhea doesn’t turn into someone else’s penis gonorrhea.

Conversely, a lot of the onus is on people with genital gonorrhea to keep it from becoming someone else’s throat gonorrhea. The STI tests you can take by peeing in a cup are always going to be the most routine, and if you’ve got insurance or access to a free clinic, there’s no excuse for not taking these tests regularly, regardless of symptoms or condom use. Be a conscientious, honest, and proactive partner, and expect the same of everyone you have sex with. Talk openly about STI risks so your sexual partners (and friends!) know better than to be too embarrassed to get tested or disclose their status. STIs really can infect anyone, and understanding that is the first step to making them less common.

Source: https://www.popsci.com/throat-gonorrhea-chlamydia-test#page-2

STD Facts – Gonorrhea

Anyone who is sexually active can get gonorrhea. Gonorrhea can cause very serious complications when not treated, but can be cured with the right medication.

What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) that can infect both men and women. It can cause infections in the genitals, rectum, and throat. It is a very common infection, especially among young people ages 15-24 years.

How is gonorrhea spread?

You can get gonorrhea by having vaginal, anal, or oral sex with someone who has gonorrhea. A pregnant woman with gonorrhea can give the infection to her baby during childbirth.

How can I reduce my risk of getting gonorrhea?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting gonorrhea:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

Am I at risk for gonorrhea?

Any sexually active person can get gonorrhea through unprotected vaginal, anal, or oral sex.

If you are sexually active, have an honest and open talk with your health care provider and ask whether you should be tested for gonorrhea or other STDs. If you are a sexually active man who is gay, bisexual, or who has sex with men, you should be tested for gonorrhea every year. If you are a sexually active woman younger than 25 years or an older woman with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection, you should be tested for gonorrhea every year.

I’m pregnant. How does gonorrhea affect my baby?

If you are pregnant and have gonorrhea, you can give the infection to your baby during delivery. This can cause serious health problems for your baby. If you are pregnant, it is important that you talk to your health care provider so that you get the correct examination, testing, and treatment, as necessary. Treating gonorrhea as soon as possible will make health complications for your baby less likely.

How do I know if I have gonorrhea?

Some men with gonorrhea may have no symptoms at all. However, men who do have symptoms, may have:

• A burning sensation when urinating;
• A white, yellow, or green discharge from the penis;
• Painful or swollen testicles (although this is less common).

Most women with gonorrhea do not have any symptoms. Even when a woman has symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Women with gonorrhea are at risk of developing serious complications from the infection, even if they don’t have any symptoms.
Symptoms in women can include:

• Painful or burning sensation when urinating;
• Increased vaginal discharge;
• Vaginal bleeding between periods.

Rectal infections may either cause no symptoms or cause symptoms in both men and women that may include:

• Discharge;
• Anal itching;
• Soreness;
• Bleeding;
• Painful bowel movements.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or bleeding between periods.

How will my doctor know if I have gonorrhea?

Most of the time, urine can be used to test for gonorrhea. However, if you have had oral and/or anal sex, swabs may be used to collect samples from your throat and/or rectum. In some cases, a swab may be used to collect a sample from a man’s urethra (urine canal) or a woman’s cervix (opening to the womb).

Can gonorrhea be cured?

Yes, gonorrhea can be cured with the right treatment. It is important that you take all of the medication your doctor prescribes to cure your infection. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not undo any permanent damage caused by the disease.

It is becoming harder to treat some gonorrhea, as drug-resistant strains of gonorrhea are increasing. If your symptoms continue for more than a few days after receiving treatment, you should return to a health care provider to be checked again.

I was treated for gonorrhea. When can I have sex again?

You should wait seven days after finishing all medications before having sex. To avoid getting infected with gonorrhea again or spreading gonorrhea to your partner(s), you and your sex partner(s) should avoid having sex until you have each completed treatment. If you’ve had gonorrhea and took medicine in the past, you can still get infected again if you have unprotected sex with a person who has gonorrhea.

What happens if I don’t get treated?

Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, untreated gonorrhea can cause pelvic inflammatory disease (PID). Some of the complications of PID are

In men, gonorrhea can cause a painful condition in the tubes attached to the testicles. In rare cases, this may cause a man to be sterile, or prevent him from being able to father a child.
Rarely, untreated gonorrhea can also spread to your blood or joints. This condition can be life-threatening.

Untreated gonorrhea may also increase your chances of getting or giving HIV – the virus that causes AIDS.

Where can I get more information?

STD information and referrals to STD Clinics
CDC-INFO
1-800-CDC-INFO (800-232-4636)
TTY: 1-888-232-6348
In English, en Español

Detailed STD Facts – Gonorrhea

What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) caused by infection with the Neisseria gonorrhoeae bacterium. N. gonorrhoeae infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. N. gonorrhoeae can also infect the mucous membranes of the mouth, throat, eyes, and rectum.

How common is gonorrhea?

Gonorrhea is a very common infectious disease. CDC estimates that approximately 1.6 million new gonococcal infections occurred in the United States in 2018, and more than half occur among young people aged 15-24.¹ Gonorrhea is the second most commonly reported bacterial sexually transmitted infection in the United States.²  However, many infections are asymptomatic, so reported cases only capture a fraction of the true burden.

How do people get gonorrhea?

Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread perinatally from mother to baby during childbirth.

People who have had gonorrhea and received treatment may be reinfected if they have sexual contact with a person infected with gonorrhea.

Who is at risk for gonorrhea?

Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans ².

What are the signs and symptoms of gonorrhea?

Many men with gonorrhea are asymptomatic ^{3, 4}. When present, signs and symptoms of urethral infection in men include dysuria or a white, yellow, or green urethral discharge that usually appears one to fourteen days after infection ⁵. In cases where urethral infection is complicated by epididymitis, men with gonorrhea may also complain of testicular or scrotal pain.

Most women with gonorrhea are asymptomatic ^{6, 7}. Even when a woman has symptoms, they are often so mild and nonspecific that they are mistaken for a bladder or vaginal infection ^{8, 9}. The initial symptoms and signs in women include dysuria, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements ¹⁰. Rectal infection also may be asymptomatic. Pharyngeal infection may cause a sore throat, but usually is asymptomatic ^{11, 12}.

What are the complications of gonorrhea?

Untreated gonorrhea can cause serious and permanent health problems in both women and men.

