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Gonorrhea used to be perhaps the most easily treatable of all the sexually transmitted infections, a single shot of penicillin usually enough to stop it almost as soon as it started. Now gonorrhea has to be treated with a combination of antibiotics.

Every year, the US Centers for Disease Control estimate, about 700,000 people in the United States alone are infected with gonorrhea, only about half of them going to see a doctor for treatment. Rates of infection in the various states of the United States vary drastically, from just 7 per 100,000 in Idaho and 8 per 100,000 in Vermont to 246 persons per 100,000 in Mississippi and 433 per 100,000 in Washington, D.C.  

There are as many as 200,000,000 new cases of gonorrhea annually worldwide, with relatively low rates of infection in North America and Europe and relatively high rates of infection in Southeast Asia and the Republic of South Africa.

Who Is Mostly Likely to Get Gonorrhea?

Women are about 20% more likely to become infected with gonorrhea than men, although men who have sex with men are the most likely to become infected with strains of the disease that cannot be treated with antibiotics. Men are far more likely to show their symptoms of the disease (painful urination, discharge, and a kind of muscle tension known as tenesmus) than women are to show their symptoms of the disease (infrequent urination, itching, painful urination, pelvic pain, and sometimes serious complications in pregnancy).

Gonorrhea can affect the genital tracts of both sexes, the rectum, the throat, and the eyes. Fellatio is more likely to cause infection than cunnilingus. Certain racial groups tend to have more infections than others, although there is nothing about the infectious microorganism itself that prefers one race over another. Gonorrhea in the eye can rapidly result in loss of the eye and blindness. In men, gonorrhea can result in sterility. In women, in rare instances, gonorrhea can result in death.

Treating Gonorrhea Is More Difficult Than It Used to Be

Some doctors commenting on modern gonorrhea treatment say that it used to be that "all you needed to do was to wave a vial of penicillin at the patient" and gonorrhea was easily cured. As recently as 2001, about 99.4% of cases of gonorrhea in the United States could be resolved with a single dose of penicillin. In 2011, however, the US Centers for Disease Control reported that:

  • 11.8% of cases could no longer be treated with penicillin;
  • 13.3% of cases could no longer be treated with antibiotics of a class known as the fluoroquinolones (including drugs like Cipro);
  • 22.7% of cases could no longer be treated with tetracycline.

What this means that the days of discovering you have gonorrhea, or having been told your sex partner has gonorrhea, and getting it treated with a pill or a shot are over. Nowadays, the standard of care is a shot of an antibiotic called ceftriaxone plus either a shot or a pill of an antibiotic called azithromycin (which isn't cheap) or seven days of treatment with an antibiotic called doxycycline twice a day for seven days. It can be necessary to re-test for gonorrhea even after taking antibiotics for a full week.

There isn't any alternative to antibiotics if you want to make sure you get gonorrhea out of your life. But there are ways you can avoid getting the infection in the first place.

Continue reading after recommendations

  • Brown T. Multidrug-Resistant Gonorrhea: New Treatment Guidelines. Available at Accessed July 1, 2013.
  • [Guideline] CDC. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007. 56(14):332-6.
  • Photo courtesy of ★ spunkinator by Flickr :
  • Photo courtesy of Peter V. Hernandez by Flickr :

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