Gonorrhea - female

Alternative names:

clap disease

Definition:

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

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 (State Board of Health). This allows for adequate follow-up and testing of sexual contacts.

There are almost 400,000 cases of gonorrhea reported to the CDC (Centers for Disease control) each year in the United States. There are probably many cases that are treated but 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 out of 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 a person's standing in society, it is not uniformly spread throughout the population. Instead, it has higher prevalence in large metropolitan areas, inner city areas, populations with lower overall levels of education, and people with 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).

Gonorrhea can be contracted during oral, vaginal, or anal sex and is very easily transmitted. The causative organism can infect the throat, producing a severe sore throat (gonococcal pharyngitis); the vagina, producing an irritated vagina with drainage (vaginitis); and the anus and rectum, producing a condition called proctitis. In addition, the organisms may spread up the female reproductive tract, through the cervix and uterus, into the Fallopian tubes (the tubes that carry the egg from the ovaries to the uterus).

In the Fallopian tubes, the infection is called PID or pelvic inflammatory disease (this occurs in 10 to 15% of the women with untreated gonorrhea). If the bacteria spreads beyond the Fallopian tubes into the peritoneum, it can produced a generalized infection in the abdomen called peritonitis. The bacteria can also spread to the blood stream causing gonococcemia and finally, typically in adolescent females, may settle in a joint causing gonococcal arthritis.

On rare occasions non-sexual transmission of gonorrhea can occur. An infected woman may transmit the infection to her newborn during childbirth. Infection of the newborn's eyes is called ophthalmia neonatorum (gonococcal conjunctivitis). Young girls who contract gonorrhea either from sexual contact or intimate contact with recently contaminated objects (such as a damp towel), develop a severe infection called vulvovaginitis.

It is unfortunate that approximately 50% of women with gonorrhea have no symptoms (asymptomatic). They may be completely unaware that they have contracted the disease, and subsequently do not seek treatment. This increases the risk of passing the disease on to other unsuspecting individuals.

Gonorrhea has a short incubation period and symptoms appear 2 to 5 days following sexual activity. When the individual is symptomatic, the most frequently observed symptoms include vaginal discharge, increased urinary frequency, and urinary discomfort (dysuria). Spread of the organism to the Fallopian tubes and abdomen may cause lower abdominal pain, guarding, rebound tenderness, fever, and generalized symptoms of bacterial infection.

Ultimately gonorrhea may result in scarring of the Fallopian tubes and permanent sterility (inability to become pregnant). Scar tissue formation around the uterus and tubes may result in painful intercourse (dyspareunia) and chronic pelvic pain.

Gonorrhea is often associated with the presence of other sexually-transmitted diseases. About half of the women with gonorrhea are also infected with Chlamydia trachomatis, another very common STD that can result in sterility. Women who have contracted gonorrhea should request testing for other sexually-transmitted diseases including AIDS.