Gonococcus is the common name for Neisseria gonorrhoeae, a bacterium that causes the sexually transmitted infection (STI) gonorrhea. As an obligate human pathogen, it exclusively infects humans and primarily colonizes the mucous membranes of the genitals, rectum, and throat. While treatable, gonorrhea is a public health challenge due to its prevalence and increasing antibiotic resistance.
Infection and Transmission
The infection process begins when Neisseria gonorrhoeae attaches to mucosal cells using hair-like structures called pili. These pili help the bacterium adhere to surfaces and invade the host cell. Within 24 to 48 hours of attachment, the bacteria can penetrate these cells to establish an infection in the subepithelial space.
Transmission occurs almost exclusively through sexual contact, including vaginal, anal, and oral sex. Ejaculation does not need to occur for the infection to be transmitted.
The infection can also be transmitted from a mother to her baby during childbirth. As the newborn passes through the birth canal, exposure can lead to an eye infection called ophthalmia neonatorum. This condition can cause severe conjunctivitis and may lead to blindness if not treated.
Symptoms of Gonorrhea
The symptoms of gonorrhea differ between men and women, and many infected people show no signs at all. This asymptomatic nature is common in women, where more than half of cervical infections may produce no noticeable symptoms. When symptoms do appear in women, they are often mild and can be mistaken for a bladder or vaginal infection. These can include a painful or burning sensation during urination, increased vaginal discharge, and vaginal bleeding between periods.
In men, infections are more likely to be symptomatic, with signs appearing within two to 14 days after exposure. Common signs include a burning sensation during urination and a white, yellow, or green discharge from the penis. In some cases, men may experience painful or swollen testicles.
Rectal infections are often asymptomatic but can cause anal itching, discharge, soreness, bleeding, or painful bowel movements. Pharyngeal, or throat, infections are also frequently without symptoms, though a sore throat can sometimes occur.
Complications of Untreated Infections
An untreated gonococcal infection can lead to serious and sometimes permanent health problems. In women, the bacteria can spread from the cervix to the upper reproductive tract, causing Pelvic Inflammatory Disease (PID). PID is an infection of the uterus, fallopian tubes, and ovaries that can result in scar tissue. This scarring can block the fallopian tubes, leading to infertility or an increased risk of ectopic pregnancy.
In men, untreated gonorrhea can lead to epididymitis, a painful inflammation of the tube that stores and carries sperm. This condition can cause testicular pain and swelling and, in some cases, may result in infertility. An untreated infection also increases the risk of getting or transmitting HIV for both men and women.
A less common complication is Disseminated Gonococcal Infection (DGI), which occurs when the bacterium spreads through the bloodstream. DGI can cause fever, skin rashes or sores, and joint pain and swelling that resembles arthritis.
Treatment and Antibiotic Resistance
Gonorrhea is a curable infection treated with antibiotics. However, the effectiveness of these treatments is threatened by the bacterium’s ability to develop drug resistance. Over decades, Neisseria gonorrhoeae has become resistant to many antibiotics that were once effective, including penicillin and ciprofloxacin, making treatment more challenging.
Increasing antimicrobial resistance has led to changes in treatment recommendations. Health organizations like the CDC monitor resistance patterns to guide protocols. The current recommended strategy is a single injection of the antibiotic ceftriaxone. Previously, dual therapy was recommended to slow the emergence of resistance, but protocols were updated as resistance patterns evolved.
The challenge of resistance means only one class of antibiotics remains reliably effective for first-line treatment. It is important for infections to be treated correctly and for any suspected treatment failures to be reported. It is also recommended that sexual partners be treated to prevent reinfection and further spread of the bacteria.