Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. This bacterium is gram-negative, which can be remembered by noting the “G” and “N” in gonorrhea. Under a Gram stain, these bacteria appear as small, round, paired cells encased in a capsule, referred to as diplococci.
Don’t forget to watch more review in the STIs nursing series.
Transmission of Gonorrhea
Gonorrhea is primarily transmitted through unprotected sexual contact, including vaginal, oral, and anal intercourse with an infected person. Additionally, an infected pregnant person can transmit gonorrhea to their baby during childbirth, leading to complications such as premature birth and neonatal eye infections, which could result in blindness. It may also cause meningitis in newborns.
Signs and Symptoms of Gonorrhea
To remember the symptoms of gonorrhea, use the mnemonic “THE CLAP,” which is also a common nickname for the infection:
- Tender testicles: In males, gonorrhea can cause significant swelling and pain in the testicles, which may lead to infertility if untreated.
- Hurts to urinate: A burning sensation while urinating is common and may be mistaken for a urinary tract infection.
- Swelling: The affected area—genitals, throat, or anus—can become swollen and inflamed.
- Conjunctivitis: This eye infection primarily affects newborns who contract gonorrhea during delivery. Erythromycin is most commonly administered in the eyes of the newborn after birth to prevent this.
- Lack of symptoms: Many individuals, especially women, may experience mild or no symptoms, often mistaking them for a vaginal infection or urinary tract infection.
- Abnormal discharge: The infection causes thick, greenish-yellow discharge from the penis, vagina, or anus.
- Pelvic Inflammatory Disease (PID): If untreated, gonorrhea can spread to the fallopian tubes, ovaries, and uterus, leading to abdominal pain, infertility, and ectopic pregnancies.
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The Nurse’s Role in Gonorrhea Screening and Treatment
Nurses play a crucial role in identifying gonorrhea in patients and ensuring they receive proper testing and treatment. The Centers for Disease Control and Prevention (CDC) recommends yearly screening for:
- Sexually active individuals under 25 years old
- Anyone with multiple sexual partners
- Individuals who engage in unprotected sex
- Incarcerated individuals
- Those who have tested positive for another STI, as gonorrhea often coexists with chlamydia.
For pregnant patients, testing is recommended during the first prenatal visit for those 25 and under, while older patients are tested only if they are considered high-risk. In addition, these patients should be retested in the third trimester (around 28 weeks). Testing involves urine samples or swabs from the affected area. There is currently NO blood test for gonorrhea.
Treatment Options
Gonorrhea is treated with antibiotics. The CDC currently recommends:
- A single intramuscular (IM) dose of ceftriaxone for uncomplicated gonorrhea.
- If Chlamydia trachomatis has not been excluded, doxycycline should be added.
- Pregnant patients follow the same ceftriaxone regimen, but an alternative to doxycycline is used due to its contraindications during pregnancy. Doxycycline can lead to bone and tooth development issues.
Past CDC guidelines recommended dual therapy with azithromycin, but this is no longer the standard treatment.
Patient Education and Prevention
Patients receiving treatment for gonorrhea should be advised to:
- Avoid all sexual activity until seven days after completing treatment and experiencing no symptoms.
- Use barrier protection (such as condoms) to prevent reinfection.
- Ensure their partner(s) are tested and treated.
- Follow up with testing three months after treatment to confirm the infection is cleared and has not recurred.
By understanding gonorrhea’s symptoms, risks, and treatments, nurses can play an essential role in controlling its spread and ensuring patients receive timely care. Proper education, screening, and treatment can help reduce complications and prevent reinfection.
You may be interested in: Gonorrhea NCLEX Questions
References:
American College of Obstetricians and Gynecologists. (2023). How to prevent STIs. Retrieved January 6, 2025, from https://www.acog.org/womens-health/faqs/how-to-prevent-stis
Centers for Disease Control and Prevention. (2021). Sexually transmitted infections treatment guidelines (pp. 73–75). U.S. Department of Health & Human Services. Retrieved January 6, 2025, from https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf
Centers for Disease Control and Prevention. (2021). Gonorrhea: Treatment recommendations for adults. U.S. Department of Health & Human Services. Retrieved January 6, 2025, from https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm
World Health Organization. (2024). Gonorrhoea (Neisseria gonorrhoeae infection). Retrieved January 6, 2025, from https://www.who.int/news-room/fact-sheets/detail/gonorrhoea-(neisseria-gonorrhoeae-infection)