Gonorrhea - Male

Definition:

Gonorrhea is a sexually-transmitted disease (commonly known as "the clap") caused by the bacterium Neisseria gonorrhoeae. See also gonorrhea - female.

Causes, incidence, and risk factors:

Gonorrhea is one of the most common infectious bacterial diseases and is most frequently transmitted during sexual intercourse, including both oral and anal sex. Gonorrhea is a reportable disease and all state governments require that cases of diagnosed gonorrhea be reported to the health authorities (the State Board of Health). This allows for adequate follow-up and testing of sexual contacts. This is significant because it is estimated that 90% of an infected male's secondary sex contacts are infected.

There are almost 400,000 cases of gonorrhea a year reported to the CDC (Centers for Disease control). There are probably many cases that are diagnosed and treated that are not reported (the total number of cases is thought to approach 1,000,000 and if unreported cases are included and some estimates reach 2,000,000). However, a rate of 400,000 cases per year means that 1 in every 687 Americans has gonorrhea (a rate of two million means that 1 in every 130 Americans are infected).

Although gonorrhea does not respect either geographic location or the person's standing in society, it is not uniformly spread throughout the population. Instead, there is a higher prevalence in large metropolitan areas, inner city areas, populations with lower overall levels of education, and people with a lower socioeconomic status. From the standpoint of age, gonorrhea is most prevalent in people 15 to 29 years old. Risk factors include having multiple sexual partners, a partner with a past history of any STD, and unprotected sex (sex without the use of a condom or the newly developed female condom).

Gonorrhea is an infection which is easily transmitted by sexual contact. It can be contracted during oral, vaginal, or anal sex. In infants and children, transmission can occur by non-sexual contact, but it is rare. In the male, the risk of acquiring gonorrhea following one episode of vaginal intercourse with an infected female is approximately 20% (1 chance in 5). Women are thought to acquire gonorrhea at a slightly higher rate from an infected male.

The causative organism can infect the throat, producing a severe sore throat (gonococcal pharyngitis); the urethra, causing urethritis with burning, painful urination, and a discharge; it may also infect the anus and rectum, producing a condition called proctitis. In addition, the organism may spread from the urethra to other portions of the reproductive tract producing epididymitis (infection of the epididymis, a structure attached to the testicle), prostatitis (inflammation of the prostate gland), and various other conditions such as periurethral abscess (a collection of pus around the urethra). Untreated gonorrhea may lead to urethral stricture (narrowing of the urethra caused by scarring), which can result in decreased urine flow, incomplete emptying of the bladder, urinary tract infection, and ultimately kidney failure.

The average incubation of gonorrhea is approximately 2 to 5 days following sexual contact with an infected partner. However, symptoms may appear as late as 2 weeks. The most common initial symptom is a discharge from the urethra that is either mucusy (clear or whitish discharge) or purulent (thick, yellowish, pus-like discharge). It appears at the opening of the penis and may stain the underwear. Other initial symptoms include painful urination and urethral burning. A small number of men will be without symptoms (asymptomatic).

Other sites of infection are relatively common Anorectal gonorrhea is common in homosexual men (it is also found in approximately 50% of women with gonorrhea). A majority of people with anorectal gonorrhea are symptom-free, but when symptoms are present they are typical of proctitis. A small percentage of people with gonorrhea have only a throat infection (gonococcal pharyngitis). Ten to 25% of homosexual men with gonorrhea also have pharyngeal infection, while 10 to 20% of women with gonorrhea have pharyngeal gonorrhea.

Gonococcal conjunctivitis (eye infection) is very rare in adults. It is normally seen only in infants delivered from mothers with gonorrhea, and is called ophthalmia neonatorum.

Gonorrhea is often associated with the presence of other sexually-transmitted diseases.