Gonorrhea - Female

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Overview, Causes, & Risk Factors

Gonorrhea is one of the most common infectious bacterial diseases and is most frequently transmitted during sexual activity, including vaginal intercourse and both oral and anal sex. Gonorrhea is a reportable disease and all state governments require that cases of diagnosed gonorrhea be reported to the health authorities (State Board of Health). This allows for adequate follow-up and testing of sexual contacts.

There are almost 400,000 cases of gonorrhea reported to the CDC (Centers for Disease Control and Prevention) each year in the United States. There are probably many cases that are treated but not reported. The total number of cases is thought to approach 1,000,000; if unreported cases are included, some estimates reach 2,000,000. A rate of 400,000 cases per year means that 1 out of every 687 Americans has gonorrhea. A rate of 2 million means that 1 in every 130 Americans are infected.

Gonorrhea is more common in large metropolitan areas, inner-city areas, populations with lower overall levels of education and people with lower socioeconomic status. Gonorrhea is most prevalent in people 15 to 29 years old. Risk factors include having multiple sexual partners, having a partner with a past history of any STD, and having unprotected sex (sex without the use of a condom).

Gonorrhea is easily transmitted during oral, vaginal, or anal sex. The bacteria can infect the throat, producing a severe sore throat (gonococcal pharyngitis). It can infect the vagina, causing irritation with drainage (vaginitis), or the anus and rectum, producing a condition called proctitis. In addition, the organisms may spread up the female reproductive tract, through the cervix and uterus, into the fallopian tubes (the tubes that carry the egg from the ovaries to the uterus).

When the infection spreads into the fallopian tubes, the infection is called PID or pelvic inflammatory disease. This occurs in 10% to 15% of women with untreated gonorrhea. If the bacteria spreads beyond the fallopian tubes, it can spread into the abdominal space and cause a severe infection, peritonitis. The bacteria can also spread to the blood stream causing gonococcemia and may settle in a joint causing gonococcal arthritis.

On rare occasions gonorrhea can spread through non-sexual contact. An infected woman may transmit the infection to her newborn during childbirth. Infection of the newborn's eyes is called ophthalmia neonatorum (gonococcal conjunctivitis). Young girls who contract gonorrhea either from sexual abuse or intimate contact with recently contaminated objects (such as a damp towel) develop a severe infection called vulvovaginitis.

Approximately 50% of women with gonorrhea have no symptoms (asymptomatic). They may be completely unaware that they have contracted the disease, and subsequently do not seek treatment. This increases the risk of complications and the risk of passing the infection on to other individuals.

Symptoms of gonorrhea usually appear 2 to 5 days after infection. When women have symptoms, they often note vaginal discharge, increased urinary frequency and urinary discomfort (dysuria). Spread of the organism to the fallopian tubes and abdomen may cause severe lower abdominal pain and fever.

Ultimately gonorrhea may result in scarring of the fallopian tubes and permanent sterility (inability to become pregnant). Scar tissue formation around the uterus and tubes may result in painful intercourse (dyspareunia) and chronic pelvic pain.

Gonorrhea is often associated with the presence of other sexually transmitted diseases. About half of the women with gonorrhea are also infected with chlamydia, another very common STD that can result in sterility. Women who have contracted gonorrhea should request testing for other sexually transmitted diseases including AIDS.