Gonorrhea: The Silent STD and Its Long-Term Health Risks

Gonorrhea is a common sexually transmitted disease (STD) caused by the bacterium Neisseria gonorrhoeae. It is the second most frequently reported bacterial STD in the United Kingdom after chlamydia11. Gonorrhea can infect the genitals, rectum, and throat, and is easily transmitted through vaginal, anal, or oral sex. If left untreated, gonorrhea can lead to serious health complications, especially in women.

Prevalence and Transmission

The World Health Organization estimated that in 2016, there were 87 million new cases of gonorrhea globally, with a prevalence of 0.9% in women and 0.7% in men1. In the UK, over 70,000 cases of gonorrhea were diagnosed in 2019, with gay and bisexual men most affected11. Gonorrhea diagnoses reached a record high in England in 2022, increasing by over 50% compared to 20216.

Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. The bacteria can also be passed from an untreated mother to her baby during childbirth11. Many people with gonorrhea, especially women, may have no symptoms, facilitating the silent spread of the infection12.

Symptoms and Diagnosis

Gonorrhea often causes no symptoms, especially in women. When symptoms do occur, they may include11:

• A thick green or yellow discharge from the penis or vagina

• Pain when urinating

• Bleeding between periods in women

• Rectal pain, discomfort, bleeding or discharge

If symptoms appear, they usually develop within 2 weeks of infection, but can take several months in some cases7. Gonorrhea is diagnosed through testing a urine sample or a swab of the affected area. Regular STD testing is important for sexually active individuals, particularly those with new or multiple partners.

Complications of Untreated Gonorrhea

If gonorrhea is not treated promptly with antibiotics, it can spread and lead to serious health problems. Complications are more common and severe in women.

In women, untreated gonorrhea can cause pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes and ovaries. PID occurs in an estimated 10-20% of women with untreated gonorrhea1. PID can lead to28:

• Long-term pelvic pain

• Scarring of the fallopian tubes

• Ectopic pregnancy (a life-threatening condition where the embryo grows outside the uterus)

• Infertility

During pregnancy, untreated gonorrhea increases the risk of miscarriage, premature labor and delivery, and serious eye infections in newborns that can cause blindness211.

In men, gonorrhea can cause epididymitis, a painful condition of the testicles that may lead to infertility if untreated24. In rare cases, untreated gonorrhea can spread to the blood or joints, causing life-threatening disseminated gonococcal infection2.

Antibiotic Resistance

Gonorrhea has progressively developed resistance to the antibiotics used to treat it. In the 1930s, sulfonamides were first used to treat gonorrhea, but resistance developed within a decade9. Penicillin was then used, but doses had to be progressively increased as resistance emerged in the 1940s-1970s9. Newer antibiotics like fluoroquinolones and cephalosporins were recommended, but resistant strains have emerged globally19.

Currently, gonorrhea is usually treated with an injectable cephalosporin antibiotic, ceftriaxone, sometimes combined with oral azithromycin1113. However, with rising resistance, treatment failures may become more common. The development of new antibiotics is not keeping pace with the evolution of resistant gonorrhea strains1.

Prevention and Control

Consistent and correct use of condoms provides effective protection against gonorrhea13. Sexually active people should get tested regularly for gonorrhea and other STDs, especially with new or multiple partners. Sexual partners of individuals diagnosed with gonorrhea should be notified, tested and treated to prevent reinfection and further spread.

Improved surveillance of antibiotic-resistant gonorrhea is needed to guide treatment recommendations113. Developing an effective vaccine against gonorrhea is a research priority to combat the threat of untreatable gonorrhea13.

Conclusion

Gonorrhea is a major public health concern, with rising rates of infection and antibiotic resistance. As a frequently silent infection, gonorrhea can cause serious complications if untreated, particularly in women. Consistent condom use, regular STD testing, partner notification, and prompt antibiotic treatment are essential to control the spread of gonorrhea. Addressing the threat of untreatable gonorrhea is critical and requires the urgent development of new antibiotics and a gonorrhea vaccine. Increased awareness of this common yet potentially dangerous STD is needed to protect individual and public health.

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