Gonorrhea - Explained

Gonorrhea

Etiology

Gonorrhea, often referred to as GC or the clap by lay people, is caused by Neisseria gonorrhoeae. Gonorrhea is a great concern, because persons with it often have another STD such as chlamydia or HIV. They also have a high reinfection rate and serious residual effects. The incubation period is 3 to 50 days in men and 3 days to an indefinite period in women.

Compounding the problem is the rapid increase of cases of gonorrhea caused by resistant strains of Neisseria gonorrhoeae. Clinically significant resistant to the three widely uses of drugs – the penicillins, the tetracyclines, and the aminoglycosides- has been reported. Plasma-mediated resistance to penicillin (penicillinase- producing Neisseria gonorrhoeae) first emerged in 1976.

Resistant strains of the gonococcus can be plasma mediated, chromosomally mediated, or both and many varieties have been identified. The three most important in terms of public health are (1) plasma mediated resistance to penicillin, (2) chromosomally mediated to penicillin; and (3) plasma-mediated, high level tetracycline resistance. There is no clinical evidence in the infections caused by resistant strains of Neisseria gonorrhoeae and those caused by sensitive strains. When a high number of resistant strains are present in the community, there is more likely to be an increase in sequelae of acute gonococcal infections such as pelvic inflammatory disease, disseminated gonococcal infection, and gonococcal opthalmia.

Epidemiology of Gonorrhea

The incidence of gonorrhea is not fully known since the cases of many patients treated by private physicians are never reported to public health authorities and therefore not reflected in the statistics. It is generally accepted that only 25 percent to 50 percent of cases treated by private physicians are reported. In addition, women have few if any signs or symptoms of gonorrhea and thus are often not diagnosed. For this reason, it is commonly believed that the actual number of cases per year in the United States is probably more than 2 million.

The cost of patient management in communities with a high rate of resistant strains of Neisseria gonorrhoeae is increased due to (1) additional laboratory tests, (2) added drug costs, (3) extra clinic visits, and (4) more extensive disease intervention. Not all laboratories are prepared to test for all three forms of resistant strains. Therefore, emphasis is placed on identification of plasma-mediated resistance to penicillin by having all isolates of Neisseria gonorrhoeae tested for beta-lactamase production.

It is estimated that the total cost of gonorrhea in the United States is several billion dollars yearly. Women and their offspring suffer the major physical, emotional, and economic burden. Pelvic inflammatory disease occurs in 10 percent to 20 percent of women with gonorrhea; and even when treated, these women are likely to suffer from recurrent salpingitis, ectopic pregnancy, menstrual abnormalities, and infertility and may face surgical removal of the pelvic organs, as well as fetal loss.

More than 1 million cases of pelvic inflammatory disease are diagnosed and treated yearly. According to one report the cost of PID and associated ectopic pregnancy and infertility exceeded 3 billion dollars annually.