In women, gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). The symptoms may be quite mild or can be very severe and can include abdominal pain and fever ¹³. PID can lead to internal abscesses and chronic pelvic pain. PID can also damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy.

In men, gonorrhea may be complicated by epididymitis. In rare cases, this may lead to infertility ¹⁴.

If left untreated, gonorrhea can also spread to the blood and cause disseminated gonococcal infection (DGI). DGI is usually characterized by arthritis, tenosynovitis, and/or dermatitis ¹⁵. This condition can be life threatening.

What about gonorrhea and HIV?

Untreated gonorrhea can increase a person’s risk of acquiring or transmitting HIV, the virus that causes AIDS ¹⁶.

How does gonorrhea affect a pregnant woman and her baby?

If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby ¹⁷. Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult a health care provider for appropriate examination, testing, and treatment, as necessary.

Who should be tested for gonorrhea?

Any sexually active person can be infected with gonorrhea. Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should stop having sex and see a health care provider immediately.

Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with an STD should see a health care provider for evaluation.

Some people should be tested (screened) for gonorrhea even if they do not have symptoms or know of a sex partner who has gonorrhea ¹⁸. Anyone who is sexually active should discuss his or her risk factors with a health care provider and ask whether he or she should be tested for gonorrhea or other STDs.

CDC recommends yearly gonorrhea screening for all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.

People who have gonorrhea should also be tested for other STDs.

How is gonorrhea diagnosed?

Urogenital gonorrhea can be diagnosed by testing urine, urethral (for men), or endocervical or vaginal (for women) specimens using nucleic acid amplification testing (NAAT) ¹⁹. It can also be diagnosed using gonorrhea culture, which requires endocervical or urethral swab specimens.

FDA-cleared rectal and oral diagnostic tests for gonorrhea (as well as chlamydia) have been validated for clinical use ²⁰.

What is the treatment for gonorrhea?

Gonorrhea can be cured with the right treatment. CDC now recommends a single 500 mg intramuscular dose of ceftriaxone for the treatment of gonorrhea. Alternative regimens are available when ceftriaxone cannot be used to treat urogenital or rectal gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease. Antimicrobial resistance in gonorrhea is of increasing concern, and successful treatment of gonorrhea is becoming more difficult ²¹. A test-of-cure – follow-up testing to be sure the infection was treated successfully – is not needed for genital and rectal infections; however, if a person’s symptoms continue for more than a few days after receiving treatment, he or she should return to a health care provider to be reevaluated. A test-of-cure is needed 7-14 days after treatment for people who are treated for pharyngeal (infection of the throat) gonorrhea.

Because re-infection is common, men and women with gonorrhea should be retested three months after treatment of the initial infection, regardless of whether they believe that their sex partners were successfully treated.

What about partners?

If a person has been diagnosed and treated for gonorrhea, he or she should tell all recent anal, vaginal, or oral sex partners so they can see a health provider and be treated ²⁰. This will reduce the risk that the sex partners will develop serious complications from gonorrhea and will also reduce the person’s risk of becoming reinfected. A person with gonorrhea and all of his or her sex partners must avoid having sex until they have completed their treatment for gonorrhea and until they no longer have symptoms. For tips on talking to partners about sex and STD testing, visit http://www.gytnow.org/talking-to-your-partnerexternal icon.

Factors associated with pharyngeal gonorrhea in young people: Implications for prevention

Sex Transm Dis. Author manuscript; available in PMC 2019 Sep 1.

Published in final edited form as:

PMCID: PMC6086760

NIHMSID: NIHMS944997

, PhD,¹, MSPH,¹ and , DrPH¹

Marjan Javanbakht

¹Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles; Los Angeles CA

Drew Westmoreland

¹Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles; Los Angeles CA

Pamina Gorbach

¹Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles; Los Angeles CA

¹Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles; Los Angeles CA

Correspondence: Marjan Javanbakht, PhD, University of California Los Angeles, Fielding School of Public Health, Department of Epidemiology, Box 951772, Los Angeles, CA 90095-1772, Phone: 310-825-3234, Fax: 310-825-7387, ude. alcu@navajThe publisher’s final edited version of this article is available at Sex Transm DisSee other articles in PMC that cite the published article.

Abstract

Background

The objective of this study was to examine the proportion of missed infections and correlates of pharyngeal gonorrhea among young people attending public STD clinics.

Methods

We conducted a case control study of 245 young men and women between April 2012 and May 2014. Participants were eligible for inclusion if they were: (1) age 15 – 29 years, (2) reported giving oral sex to a partner of the opposite sex, in the past 90 days, and (3) attended one of twelve public STD clinics in Los Angeles County. Computer assisted self-interviews were used to collect information on sexual behaviors and tests were conducted for pharyngeal and urogenital gonorrhea.

Results

The majority of participants were less than 25 years of age (69%) and more than half were female (56%). We identified a total of 64 cases (27%) of gonorrhea of which 29 (45%) were a urogenital only infection, 18 (28%) were a pharyngeal only, and 17 (27%) were dually infected at both sites. Pharyngeal testing increased case finding by 39% from 46 cases to 64 cases. After adjusting for age, gender, and number of sex partners, those who reported consistent pharyngeal exposure to ejaculate/vaginal fluids were three times as likely to have pharyngeal gonorrhea as compared to those without this exposure (adjusted odds ratio=3.1; 95% CI: 1.3-7.5).

Conclusion

A large proportion of gonorrhea cases among young people would be missed in the absence of pharyngeal testing. These results have implications for those who provide medical care to clients at STD clinics and highlight the need for pharyngeal screening recommendations and counseling messages related to strategies to reduce exposure to infected fluids.

