Written by Leeon Maher, Peer Reviewed by Kwan Ho Lee, Edited by Courtney Coleman
With its first diagnosis tracing back to the 19th century, and symptoms arising in even the earliest of human beings, gonorrhea has remained prevalent to date (1). With gonorrhea being the second most common STI in the United States, as of 2020, it is crucial to know the seriousness of its contraction and take preventative measures (2).
Overviewing the epidemiology of gonorrhea poses the question: What makes gonorrhea so prevalent? Given the patterns of other epidemics, the absence of symptoms could contribute to the spread of gonorrhea. Furthermore, analyzing the demographics of gonorrhea and statistics regarding its symptoms will test this hypothesis.
What is Gonorrhea?
Gonorrhea is a sexually transmitted infection that can cause detrimental effects to various parts of the body. Upon contraction, bacteria attach to epithelial cells and proceed to attack cells through intrusion. The bacteria in gonorrhea infections have hair-like surfaces that allow for easy attachment. Once the bacteria infiltrate the cells, they multiply and cause the infection to spread (3). As the infection spreads, symptoms may arise that could be detrimental to the host.
Transmission and Etiology
Gonorrhea can be contracted by both males and females, although it is more common among teens and young adults (4). Transmission can occur through sexual means or perinatal (mother-to-child) infections. Those with multiple sexually active partners are at higher risk of contracting gonorrhea, which increases further if no condom or sexual protection is used (5). The bacteria in gonorrhea cannot survive outside of the host of a human; thus, transmission can only occur between humans (3).
Symptoms and Complications
The symptoms of gonorrhea can vary between men and women in sites such as the pelvis, vagina, and penis. For women, many symptoms in the vaginal area can arise, including vaginal discharge, vaginal bleeding, and pelvic pain. Symptoms experienced by men may include penile discharge and testicular swelling. For both sexes, in sites such as the rectum, eyes, throat, urethra, and joints, they may each experience dysuria (painful urination), discharge, anal itching, soreness, bleeding, and abdominal pain.
While these symptoms serve as clear short-term indicators that can be treated, leaving gonorrhea untreated may lead to long-term complications. The major, and possibly permanent, complications include pelvic inflammatory disease (PID), inflamed epididymis (epididymitis), diffusion of infection throughout the body, higher risk of HIV, scar tissue in fallopian tubes, and long-term abdominal pain. In addition, these complications can contribute to infertility in both men and women, congenital disabilities during pregnancy, and life-threatening conditions (4,5).
Screening and diagnosing these symptoms and conditions pose another conflict. Although the symptoms are identifiable, the probability of symptoms arising from the contraction of gonorrhea for women is less than 50%. Asymptomatic conditions may lead to a lack of proper screening, increasing unintentional transmission. For those with symptomatic conditions, a medical professional may require a differential diagnosis, as the symptoms of
gonorrhea are like those of other STIs (e.g., chlamydia) (3).
The end of 2020, during the COVID-19 pandemic, marked a sharp increase in reported gonorrhea cases in the United States. According to the CDC:
“In 2020, a total of 677,769 cases of gonorrhea were reported to the CDC, making it the second most common notifiable sexually transmitted infection in the United States for that year. Rates of reported gonorrhea have increased by 111% since the historic low in 2009. During 2019–2020, the overall rate of reported gonorrhea increased by 5.7%.” (2)
Compared to 2019, the CDC reported a total 10% increase in reported cases of gonorrhea by the end of 2020. With 677,769 cases, that would mark a 45% increase in cases of gonorrhea since 2016. Although the CDC is still monitoring concrete data for 2021, their preliminary data (reported through various STD surveillance groups) shows a total of 696,674 reported cases. The CDC stated that through 2021, STDs continued to increase “with no signs of slowing.” The rates of reported gonorrhea cases through 2021 also differ for men and women, as men consistently have a higher rate of reported gonorrhea than women (6).
The continued increase in reported gonorrhea cases can be attributed to the possible asymptomatic conditions of women with gonorrhea. As asymptomatic infections discourage sufficient screening for populations, more people unknowingly transmit gonorrhea, thus increasing the number of reported cases. The differential rates of men and women reporting gonorrhea cases support this aspect. The chances of symptomatic conditions arising for
men with gonorrhea is greater than 90%, promoting more screening for men. As fewer women get screened due to asymptomatic infections, higher risks of gonorrhea being transmitted arrive. Another point that could increase the number of reported gonorrhea cases is the mutating bacteria strains resistant to antibiotics. As the number of resistant strains of gonorrhea increases, the reported cases of gonorrhea will also increase.
Treatment and Prevention
Gonorrhea can be treated with antibiotics before any severe complications can occur. A 500 mg dose of intramuscular ceftriaxone is the base standard for gonorrhea; however, due to antimicrobial-resistant strains in gonorrhea, if symptoms persist for longer than a week on the base antibiotics, doctors may require a second appointment to be re-evaluated. From here, health professionals will prescribe certain antibiotics based on the site of infection and the presence of resistant strains (1,3).
The easiest way to deal with gonorrhea is to prevent transmission from occurring. Due to the sexual nature of the transmission of gonorrhea, adjusting one’s sexual lifestyle is often the key to prevention. Adjustments to prevent transmission and contraction include using a condom, limiting the number of sex partners, scheduling regular gonorrhea and STI checks, and avoiding sex with someone exposed to gonorrhea (4). In addition, abstaining from sex and pregnancy due to suspicion of, or exposure to, gonorrhea could prevent a child’s congenital disabilities.
The statistics and demographic information provide insight into the spread of gonorrhea. With the correlation between asymptotic female carriers and reported male carriers, the absence of symptoms becomes the most probable agent in the increasing spread of gonorrhea. With how easily undetected gonorrhea is as a potentially lethal STI, awareness for screening and treatment is the key to decreasing rates of reported gonorrhea transmission. It is always best to be prepared for these possibilities than to handle them when they become serious.
1. “CDC - Gonorrhea Treatment.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 Apr. 2022, https://www.cdc.gov/std/gonorrhea/treatment.htm.
2. “National Overview of STDs, 2020.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 Apr. 2022, https://www.cdc.gov/std/statistics/2020/overview.htm#Gonorrhea.
3. Springer, Charles, and Philip Salen. “Gonorrhea.” National Library of Medicine, National Library of Medicine, 21 Apr. 2022, https://www.ncbi.nlm.nih.gov/books/NBK558903/.
4. “Gonorrhea.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 Oct. 2021, https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774.
5. “Gonorrhea – CDC Basic Fact Sheet.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 22 Aug. 2022, https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm.
6. “Preliminary 2021 STD Surveillance Data.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 Sept. 2022, https://www.cdc.gov/std/statistics/2021/default.htm.
This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research is constantly evolving. This post contains information that was last updated on November 21, 2022.
Leeon Maher is currently an intended Molecular and Cell Biology (Immunology) major undergraduate at UC Berkeley.
Kwan Ho Lee is a third year PhD student in Biostatistics and Epidemiology at UC Davis.
Courtney Coleman is a master's degree candidate in biology at Harvard and Co-President of Students vs. Pandemics.