Treatment

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If you test positive for gonorrhea, the infection can be cured with antibiotics. Because patients infected with N. gonorrhoeae are often also with C. trachomatis (the bacterium that causes chlamydia), some health care professionals may recommend dual therapy against both microorganisms to be safe. Most effective antibiotics can be given in one dose orally. All require a prescription and in most cases your health care professional will treat you while you are at his or her office or clinic.

If you are pregnant and are also infected with gonorrhea, you can be treated without harming the fetus, but it is critical that you tell your health care professional that you are pregnant. Because fluoroquinolones and tetracyclines-two commonly prescribed drugs for gonorrhea-are not recommended for pregnant women, the preferred regimen is a cephalosporin and a macrolide. As with any antibiotic treatment, it is important that you take all your pills, even after symptoms disappear.

Less than five percent of pregnant women are infected with gonorrhea, but those who are put their infants at high risk of developing health problems, including reactive arthritis (a common cause of arthritis in childhood that usually follows a viral infection such as strep, meningitis or gonorrhea) and gonococcal scalp abscesses. Infants with gonorrhea may be born prematurely. They also may experience eye inflammation (conjunctivitis). Detecting infection in newborns, which is often without symptoms, requires sensitive and specific methods, including tissue culture. The most common symptom is conjunctivitis that develops five to 12 days after birth. Gonorrhea can involve not only the eyes, but also the infant's genital tract and rectum. Recommended treatment for neonatal gonorrhea is ceftriaxone, either as an intravenous or intramuscular injection. Eye drops used routinely in hospitals soon after birth prevent gonococcal conjunctivitis.

Although treatment is highly effective, women are often retested for gonorrhea after treatment to ensure the infection is gone. Some gonococcal organisms have become resistant to some antibiotics, and therefore a repeat culture and an alternate antibiotic may be needed if symptoms persist in spite of a full course of treatment. Reinfection can occur if partners do not get diagnosed and treated. Therefore, it is important that you abstain from sexual contact until your partner has been tested and completed treatment (seven days after a single-dose regimen or after completion of a seven-day regimen).

In general, treatment is recommended for any partner or partners you've had sexual contact with up to 60 days prior to having symptoms or a diagnosis of gonorrhea.

Treating PID

Pelvic inflammatory disease (PID) treatment begins with an antibiotic regimen that primarily provides coverage against gonorrhea and chlamydia. Treatment should begin as soon as a diagnosis is made, because immediate therapy has been shown to reduce the risk of long-term damage from PID. Oral therapy and a muscular injection are most commonly used; in certain cases, medication may be administered via injection into the veins. Hospitalization is recommended in the following circumstances:

• Surgical emergencies such as appendicitis cannot be excluded

• Pregnancy

• Allergy to orally available antibiotics

• Severe illness, nausea, vomiting or high fever

• Presence of tubo-ovarian abscess

• No response to oral therapy

While medication can stop PID, some women may need surgery to remove scar tissue and blockages caused by long-term infection. This surgery is performed after the acute infection is treated with antibiotics. The most common type of surgery involves laparoscopy. This outpatient surgery uses a laparoscope inserted through a small incision in the abdomen, allowing the surgeon to assess the degree of damage to the fallopian tubes and remove scar tissue, if necessary.

Ongoing Research

Scientists recently have determined the sequence of the Neisseria gonorrhoeae bacterial genome. The sequence represents an encyclopedia of information about the bacterium that causes gonorrhea. This accomplishment will give scientists important information as they try to develop a safe and effective vaccine.

Neisseria gonorrhoeaeexpresses a special adhesin protein called Opa, which allows it to invade human cells. Scientists at the University of Toronto are conducting research to better understand the process by which this invasion occurs, and to determine whether it is possible to use the Opa proteins as a vaccine to protect against gonorrhea.

Drug-resistant strains of gonorrhea continue to emerge, and successful treatment of this sexually transmitted disease is becoming more difficult. Scientists are continually searching for new antibiotics to replace those that are becoming ineffective. In the 1980s, for example, gonorrhea became resistant to penicillin and tetracycline, rendering these drugs ineffective. Quinolone-resistant Neisseria gonorrhea have emerged over the past five years, currently prevalent in Hawaii and on the West Coast in the United States, and in Southeast Asia. In April 2004, the U.S. Centers for Disease Control and Prevention recommended avoiding quinolones in men who have sex with men because of resistance.