Keywords: gonorrhea, oral sex, young people

Introduction

Infections with Neisseria gonorrhoeae are a significant public health problem and represent the second most common reportable disease in the United States. In 2016over 460,000 cases of gonorrhea were reported, which represents a 19% increase since 2015.¹ Additionally, gonorrhea infections disproportionately affect young people, with30-24 year-old men and women highest rates of gonorrhea in 2016 (616.8 and 595.5 per 100,000 respectively).¹ Gonorrhea can cause substantial morbidity and serious health complications, particularly in women, including ectopic pregnancy, chronic pelvic pain, infertility and can increase the risk of transmission and acquisition of HIV.^2-4

Most reported cases of gonorrhea are based on urogenital testing and information on the epidemiological significance of pharyngeal infections is limited. Among men who report sex with men (MSM), pharyngeal gonorrhea is well documented with the prevalence ranging from 2-11%.^5-7 Data among heterosexuals are limited, however, pharyngeal gonorrhea has been noted in 3-7% of heterosexual men and 2-10% of women.^10-14 Although the majority of women and heterosexual men report oral sex, most clinics do not routinely offer screening of the oropharynx. In fact, current screening guidelines recommend screening for pharyngeal gonorrhea among MSM who report receptive oral sex, though no such recommendations are in place for non-MSM populations.¹⁵

Transmission of gonorrhea to the pharynx is thought to be more efficient through oral-penile contact than oral-vaginal contact.¹⁶ Furthermore, there is increasing evidence of pharynx to genital transmission of gonorrhea.^17-20 In one study, the prevalence of pharyngeal gonorrhea among men whose only urethral exposure was receiving oral sex from women was 3.1%, which was comparable to the 4.1% prevalence noted among MSM seen at the same clinic.²⁰ These data suggest that pharyngeal infections may serve as an important reservoir and source of urethral gonorrhea, and that oral sex may be contributing to the ongoing transmission of gonorrhea between men and their female sex partners. Moreover, gonococcal infections in the pharynx are more difficult to eradicate than infections at urogenital sites.²¹ Consequently, gonorrhea infections of the pharynx require a different treatment strategy further stressing the importance of the pharynx as a reservoir for continual transmission of gonorrhea and a potential source of drug resistant strains of gonorrhea.

Very little is known about the epidemiology of pharyngeal gonorrhea among young people. Understanding factors that place young people at increased risk for pharyngeal gonorrhea is not only critical to understanding the contribution of these infections to the maintenance of high endemic rates of gonorrhea among young people, but will also help us develop more appropriate STI risk reduction messages and interventions. Therefore, we sought to investigate the correlates of pharyngeal gonorrhea among young people attending public STD clinics, including individual and partnership level behaviors, knowledge, and attitude.

Methods

Study setting and participants

This was a case control study of young men and women visiting public STD clinics in Los Angeles County between April 2012 and May 2014. Those presenting to the clinics for Chlamydia/gonorrhea testing were informed of the study by clinic staff and potentially eligible participants were then referred to study staff located at the clinic. Recruitment of study participants was based on a consecutive sample of those who met the eligibility criteria. Participants were eligible for inclusion in the study if they were: (1) age 15 – 29 years, (2) reported giving oral sex to a partner of the opposite sex, in the past 90 days, and (3) attended one of twelve public STD clinics in Los Angeles County. All participants provided written consent for screening procedures which included verification of eligibility criteria as well as screening for pharyngeal gonorrhea. Given that pharyngeal gonorrhea screening was not routine practice in the clinics, we conducted active screening in order to identify participants with and without pharyngeal gonorrhea. By design we aimed to recruit individuals that were pharyngeal gonorrhea positive (cases) as well as those who were negative (controls). Those who were eligible and interested in participating also completed a self-administered questionnaire on sexual risk behaviors. Participants provided written informed consent and received $25 for their time. The study was approved by the Institutional Review Board at the University of California Los Angeles and the Los Angeles County Department of Public Health.

Data collection

The study survey was administered using a web-based, computer assisted self-interview and took approximately 45 minutes to complete. The questionnaire collected information on demographics, sexual practices and risk behaviors, and attitudes and behaviors surrounding oral sex. In answering questions regarding oral sex, participants were asked to consider oral sex as mouth contact with vagina, penis, or anus. Participants were asked how they would rate the intimacy of oral sex using a 5-point likert scale ranging from not at all intimate to extremely intimate; they were also asked to describe partnerships they would feel comfortable giving oral sex including a main partner, a casual partner, one-time partner, or trade partner. In order to assess exposure to vaginal fluids and/or semen during oral sex, participants were asked “In the past 3-months when you have given oral sex, on how many of these occasions did your partner cum (ejaculate or squirt) in your mouth?” This question was followed by “In the past 3 months when you have given oral sex, on how many of these occasions did you swallow the cum (ejaculate or squirt)?” In order to assess concurrent partnerships, participants were asked to think about their sex partners in the past 6 months and they were presented with the following definition of concurrency: “Sometimes two people in a sexual relationship have sex with each other and do not have sex with anyone else outside of the relationship. Other times one or both people in a sexual relationship also have sex with other people. For example, during the first three weeks in January, Jamie and Alex had sex with each other on a number of different occasions. During these same three weeks, Jamie also had sex with two other people. Alex had sex with one other person during this same time.”Participants were then asked during the time they were sexually active with each of their last three partners (in the past 6 months), how many other people did they have sex with. Transactional sex was assessed by asking participants how many times they had been paid to have sex in the past 12 months. Substance use with sex was measured by providing a list of drugs including Marijuana, methamphetamine, cocaine, ecstasy, etc. and asking which, if any of the drugs were used during sexual activing in the past 12 months.

All study participants were tested for pharyngeal gonorrhea and urogenital Chlamydia and gonorrhea using nucleic acid amplification testing with Gen-Probe Aptima Combo 2^® test (San Diego, CA). All laboratory tests were conducted by the Los Angeles County Public Health Laboratory, which has validated the use of Gen-Probe Aptima Combo 2^® test for detecting N. gonorrhoeae in pharyngeal swabs.

Statistical Analysis

Descriptive statistics including mean, range, and frequency distributions were performed for all demographic and risk behavior characteristics. Differences between groups were evaluated using t-tests, chi-square methods, and Fisher’s exact test as appropriate. Logistic regression analysis was used to investigate the associations between pharyngeal gonorrhea and other factors including demographic characteristics, substance use, and other risk behaviors. Variables tested for inclusion in the multivariable models were based on bivariate analyses or specified a priori as risk factors based on the existing literature. Given the correlated nature of some of our covariates of interest, collinearity was assessed using correlation coefficients and variance inflation factor and multivariable models were developed in such a way as to limit multi collinearity. All analyses were conducted using SAS version 9.4 (SAS Institute, Cary NC).

