Gonorrhea, a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae, has become increasingly common in recent years. According to the Centers for Disease Control and Prevention (CDC), reported cases of gonorrhea increased by 63% from 2009 to 2014. In 2018 alone, 583,405 cases of gonorrhea were reported in the United States. But why has this STI become so widespread?
Ways gonorrhea spreads
Gonorrhea spreads through unprotected oral, anal, or vaginal sex with an infected partner. It can infect the genitals, rectum, and throat. Gonorrhea can also spread from a mother to her baby during childbirth. Some key reasons gonorrhea transmission is so common include:
- Many people with gonorrhea are asymptomatic and unaware they have the infection. This allows them to unknowingly spread it to partners.
- Condoms do not provide 100% protection against gonorrhea, especially when infected skin is not covered by the condom.
- Untreated gonorrhea can persist in the body for months or years, allowing for continued spread.
- Gonorrhea can develop resistance to antibiotics, making infections harder to treat.
Risk factors
Certain social and behavioral factors put people at increased risk of contracting and spreading gonorrhea. Risk factors include:
- Having multiple or anonymous sexual partners
- Not using condoms consistently and correctly
- Having previous STIs
- Exchanging sex for money or drugs
- Being between the ages of 15-24 years old
- Living in crowded urban areas and lower socioeconomic statuses
When these risk factors are common within a community, gonorrhea is more likely to spread. Some populations, such as adolescent girls, sexual minorities, and people living in poverty, carry a higher burden of these risks.
Biological factors
Certain biological factors allow gonorrhea to spread efficiently:
- Gonorrhea can infect and persist in multiple body sites: cervix, urethra, rectum, pharynx
- Gonorrhea has a short incubation period of 2-7 days on average
- The bacteria can shed from the body even when no symptoms are present
- Gonorrhea can mix with other fluids and infect partners through vaginal, anal, and oral sex
The bacteria’s basic reproductive physiology enables it to spread rapidly through unprotected sexual networks.
Lack of education
Insufficient education about gonorrhea transmission and prevention allows misinformation to spread. Key knowledge gaps include:
- Not understanding asymptomatic spread of STIs
- Believing condoms fully protect against gonorrhea
- Failing to get tested regularly, especially when asymptomatic
- Not knowing untreated gonorrhea can cause serious complications like infertility
Comprehensive sex education in schools and public health campaigns are necessary to raise awareness.
Difficulties accessing healthcare
Barriers to accessing high-quality sexual healthcare also enable the spread of gonorrhea. Issues include:
- High costs and lack of health insurance coverage
- Shortages of primary care doctors and STI specialists
- Distance from and hours of clinics
- Stigma surrounding STIs and sexuality
- Language and cultural barriers
- Fear related to immigration status
When people cannot access STI testing and treatment conveniently and comfortably, infections go undetected and spread.
Changes in sexual behaviors
Shifts in sexual norms and behaviors may also be contributing to gonorrhea transmission:
- Higher numbers of lifetime sexual partners
- Higher frequency of casual sex and “hookup culture”
- Using dating apps to arrange anonymous sexual encounters
- Lower rates of condom use with non-regular partners
- Increased oral and anal sex compared to vaginal sex
These provide more opportunities for gonorrhea to spread between overlapping sexual networks.
Travel and urbanization
Human mobility and urbanization help gonorrhea spread geographically:
- International travel allows strains of gonorrhea to cross borders
- Domestic travel spreads gonorrhea between urban and rural areas
- Densely populated cities enable transmission between many sexual networks
- Anonymity of sexual encounters in urban areas
Mobile populations rapidly spread gonorrhea to new areas before health systems can respond.
Conclusion
Gonorrhea has become so widespread due to a combination of biological, social, behavioral, and structural factors. Understanding these drivers is key for policymakers and public health professionals to control this epidemic. Comprehensive solutions must address transmission dynamics as well as underlying risks in vulnerable populations. With ongoing efforts, the rising tide of gonorrhea can be stemmed.
Frequently Asked Questions
What is gonorrhea?
Gonorrhea is a common sexually transmitted bacterial infection caused by Neisseria gonorrhoeae bacteria. It can infect the genitals, rectum, and throat. Gonorrhea spreads through unprotected oral, anal, or vaginal sex with an infected partner.
How common is gonorrhea?
Gonorrhea is one of the most commonly reported bacterial infections in the United States. In 2018, over 580,000 gonorrhea cases were reported to the Centers for Disease Control and Prevention (CDC). Estimates suggest the actual number of annual infections may be closer to 1.14 million.
What are the signs and symptoms of gonorrhea?
Many people with gonorrhea are asymptomatic. When present, signs and symptoms can include a burning sensation while urinating, yellow or green discharge from the penis or vagina, swollen testicles, pain or bleeding during sex, itching, sore throat, and painful bowel movements.
