What is gonorrhea?

Gonorrhea is a serious but curable bacterial infection that can be transmitted through genital, oral, or anal sex, as well as from an infected woman to her baby during delivery. The incubation period (the time it takes for an infection to develop) is usually two to ten days after exposure. Gonorrhea has a high transmission rate, so if you have unprotected sex with an infected partner, your chances of becoming infected are high. The Centers for Disease Control and Prevention (CDC) estimates that there are about 820,000 new cases of gonorrhea in the United States annually, including about 13,200 in pregnant women. How can gonorrhea affect my pregnancy? Women who have gonorrhea during pregnancy tend to have higher rates of miscarriage, infection of the amniotic sac and fluid, preterm birth, and preterm premature rupture of membranes (PPROM), although prompt treatment reduces the risk of these problems. An untreated gonorrhea infection makes you more susceptible to HIV and some other sexually transmitted infections (STIs), if you're exposed to them, and raises your risk of a uterine infection after you have your baby. If you have a gonorrhea infection when you go into labor, you can pass the bacteria to your baby. Gonorrhea in newborns most commonly affects the eyes, and babies may eventually go blind if left untreated. The U.S. Preventive Services Task Force strongly recommends and most states require by law that all babies be treated with medicated eye drops or ointments soon after birth as a preventive measure. If the mother is known to have gonorrhea or the baby has a gonorrheal eye infection, he'll be treated with systemic antibiotics as well. Less often, an untreated gonorrhea infection can spread to other parts of a baby's body, causing problems such as serious blood or joint infections and meningitis. What are the symptoms of gonorrhea? Many women with gonorrhea have no symptoms, so without testing it's likely you wouldn't have any idea that you were infected.

Symptoms, if you do get them, vary depending on the site of the infection. If your cervix, vagina, or urethra are involved, your symptoms may include abnormal vaginal discharge, burning or pain during urination, spotting, and pain during intercourse. With an anal infection, you might have discharge, itching, or experience pain when you move your bowels. If you have oral sex with an infected partner, you can develop a gonorrhea infection in your throat or mouth. It may be accompanied by redness or soreness. And if your eyes come in contact with the bacteria (for example, by touching infected genitals and then rubbing your eyes), you can develop an eye infection and may have discharge and itchy, red eyes. What are the risks if gonorrhea isn't detected and treated? Left untreated, gonorrhea can spread and cause a number of serious problems, along with other symptoms. Before and after pregnancy, gonorrhea can spread to your uterus and fallopian tubes and cause pelvic inflammatory disease (PID), with symptoms that include pain in your lower abdomen or back, pain during sex, vaginal bleeding, fever, and nausea. It's possible to get PID during pregnancy, but it happens only rarely. PID can result in permanent damage to your fallopian tubes and lead to chronic pelvic pain and infertility, as well as an increased risk of ectopic pregnancy if you do become pregnant. In rare cases, the bacteria can enter the bloodstream and cause a serious condition called disseminated gonococcal infection. If that happens, you may get fever and chills, sores on your skin, and infection and pain in your joints. Other problems may include inflammation around your liver and, more rarely, a heart infection or meningitis. Disseminated gonococcal infection can occur in anyone with an untreated gonorrhea infection, though it's more common in women than men and seems to occur more often during pregnancy. Will my partner have symptoms?

Probably. Unlike women, the vast majority of men infected with gonorrhea have symptoms, which may include burning or pain while urinating, discharge from the penis, and tender or swollen testicles. If your partner has any of these symptoms, he needs to see his doctor (or go to a clinic if he doesn't have one), and you need to see your caregiver. Both of you should get tested as soon as possible and get treated if necessary. In the meantime, you should remain abstinent. If either or both of you test positive, you'll need to remain abstinent until you've completed treatment. Will I be tested for gonorrhea during my pregnancy? Maybe. The CDC currently recommends that pregnant women who live in a community where the infection is relatively widespread, as well as those who are otherwise at risk for the infection, should be tested for gonorrhea at their first prenatal visit and again in the third trimester if they remain at risk. Sexually active females younger than 25 are at highest risk. Other risk factors include prior gonorrhea infection, other STIs, onset of sexual activity at a young age, new or multiple sex partners, commercial sex work, inconsistent condom use, and substance abuse. Those who are nonwhite, unmarried, or of a low socioeconomic level are also at higher risk. If you think there's any possibility that you might have contracted gonorrhea or any other STI, let your caregiver know and ask to be tested. You should also be tested (or retested) at any time during pregnancy if you or your partner develops any symptoms of gonorrhea, or if you contract another STI, because they're often found together. To test for gonorrhea, your practitioner will swab your cervix and send the swab to the lab for analysis. Sometimes a urine specimen is used instead. If your test is positive, you'll be treated immediately. And if you weren't tested for other STIs along with the gonorrhea test, you'll be tested for them now. You'll be retested for gonorrhea in two to

four weeks (sooner if you have symptoms) to make sure you haven't been reinfected, and again in the third trimester. How is gonorrhea treated during pregnancy? Gonorrhea can be treated with antibiotics that are safe to take during pregnancy. Your partner should also be treated, and you should abstain from sex until you've both completed treatment so you don't get reinfected. If you have more than one STI, your practitioner will treat you for both at the same time. (About 40 percent of the time women who have gonorrhea also have chlamydia, another STI.) How can I avoid getting gonorrhea? Have sex only with a long-term partner who is disease-free and who has sex only with you. Otherwise, use latex condoms for intercourse and a dental dam for oral sex in order reduce your risk of getting gonorrhea and certain other STIs. (Note that birth control pills, shots, implants, and diaphragms will not protect you from gonorrhea or other STIs.) Again, if it's possible that you've been exposed to gonorrhea (or any other STI) during pregnancy, tell your practitioner right away so that you can be tested and treated if necessary.