Results

Characteristics of study population

Among the 245 participants enrolled in the study, the majority were less than 25 years of age (69%), slightly more than half identified as female (56%), and African Americans comprised the largest race/ethnicity group (50%), followed by Hispanics (35%) (). We identified a total of 64 cases (27%) of gonorrhea of which39(45%) were a urogenital only infection, 18 (28%) were a pharyngeal only infection, and the remaining 17 (27%) were dually infected at both urogenital and pharyngeal sites (). In the absence of pharyngeal gonorrhea testing 18 out of the 64 cases (28%) would have been missed.

Table 1

Demographic and sexual risk behavior characteristics of participants enrolled in the pharyngeal gonorrhea study, April 2012 – May 2014 (n=245)

Practices and behaviors surrounding oral sex

Given our inclusion criteria all participants reported having oral sex in the past 3 months. The majority of participants (88%) reported never using condoms or dental dams for oral sex (). Slightly more than half reported that they felt that giving oral sex was extremely or very intimate, with few reporting that they felt comfortable giving oral sex in casual or one-time partnerships (28% and 7% respectively). Attitudes around oral sex were comparable for men and women with the exception of partnership type with fewer women feeling comfortable giving oral sex to a casual partner as compared to men (19% vs. 40%; p value <.01; data not shown).

Table 2

Practices and attitudes surrounding oral sex, among participants in the pharyngeal gonorrhea study, April 2012 – May 2014 (n=245)

Prevalence of demographic and sexual risk behaviors by pharyngeal gonorrhea status

While age distribution and gender did not vary by pharyngeal gonorrhea status, a greater proportion of those who reported same sex partners had pharyngeal gonorrhea (). Being incarcerated was not associated with pharyngeal gonorrhea. However, among those with pharyngeal gonorrhea, the proportion who reported having a sex partner who was incarcerated in the past 12 months was higher (24%) when compared to those without pharyngeal gonorrhea (14%; p value=0.04). While other factors such as homelessness, transactional sex, and concurrent partnerships were higher among those with pharyngeal gonorrhea as compared to non-pharyngeal gonorrhea controls, these differences were not statistically meaningful ().

Prevalence of risk behaviors by pharyngeal gonorrhea status among participants in the pharyngeal gonorrhea study, April 2012 – May 2014 (n=245)

*p <.05; **p<.01

Abbreviations. Mos=Months; MSMW=Men who have sex with men and women; WSMW=Women who have sex with men and women, Homelessness reflects housing status at the time the study questionnaire was completed

Given that none of the participants reported consistent use of condoms or barrier methods for oral sex acts in the past three months, we explored potential pharyngeal exposure to seminal and vaginal fluids. We found that a higher proportion of those with pharyngeal gonorrhea reported having a partner (male or female) ejaculate in their mouth as compared to those without pharyngeal gonorrhea (35% vs. 19%; p value=0.01)(). Furthermore, a higher proportion of those who reported swallowing ejaculate/vaginal fluids had pharyngeal gonorrheaas compared to those who did not report swallowing (29% vs. 15% respectively; p value=0.01).

Factors associated with pharyngeal gonorrhea

Based on multivariable analyses and after adjusting for age and gender, the number of oral sex partners was independently associated with pharyngeal gonorrhea with those who reported 5 or more oral sex partners having a nearly 6-fold increased odds of pharyngeal gonorrhea as compared to those with 1 oral sex partner (adjusted odds ratio [AOR]=5.7; 95% confidence interval [CI]:1.3-25.6)(). Those who reported consistent exposure to ejaculate/vaginal fluids (as a result of oral sex) were three times as likely to have pharyngeal gonorrhea as compared to those without this exposure (AOR=3.1; 95% CI: 1.3-7.5).

Table 3

Factors associated with pharyngeal gonorrhea among participants in the pharyngeal gonorrhea study, April 2012 – May 2014 (n=245)

Discussion

Oral sex is a widely practiced behavior, yet there is a dearth of research about behaviors associated with infections of the pharynx among men and women who report opposite sex, sex partners. Increased availability of pharyngeal testing for STIs and the recent spike in the prevalence of STIs in the US highlights the need for a better understanding of the risks for pharyngeal infections. Findings from our study indicate that pharyngeal gonorrhea in the absence of a concomitant urogenital infection is relatively common among young people attending public STD clinics, with up to 28% of infections being missed in the absence of pharyngeal testing. Moreover, we find that factors independently associated with pharyngeal gonorrhea include the number of oral sex partners, the level of oral exposure to vaginal/seminal fluids, and a concomitant urogenital infection with gonorrhea. This provides important evidence for the need to broaden counseling and education about risks for STIs to include oral sex, the need for providers to ask about specific sex acts during risk assessment especially among those with urogenital gonorrhea,¹⁵ and reinforces that oral sex exposure IS sexual exposure.

Prior studies have demonstrated the importance of extra-genital testing among MSM, with evidence indicating that one-third of gonorrhea infections would be missed in the absence of pharyngeal testing.^5,6 Evidence indicative of missed infections, along with the high disease burden has resulted in guidelines for extragenital testing among MSM,²⁴ though no such recommendations exist for other high risk non-MSM populations. Findings from our study suggest that pharyngeal testing in other high risk non-MSM populations, such as young people seeking care at STD clinics may be warranted. A limited number of studies have explored the utility of pharyngeal screening, particularly among women and note that testing women may not be cost-effective with the number of patients needed to test to diagnose a single extra-genital infection being 6- to 10-fold higher among women when compared to MSM.²⁵ However, overall morbidity in this study population was lower than that noted in our study with a prevalence of 2.8% and 4.3% for genital gonorrhea among women and men respectively.²⁵ Our study design precluded us from estimating the prevalence of gonorrhea, however, morbidity reporting data from the same clinics this study population was recruited suggest that the prevalence of gonorrhea among young people served in these clinics is high with a prevalence of 6.9% among women and 10.3% among men.²⁶ This along with our data showing that the proportion of infections missed suggest that the utility of pharyngeal screening is likely to be higher and may be essential in this population in order to disrupt ongoing transmission and the high endemic rates of gonorrhea among young people.

