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Gonorrhea: Symptoms, Treatments, and Facts

Gonorrhea continues to evade our best efforts to kill it.

Eric Spitznagel

Theresa Chromati

Back in the 1940s, gonorrhea was mostly a nuisance. World War II soldiers were known to dismiss it as "no worse than a bad cold." A shot of an antibiotic like penicillin and you'd be good as new. It even had an adorable pet name, "the Clap," whose origins are a little unclear; it's either derived from an old French term ("clapier") for brothel—which just so happened to be where many people got gonorrhea—or from an archaic practice of treating gonorrhea by "clapping" both hands against the penis, like a cymbal crash, which forcefully expelled pus from the urethra and allegedly cured the infection. (You're welcome for that mental image!)

But gonorrhea isn't your grandfather's minor inconvenience anymore; it's grown into a full-on epidemic, and the number of infections are rising. There were nearly 400,000 reported cases of gonorrhea in the US in 2015, according to the CDC, an increase by 12.8 percent from the previous year. Even scarier, it's not as easy to cure anymore. Gail Bolan, the director of the CDC's Division of Sexually Transmitted Disease Prevention, says that, over the years, "gonorrhea has developed resistance to nearly every drug ever used to treat it." Here are the answers to your most burning questions.

So who gets it?
If you're a man and/or woman, and your genitals, rectum, and/or throat have had sexual contact with the genitals, rectum, and/or throat of another man or women, you're at risk. Gonorrhea is caused by the bacteria neisseria gonorrhoeae targeting body parts containing mucus membranes. That includes not just the penis, vagina, and anus, but also the mouth, eyes, and throat. (Yeah, we were surprised by eye gonorrhea too, but apparently it's a thing.)


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According to the CDC, it's an especially common infection among young people ages 15 to 24, and the biggest increase in infection rates in recent years were men, particularly gay men.

I heard a rumor that you can get it from a hot tub or a toilet seat. True?
These are weirdly persistent urban myths that somehow won't go away, likely because they occasionally get repeated by reality show doctors. Gonorrhea "is almost always transmitted during sex and it is highly unlikely that you catch it without having sex," Bolan says. If you have sex in a hot tub or on top of a toilet, and your partner has gonorrhea, then sure, you could get infected. But don't blame the hot tub or toilet seat. "The CDC is not aware of any cases of gonorrhea transmission from an inanimate object in a public setting," Bolan says.

"Highly unlikely" doesn't mean "never," however. According to a report from 2003, an 8-year-old girl contracted gonorrhea after using her hand to wipe a toilet seat before urinating, and then using the same hand to wipe herself. A 2009 study published in the American Journal of Infection Control found that 3.3 percent of the hospital toilets in their research contained traces of gonorrhea. That's a hospital toilet. And although it's very, very unlikely that the next public toilet seat you use has live bacteria from a previous user, we still recommend following the advice of the hospital study researchers, who suggest giving any unfamiliar toilet a quick once-over with an alcohol wipe.

How do I know if I'm infected?
Symptoms, if they occur at all, will usually appear anywhere from a week (two to five days) up to 30 days after infection, and they're the usual red flags for a sexually active person. Yellowish pus, burning urination, itchy or red genitals. In many cases, however, symptoms never develop at all, especially in women, or they're so mild that they're mistaken for a bladder or vaginal infection.

If you've had sex with a new partner (or partners, if that's how you roll), don't opt for the "let's wait for genital smoke alarm" approach, because those annoying beeps may never come. Peter Anthony Leone, medical director of the North Carolina HIV/STD Prevention and Control Branch, recommends "a three site screening, throat, rectum, and either vaginal screening for women or urine based screening in men. Infection of the throat and rectum is usually without symptoms but can be passed to a partner through sex. Best to screen the orifices you use rather than miss an infection."

And what if I don't get treated? What's the worst that can happen?
All sorts of painful and sometimes tragic things. For guys, untreated gonorrhea can lead to scarring of the urethra and possibly epididymitis, a condition in which the tubes inside the testicles become inflamed and it feels like you're being constantly kicked in the nuts. For women, it can result in pelvic inflammatory disease and infertility. And for both men and women, it can increase the risk of contracting HIV.

Wait a sec, didn't gonorrhea used to be an easy fix? What the hell happened to one shot of antibiotics and it's gone?
Here's the problem with gonorrhea: It's a smart little bastard. It can mutate quickly to defend itself. When penicillin stopped being effective against gonorrhea in 1976, we turned to fluoroquinolone. Then that stopped working around 2007, so the new treatment became cephalosporins (oral antibiotics like cefixime and ceftriaxone.) That did the trick—until a 2012 study noticed that gonorrhea was starting to become resistant again.

A combination of ceftriaxone and azithromycin, another antibiotic, are "the only recommended treatment options left for gonorrhea," Bolan says. "But we have seen some early indications that new antibiotic resistance patterns could jeopardize this treatment as well."

So there's no hope then? If I catch gonorrhea, I'm just screwed?
Not necessarily. There have been recent medical discoveries that could completely change how we think about treating gonorrhea. Researchers in Melbourne, Australia published a study last year which revealed that commercial mouthwash—they used Listerine in their tests—resulted in "significant reduction" of the bacteria Neisseria gonorrhoeae in both lab petri dishes and in the throats of patients infected with pharyngeal gonorrhea.

Which isn't to say they've cured gonorrhea. The participants were tested just once, shortly after getting the rinse, so the researchers admit that they "cannot exclude the mouthwash having only a short lived effect." Also, this was just for pharyngeal gonorrhea, and there's yet to be any research on what happens when you dump a bunch of Listerine on your baby-makers.

At least for the time being, until we have all the facts, it's a good idea to play it safe. The next time you visit a pharmacy for some sex supplies, steer away from the oral hygiene section and head straight for the condom aisle. Your genitals—and possibly your anus and mouth—will thank you for it.

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