How does someone get gonorrhea?
Gonorrhea is transmitted through unprotected oral, anal, or vaginal sex with an infected partner. It can infect the penis, testicles, vagina, cervix, anus, urethra, eyes, and throat. Gonorrhea can also spread from an untreated mother to her baby during childbirth.
How is gonorrhea diagnosed?
Gonorrhea is usually diagnosed using a urine test, a swab of the infected site, or a blood test. Some of the most accurate gonorrhea tests use nucleic acid amplification tests (NAATs) to detect the bacteria’s genetic material in body fluids. Home test kits are also becoming available.
Can gonorrhea be cured?
Yes, gonorrhea can be cured, usually with antibiotics such as ceftriaxone and azithromycin given together in one shot. It is important to complete the full course of treatment and avoid re-infection. Untreated gonorrhea can increase the risk of serious complications.
What are complications of untreated gonorrhea?
Complications of untreated gonorrhea in women include pelvic inflammatory disease, ectopic pregnancy, and infertility. In men, complications include epididymitis and infertility. Gonorrhea can also spread to the blood and joints. Rarely, it can cause blindness if it infects the eyes.
Who is at risk for gonorrhea?
Those at highest risk include sexually active women under age 25, people with multiple sex partners, those who do not use condoms consistently, people with a history of gonorrhea or other STIs, sex workers, and men who have sex with men.
How can someone reduce their risk of getting gonorrhea?
Abstaining from sex, maintaining a mutually monogamous relationship, and using latex condoms correctly every time you have sex can reduce gonorrhea risk. Limiting sexual partners and getting regularly tested for STIs also helps lower risk. Having open conversations about sexual history and protection can help prevent spread.
How can the spread of gonorrhea be reduced?
Strategies to reduce gonorrhea spread include improving access to sexual healthcare, testing and treating infections early, increasing condom use, training healthcare providers, tracking antibiotic resistance, developing new treatments, and promoting comprehensive sex education.
Key Statistics
U.S. Gonorrhea Rates
The table below shows gonorrhea rates in the United States from 2009-2018, as reported by the Centers for Disease Control and Prevention (CDC).
| Year | Number of Reported Cases | Rate per 100,000 Population |
|---|---|---|
| 2009 | 301,174 | 99.1 |
| 2010 | 309,341 | 100.8 |
| 2011 | 321,849 | 104.2 |
| 2012 | 334,826 | 109.1 |
| 2013 | 333,004 | 105.3 |
| 2014 | 350,062 | 110.7 |
| 2015 | 395,216 | 123.9 |
| 2016 | 468,514 | 145.8 |
| 2017 | 555,608 | 171.9 |
| 2018 | 583,405 | 179.1 |
Gonorrhea rates increased by 63% from 2009 to 2014, and have continued to rise. In 2018, the rate reached 179.1 cases per 100,000 population, the highest level recorded since 1991.
Gonorrhea Cases by State
Prevalence of reported gonorrhea cases varies widely by state. The map below shows gonorrhea rates per 100,000 people by state in 2018.
Source: CDC
The Southern United States has particularly high rates of reported gonorrhea cases. In 2018, Mississippi, Louisiana, South Carolina, Alabama, and North Carolina had the highest incidences of gonorrhea, all over 200 cases per 100,000 people.
Gonorrhea Cases by Age and Gender
In the United States, gonorrhea infection rates are highest among adolescents and young adults. The table below shows gonorrhea rates by age and gender in 2018.
| Age Group | Rate per 100,000 Males | Rate per 100,000 Females |
|---|---|---|
| 15-19 years | 452.1 | 848.8 |
| 20-24 years | 982.4 | 1340.4 |
| 25-29 years | 617.9 | 528.5 |
| 30-39 years | 233.4 | 159.9 |
| 40-54 years | 54.5 | 32.5 |
Source: CDC
Adolescent girls and young women face exceptionally high gonorrhea rates. Men also have higher rates than women by age 30. Targeted outreach to these high-risk groups is important for public health.
Antibiotic Resistance
Gonorrhea has developed resistance to many antibiotics over time:
| Antibiotic | Year Resistance Detected |
|---|---|
| Sulfonamides | Late 1930s |
| Penicillins | Mid 1940s |
| Tetracyclines | Mid 1950s |
| Fluoroquinolones | Late 1990s |
| Azithromycin | Early 2000s |
| Cephalosporins | 2010s |
Antibiotic resistance makes gonorrhea much harder to treat and control. Research into new treatment options is a high priority.
Conclusion
Gonorrhea has reached epidemic levels in the United States due to a convergence of social, behavioral, biological, and structural factors that promote transmission. Raising awareness, reducing barriers to care, developing new treatments, and targeted public health interventions for high-risk groups are all necessary to curtail this widespread and common sexually transmitted infection.