Oral sex, which is only defined as having “had sex” by a minority of young people,²⁷ is also a commonly practiced behavior,²³ particularly among those in serious relationships (more so for women than men), suggesting a need to be more inclusive in our dialogue about oral sex as a sexual health issue. Additionally, our findings support other studies that show condom/barrier method use with this behavior was rare.²³ This may partly reflect the fact that most reported feeling comfortable giving oral sex in the context of main partnerships, where condom use in general was likely to be lower. Our results also extend the limited data on factors associated with pharyngeal infections and we find that the level of exposure to vaginal/seminal fluids is important with the odds of pharyngeal gonorrhea increased for those who report increased exposure to vaginal/seminal fluids including swallowing. Together, these data suggest that prevention strategies and counseling messages that include a discussion about limiting exposure to these fluids that go beyond the use of condoms/barrier methods may be useful. Young people and those most at risk for these infections could be made aware of the potential heightened risk for gonorrhea from swallowing vaginal/seminal fluids and there could be utility in counseling patients to spit more than they swallow. Furthermore, recent evidence of the preliminary efficacy and acceptability of the use of antiseptic mouthwash for the prevention of pharyngeal gonorrhea provides yet another potential option for a non-condom based prevention strategy.^28,29

Our findings should be interpreted in light of some of the limitations of this study. Assessment of oral sex and other sexual behaviors was based on self-report. Although this information was collected using self-interviews, data on socially stigmatized or illicit activities may suffer from reliability and validity issues resulting in response bias and potential underestimation of these behaviors.^30,31 Given that we defined oral sex to include genital and anal contact, it precludes us from disentangling differences in pharyngeal gonorrhea between those oral and penile/vagina contact as compared to oral-anal contact (i.e. rimming). While other STIs with similar epidemiology – namely chlamydia – may be transmitted through oral sex, this study only assessed pharyngeal gonorrhea given the lack of a validated and approved test for pharyngeal chlamydia during the time this study was conducted. Consequently, it is likely that our study underestimates and misclassifies the true extent of pharyngeal infections. Finally, the participants in this study were based on a convenience sample of those attending public STD clinics who reported oral sex as an exposure, and may not be representative of all young people attending sexual health clinics.

Our results highlight the fact that a relatively large number of infections in this population would be missed in the absence of pharyngeal testing. This along with other data demonstrating that once a pharyngeal infection is established bacterial loads in the pharynges and the saliva are high enough that gonorrhea can be transmitted via sexual practices involving exposure to saliva, suggests that these infections may contribute to ongoing high endemic rates among young people.³² These results have implications for those who provide medical care to clients at STD clinics and highlight the need for pharyngeal screening recommendations for young people, specific patient counseling messages related to strategies to reduce exposure to infected fluids, and the potential for transmission of STIs with oral sex.

​

Summary

A study of young people attending public STD clinics found a large proportion of gonorrhea cases would be missed in the absence of pharyngeal testing and factors associated with pharyngeal gonorrhea suggest the potential for continued transmission/acquisition of these infections.

Acknowledgments

This research was supported by a grant from the National Institutes of Health (NIH)/National Institutes of Allergy and Infectious Diseases (NIAID) (grant number K01AI091861).

References

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Diagnostics of gonorrhea in the SINEVO medical laboratory

Important to remember!
The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and correct prescription of treatment, you should contact your doctor.

Gonorrhea is one of the most common sexually transmitted infections (STIs).WHO estimates that over 100 million people are infected with gonorrhea every year. Gonococcal infection, entering the body, damages the mucous membranes of the genitourinary organs. In women, the inflammatory process is localized in the urethra and cervix, in men, the lower parts of the genitourinary system are affected. Infection of the oral mucosa and rectum is possible, which is typical after orogenital contacts. Gonorrhea can also affect the pelvic organs and, in rare cases, the lining of the eyes.

Mostly infection occurs during genital, oral and anal intercourse with a sick person. Rarely enough, infection is noted when using infected hygiene items, bedding or underwear. There is a possibility of infection in newborns during delivery of a mother with gonorrhea.

Symptoms in men

In men, the first symptoms of gonorrhea appear after 2-5 days. Purulent discharge from the urethra appears, accompanied by frequent, painful urination.The urine becomes cloudy, and there may be blood. There is a burning sensation and itching in the urethra. If during this period you do not consult a doctor, the pain will decrease and the disease will turn into a chronic stage.

Symptoms in women

Women often do not have any signs of the disease. In some cases, the symptoms are so mild that they are confused with other infectious diseases of the vagina or bladder: yellowish-white vaginal discharge, pain in the lower abdomen appear.After a while, there is frequent, painful urination, itching in the genitals, bleeding between periods.

If a gonococcal infection enters the pharynx, gonorrheal pharyngitis or stomatitis develops. Signs of pharyngitis are similar to angina: sore throat, purulent plaque, laryngeal edema, swollen lymph nodes.

In case of rectal lesion, gonorrheal proctitis develops. The disease usually proceeds without any special symptoms and is often confused with hemorrhoids.There is anal itching, pain and burning in the rectum, constipation, purulent discharge from the rectum.

When a gonococcal infection enters the mucous membrane of the eyes, acute pain appears in the eyes, accompanied by purulent discharge, and an increased sensitivity to light appears.

As soon as symptoms of gonorrhea appear, an urgent need to consult a specialist. Gonorrhea is a disease that will not go away on its own and will not just disappear. In men, gonococcal infection can cause inflammation of the testicles and prostate gland, which can lead to impotence and infertility .In women, inflammatory diseases of the uterus, ovaries and fallopian tubes are noted, which in the future can cause infertility . Gonorrhea can also lead to ectopic pregnancy and spontaneous abortion, provoke premature birth and stillbirth. Gonorrhea is also dangerous for a child. For example, 30% of children born to women with untreated gonorrhea develop a severe eye infection that can lead to blindness. Immunity to gonococcal infection is not produced, and you can get sick with gonorrhea many times.

Where to get tested for gonorrhea?

You can take an analysis for gonorrhea at any point of Sinevo in Minsk, Baranovichi, Bobruisk, Borisov, Brest, Vitebsk, Gantsevichi, Gomel, Grodno, Zhlobin, Lida, Mogilevka, Novgorod, Novogrudok, Novogrudok , Pinsk, Polotsk, Rechitsa, Svetlogorsk, Slutsk, Smorgon, Soligorsk.

Medical laboratory Synevo offers the following laboratory tests for the diagnosis of gonorrhea :

• Swab for flora. The presence or absence of gonococcus is determined.
• Determination of gonococcus DNA (scraping). High accuracy of identification of the genetic material of gonorrhea.
• General analysis of blood and general analysis of urine, biochemical analysis of blood. Indicator of the presence of an inflammatory process in the genitourinary system.

