It is a common misconception that sexually transmitted infections (STIs) always present with clear symptoms. For gonorrhea, “asymptomatic” is a more accurate term than “dormant.” This means an individual can carry the bacteria, Neisseria gonorrhoeae, without noticeable signs or discomfort. Many gonorrhea infections, particularly in women, do not show symptoms, making detection and management challenging. Understanding this asymptomatic nature is important for controlling the spread and preventing its potential health consequences.
The Nature of Asymptomatic Gonorrhea
Asymptomatic gonorrhea means Neisseria gonorrhoeae is present without visible symptoms, making it difficult for individuals to know they are infected. While some men may experience symptoms, 10-15% may have none, and up to 80% of women often remain asymptomatic. The bacteria can infect various mucous membranes, including the urethra, rectum, and throat. In women, the cervix is another common site. Even without symptoms, the bacteria remain active and transmissible, posing health risks and spreading unknowingly.
Risks of Undiagnosed Infection
The asymptomatic nature of gonorrhea carries significant risks for infected individuals and their sexual partners. Unaware individuals can unknowingly transmit the bacteria, contributing to its silent spread within communities. If left untreated, asymptomatic gonorrhea can lead to serious health complications.
Complications in Women
In women, the infection can ascend from the cervix to the upper reproductive tract, causing pelvic inflammatory disease (PID). PID can result in long-term pelvic pain, life-threatening ectopic pregnancy, and infertility due to fallopian tube scarring.
Complications in Men
For men, untreated gonorrhea can lead to epididymitis, an inflammation of the coiled tube at the back of the testicles, which can, in rare cases, cause infertility. It can also cause urethral strictures.
Increased HIV Risk
Beyond reproductive health, untreated gonorrhea increases the risk of acquiring and transmitting HIV. It creates an inflammatory environment that makes individuals more susceptible to HIV and can increase HIV viral load, making transmission more likely if co-infected.
Disseminated Gonococcal Infection (DGI)
In rare instances, the bacteria can spread through the bloodstream, leading to disseminated gonococcal infection (DGI). DGI can manifest as fever, skin lesions, painful joint swelling, and in very rare cases, affect the heart or brain.
Testing and Treatment Strategies
Given the high prevalence of asymptomatic cases, regular testing is paramount for detecting gonorrhea. Nucleic acid amplification tests (NAATs) are the preferred method for diagnosing gonorrhea due to their high accuracy in detecting the genetic material of the bacteria. These tests can be performed on various samples, including urine, or swabs collected from the urethra, cervix, rectum, or throat. Screening for gonorrhea is particularly recommended for sexually active individuals at increased risk, even if they do not have symptoms.
Treatment for gonorrhea typically involves antibiotics. The Centers for Disease Control and Prevention (CDC) currently recommends a single intramuscular dose of ceftriaxone, usually 500 mg, for uncomplicated gonorrhea infections of the urethra, rectum, or throat. For individuals weighing 150 kg (300 lbs) or more, a 1-gram dose of ceftriaxone may be administered. If a co-infection with chlamydia is suspected or has not been ruled out, doxycycline may also be prescribed. It is important to complete the entire course of medication as prescribed, even if symptoms improve or disappear. Due to concerns about antibiotic resistance, retesting after treatment is often recommended, particularly for pharyngeal (throat) infections, to confirm the infection has been cured. For urogenital and rectal gonorrhea, a test of cure is generally not needed unless symptoms persist, but retesting for reinfection is recommended three months after treatment. Sexual partners of an infected individual should be notified and treated to prevent reinfection and further spread.