In addition, it is recommended to be tested for syphilis, HIV, chlamydia.

If gonorrhea is found, it is advisable for your partner to get tested.

Remember, preventing gonococcal infections is easier than treating them. And the most reliable prevention of disease is safe sex and loyalty to your partner.

90,000 symptoms, prevention and treatment of STDs

Sexually transmitted diseases (STDs) are transmitted as a result of various types of sexual activity. Oral intercourse – according to the charity AVERT – is common among sexually active people of all ages and orientations.As a result of such intercourse, the disease can affect the tissues surrounding the contact area, with some infections more often in the oral cavity than others.

The most common oral STDs are herpes, chlamydia, gonorrhea and syphilis. Remember, however, that you can get infected with diseases such as hepatitis A, B, and C, as well as some gastrointestinal infections.

Transmission path

STDs affecting the oral cavity are transmitted primarily through body fluids.In most cases, the formation of mouth ulcers is caused by bodily fluids released from the genitals of an infected partner. After the penetration of such fluids into the body, a local infection develops. Diseases can also be transmitted through the ingestion of an infected person’s saliva on the genitals of his partner.

Symptoms

Symptoms depend on the type of STD. Oral gonorrhea, according to MedicineNet, is also called “pharyngeal gonorrhea” because it usually affects the pharynx.

Intraoral symptoms that may indicate an STD include the following:

• Mouth ulcers, which may be painless;
• Lip lesions like herpes or cold sores;
• Redness and soreness of the throat, difficulty swallowing;
• Tonsillitis;
• Redness with white patches resembling strep throat;
• Whitish or yellow discharge.

According to the data of the Student Health Service of the University. Brown’s STDs are often not accompanied by any noticeable intraoral symptoms. Therefore, it is important to be as aware as possible about the health of both your own oral cavity and the oral cavity of your sexual partner.

Treatment of STDs affecting the oral cavity

The method of treatment depends on the type of STD the patient is suffering from and its severity. For example, treating mild cold sores may involve prescribing local pain relievers to relieve pain from mouth blisters and lesions while the immune system works to restore health.In more severe cases, antiviral drugs may be used to speed up the cure. In addition, products can be used that cleanse mouth ulcers, relieve pain, and promote healing, such as Colgate® Periogard® mouthwash.

In the treatment of oral gonorrhea, antibiotics of the cephalosporin class are usually used; however, the medical community is concerned about the emergence of bacterial strains that are resistant to such drugs, so it is important to follow the doctor’s instructions very closely.Syphilis – according to the Healthline website – is most commonly treated with penicillin or synthetic analogues, and chlamydia of the mouth with antibiotics such as azithromycin and doxycycline, according to the Centers for Disease Control and Prevention (CDC).

Forecast

If you have previously had any of the oral STDs described above and have received appropriate treatment, you may get the same disease or a different disease again if you have sex with an infected partner.Herpes can be in a “dormant” state for some time, and then again take an active form, especially in patients with a weakened immune system.

Precautions

The only way to keep yourself from getting an STD that affects your mouth is through safe sex, including safe oral sex. In addition, to reduce the risk of developing oral ulcers and infections, careful care of her health should be maintained.

90,000 Most antibiotics have lost their effectiveness against gonorrhea

“The bacteria that cause gonorrhea have become very sophisticated.Whenever we use a new class of antibiotics to treat this infection, the bacteria adapt and develop drug resistance, ”said WHO spokesman Theodore Vee.

78 million people are infected with gonorrhea every year. Gonorrhea affects the genital mucosa, rectum, and throat. Women are disproportionately affected by the complications of gonorrhea. These complications include pelvic inflammatory disease, ectopic pregnancy and infertility, and a higher risk of contracting HIV.

Experts are concerned that gonorrhea is virtually unresponsive to older and less expensive antibiotics. In some wealthy countries with a high level of surveillance, cases of infection have been reported that cannot be treated with any of the antibiotics known today.

“It is very possible that these data are just the tip of the iceberg, since systems for diagnosing and reporting incurable infections are often lacking in lower-income countries, which are characterized by a higher prevalence of gonorrhea,” said Theodore Vee.

At the moment, in most countries, broad-spectrum cephalosporins are the only group of antibiotics still effective for the treatment of gonorrhea. However, already in more than 50 countries, cases of resistance to two antibiotics from this group have been identified – to cefixime and, somewhat less often, to ceftrixanone. In this regard, WHO published an updated global guideline in 2016 that encourages physicians to prescribe two antibiotics: ceftriaxone and azithromycin.

Research and development on drugs for gonorrhea is relatively low. To date, there are only three drugs at various stages of clinical development: solithromycin, which has recently completed its third phase of clinical trials; zoliflodacin, which passed the second phase of trials, and hepotidacin, which also passed the second phase of trials.

Commercial pharmaceutical companies are not overly interested in the development of new antibiotics. The point is that antibiotics are usually given during short courses of treatment.In addition, over time, as resistance develops, antibiotics become less effective. This creates a constant need to develop more and more new drugs, to establish their production.

To address this issue, the Global Antibiotic Research and Development Partnership, a non-profit research organization, was established under the auspices of WHO. The global partnership is developing new antibiotics, including for the treatment of gonorrhea.

“In the short term, our goal is to accelerate the creation and market launch of at least one of these new drugs. We will explore the possibility of creating combination drugs for use in the public health system, ”said Manika Balasegaram, a spokesman for the Global Partnership. He stressed that new drugs must be available to everyone who needs them. But at the same time, it is necessary to ensure control over their rational use in order to prevent the rapid development of resistance to them.

What is gonorrhea and how to treat it

What is gonorrhea

Gonorrhea ^{, or gonorrhea, is a disease caused by the sexually transmitted bacteria gonococcus. They usually affect the urethra, rectum and throat, and in women, the cervix. WHO estimates that 98 million 90,153 people are infected with gonorrhea every year.}

How can you get infected with gonorrhea

The main route of infection is unprotected sex, and it can be anal or oral.The risk of infection increases ^:

• when changing partners; 90,066 90,063 polygamous relationships;
• The presence of other sexually transmitted infections (STIs).

If a pregnant woman has gonorrhea, the baby can also become infected during childbirth.

What are the symptoms of gonorrhea

Very often the infection proceeds ^{without visible signs. In general, its manifestations depend on where the bacteria got to.}

Gonorrhea of ​​the genital tract

If a man is infected, he may notice the following signs of the disease ^:

• pain when urinating;
• purulent discharge from the penis;
• Swelling and tenderness of one testicle.

The woman has slightly different symptoms ^:

• yellow or white vaginal discharge;
• pain when urinating;
• Vaginal bleeding between periods, such as after sex
• pulling pains in the lower abdomen.

Gonorrhea of ​​the rectum

Itching and burning in the anal region, purulent discharge. You may notice blood on the toilet paper after a bowel movement.

Gonorrhea of ​​the pharynx

A person complains of a sore throat, sometimes swollen lymph nodes in the neck.

Eye gonorrhea

Purulent discharge collects in the corners, worries about pain, increased sensitivity to light. One or both eyes may be affected.

Why is gonorrhea dangerous

If the disease is not treated, it can become chronic and lead to serious complications. This is ^:

• Infertility in men. The infection causes inflammation of the epididymis (epididymitis). If you do not pay attention to him, a man will not be able to have children.
• Infertility in women.If bacteria spread to the uterus and appendages, inflammation develops in them and adhesions form – proliferation of connective tissue. As a result, some are unable to conceive, while others develop ectopic pregnancies ^.
• Damage to other organs. The infection can get through the blood into the liver, heart, and brain. ^{and joints can be damaged. They swell, hurt, and the skin turns red.}
• Increased risk of HIV infection. Gonorrhea makes a person more susceptible to infection.
• Diseases of the newborn. If the baby becomes infected during childbirth, it may go blind and ulcers may develop on the scalp.

How gonorrhea is diagnosed

To confirm the ^{diagnosis, the doctor must find gonococcus DNA at the site of the suspected infection. To do this, they may be asked to pass urine, in men they will take a swab from the urethra, and in women – from the cervix. Sometimes swabs from the rectum, pharynx, or eyes are needed.}

Most often, research is carried out on genital gonorrhea.You need to prepare a little for them in order for the result to be accurate.

How to prepare for the test

There is no need to take antibiotics on your own before the test. And if, in addition to the smear, urine is taken, then you cannot go to the toilet 1-2 hours before the test.

Doctors advise ^{women on the eve of testing for gonorrhea not to douche or use any vaginal means.}

How the test is done

To obtain a smear from the cervix, a woman sits on a chair, like a gynecologist.With a special small brush or spatula, the doctor takes a little mucus from the vagina and places it on the glass. Then this smear is sent to the laboratory.

In men, a sample of discharge is obtained using a small spoon or brush, which is gently inserted into the urethra. This can be frustrating.

What to do if you find gonorrhea

A urologist for men or a gynecologist for women can treat the infection. But most often people with STIs go to a venereologist.The doctor prescribes antibiotics ^{– a single shock dose or a course for several days.}

It is necessary to take medications not only for the person who was found to have gonococci, but also for all his partners. You cannot have sex at this time, even with condoms. Usually, doctors allow ^{to resume sex a week after the last antibiotic dose.}

After treatment, you will need to re-test for gonorrhea. If it is confirmed, the doctor may refer you to a study of the sensitivity of gonococci to antibiotics.To do this, a sample of the discharge will be taken from the person again.

But even if everything goes well, you cannot relax: immunity to gonorrhea is not formed, it can be infected again.

How not to get gonorrhea

To never get an STI, follow these simple guidelines ^:

• Use condoms during sex.
• Reduce the number of sexual partners or maintain a relationship with only one person.
• Avoid casual relationships.
• Even with a condom on, do not have sex with someone who has signs of an STI.
• Get tested for genital infections with your partner and repeat the diagnosis annually.

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Analyzes at KDL. DNA gonococcus (Neisseria gonorrhoeae)

Select the required type of biomaterial

Scrapings from the urogenital tract are not taken within 24 hours after local therapy (suppositories, ointments, douching), after sexual intercourse and during menstruation in women.After colposcopy, intravaginal ultrasound should pass 48 hours. If there are signs of acute inflammation, the need for a smear is determined by the attending physician. If you need to get a scraping from the urethra, then before taking the material, you need not to urinate for 1.5 – 2 hours. If the study is prescribed to control the cure, then taking the material for research by the PCR method is possible no earlier than 28 days after the end of the antibiotic intake, for microbiological studies no earlier than 14 days.

Taking material for research is possible only by a doctor of appropriate qualifications.

Sputum can only be collected if there is a cough! Before collecting sputum, it is recommended to brush your teeth and rinse your mouth with boiled water. Avoid getting saliva and nasal mucus into sputum. Sputum is collected in a sterile container as you cough up. A cough can be triggered by taking a few deep breaths.

The first portion of the morning urine is collected after a thorough toilet of the external genitals.Do not apply topically antibacterial soap and antiseptic agents before testing.

Taking material for research is possible only by a doctor of appropriate qualifications.

Taking material for research is possible only by a doctor of appropriate qualifications.

On the eve of the study, do not use local medications and procedures, exclude intercourse. When taking a scraping from the urethra, do not urinate for 1.5-2 hours before the procedure. If the study is prescribed to control the cure, then taking the material for research by the PCR method is possible no earlier than 28 days after the end of the antibiotic intake, for microbiological studies no earlier than 14 days.

Taking material for research is possible only by a doctor of appropriate qualifications.

It is recommended to collect the material before topical application of antibiotics or antiseptics, before meals (or at least 2 hours after meals), you can take it in the morning on an empty stomach (you can drink water and brush your teeth).

Taking material for research is possible only by a doctor of appropriate qualifications.

The patient collects the material on his own by masturbation in a sterile container.

Mixed scraping of the urogenital tract is not taken against the background of local therapy (suppositories, ointments, douching) and during menstruation in women. After colposcopy, intravaginal ultrasound or sexual intercourse, 48 hours should elapse. If there is a need to take material from the urethra, then before taking the material, you need not to urinate for 1.5 – 2 hours. If the study is prescribed to control the cure, then taking the material for the study is possible 14-21 days after the end of the antibiotic intake.

Scrapings from the urogenital tract are not taken within 24 hours after local therapy (suppositories, ointments, douching), after sexual intercourse and during menstruation in women. After colposcopy, intravaginal ultrasound should pass 48 hours. If there are signs of acute inflammation, the need for a smear is determined by the attending physician. If you need to get a scraping from the urethra, then before taking the material, you need not to urinate for 1.5 – 2 hours. If the study is prescribed to control the cure, then taking the material for research by the PCR method is possible no earlier than 28 days after the end of the antibiotic intake, for microbiological studies no earlier than 14 days.

Taking material for research is possible only by a doctor of appropriate qualifications.

On the eve of sampling, do not use local antibiotics and antiseptics in the form of sprays, rinsing, drops, ointments. The material is taken on an empty stomach or not earlier than 2 hours after a meal. You can brush your teeth (with a paste without antibacterial components).

Material for research can be taken in the morning on an empty stomach or during the day, no earlier than 2 hours after eating. You can brush your teeth and drink water.On the eve of taking the material, do not apply topically antibiotics or antiseptics in the form of rinses, drops or sprays. A repeated study to control the cure is advisable no earlier than 4 weeks later.

Material for research can be taken in the morning on an empty stomach or during the day, no earlier than 2 hours after eating. You can brush your teeth and drink water. On the eve of taking the material, do not apply topically antibiotics or antiseptics in the form of rinses, drops or sprays. A repeated study to control the cure is advisable no earlier than 4 weeks later.

Material for research can be taken in the morning on an empty stomach or during the day, no earlier than 2 hours after eating. You can brush your teeth and drink water. On the eve of taking the material, do not apply topically antibiotics or antiseptics in the form of rinses, drops or sprays. A repeated study to control the cure is advisable no earlier than 4 weeks later.

The material is taken before the start of therapy. On the eve, do not use antiseptics, exclude any local procedures (washing, drops) for two hours.If it is impossible to take the material at the medical office, you can get free supplies and contact your ophthalmologist.

Causative agent of gonorrhea (Neisseria gonorrhoeae), determination of ribosomal RNA by NASBA

Biomaterial

For this study, the laboratory accepts the following biomaterial:

• Piss
• Scraping / discharge from the urethra
• Scraping / discharge from the cervical canal

Preparation for research

The conditions of training are determined by the attending physician.

Taking biomaterial is recommended:

• Not earlier than 48 hours after sexual intercourse;
• not earlier than 2 weeks after treatment with antimicrobial drugs;
• on the eve of excluding the use of local antiseptics, disinfectants

For men:

Scraping from the urethra: it is recommended to take 2 hours after the last urination.

Urine: The collection of urine is carried out after a thorough toilet of the external genitalia.Free the external opening of the urethra by pulling the skin fold. Collect the first portion of morning urine in the amount of 10-15 ml into a universal plastic container.

For women:

Scraping from the urogenital tract. No smears should be taken:

• during menstruation;
• earlier than 5 days after using vaginal suppositories, tampons or spermicides;
• after vaginal examination (pelvic ultrasound, colposcopy), douching;

Attention! For women, the determination of STI pathogens by the NASBA method in urine is not informative !

Scraping for NASBA diagnosis is carried out in all CMD offices

Gonorrhea in women

Contents:

Female venereal disease

Ways of infection

Symptoms of gonorrhea

Complications of gonorrhea

gonorrhea

Complications of gonorrhea

gonorrhea

gonorrhea

Gonorrhea (gonorrhea) is a sexually transmitted disease that is often asymptomatic in women.

However, it is for them that it is the most dangerous, as it causes inflammatory diseases of the uterus and appendages, which are one of the main causes of female infertility.

The causative agent gonorrhea – gonococcus, which most often multiplies in the urinary tract, causing purulent inflammation.

Untreated, gonorrhea can lead to serious health problems.

Immunity to gonococcus is not developed, so gonorrhea can be infected and hurt more than once.

Ways of infection

The disease is transmitted mainly through sexual contact, and even after one sexual contact, the risk of infection is up to 90%. Anal and oral sex with an infected partner is just as dangerous as traditional sex. Gonococcus trapped in the throat or rectum causes gonorrheal pharyngitis or gonorrheal proctitis.

• Intrauterine.

The infection is also transmitted from mother to child during childbirth.

Possible household route of infection through shared towels and personal items of intimate hygiene with the patient.

Symptoms of gonorrhea

The incubation period ranges from 3 days to 1.5 weeks.

Gonorrhea can occur in acute, chronic and latent forms and be localized in different places – the throat, rectum or urogenital organs, depending on the place where the microbe enters.

Half of women infected with gonorrhea have no infection. In this case, a woman is a source of infection for her sexual partners.

Complications of gonorrhea

• inflammatory diseases of the uterus and appendages, which are one of the main causes of female infertility
• ectopic pregnancy
• risk of miscarriage
• bartholinitis (inflammation of the gland of the vestibule of the vagina)

This is a painful formation near the entrance to the vagina that requires surgical treatment.

• Acute gonorrhea of ​​the uterine appendages

Severe form of gonorrhea, dangerous by peritonitis – inflammation of the peritoneum, and requiring surgical intervention. Symptoms are high fever, sharp pain in the lower abdomen.

• Gonococcal sepsis

Complication occurs if gonorrhea is left untreated. Once in the bloodstream, the pathogen affects the joints, heart, liver, brains, and other organs.

• Gonococcal conjunctivitis

It occurs when the pathogen gets into the eyes, often in newborns who were infected from the mother during childbirth.

Diagnosis of gonorrhea

The diagnosis is made by a venereologist together with a gynecologist based on visual examination, symptoms and laboratory results:

• laboratory culture test to isolate gonococcus – the result is ready in a week and is reliable in 95% of cases;
• Microscopic examination of smears from the cervical canal – the result is quick, but the accuracy is about 75%;
• PCR (polymerase chain reaction).Allows to identify the DNA of the pathogen, however, it often gives false positive results and requires testing by another method:
• test for antibodies to gonococcus. The most accurate research method.

Treatment of gonorrhea

The earlier the disease is detected and treatment is started, the more successfully gonorrhea is treated. Treatment of gonorrhea is prescribed for pregnant women at any time, most often it takes place in a hospital.

• antibiotic therapy
• immunostimulants
• topical drugs
• for pregnant women drugs that support the placenta

Together with the woman, it is necessary to treat her husband’s gonorrhea and examine her children for gonococci.

The first control study is carried out 10 days after the start of treatment.

Prevention of gonorrhea

• Compulsory examination for gonorrhea of ​​women planning pregnancy
• Study for gonorrhea of ​​pregnant women at the earliest stages
• Exclusion of casual sexual intercourse

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