Gonorrhea - Male

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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 intercourse, including vaginal, 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 (the State Board of Health). This allows for adequate follow-up and testing of sexual contacts. This is important because an estimated 90% of an infected male's sex contacts are or will become infected. In the male, the risk of acquiring gonorrhea following one episode of vaginal intercourse with an infected female is approximately 20% (1 in 5).

There are almost 400,000 cases of gonorrhea a year reported to the CDC (Centers for Disease Control). There are probably many cases that are diagnosed and treated that are not reported as required (the total number of cases is thought to approach 1,000,000. If unreported cases are included, some estimates reach 2,000,000). However, a rate of 400,000 cases per year means that 1 in every 687 Americans has gonorrhea (a rate of two million means that 1 in every 130 Americans are infected).

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

The causative organism can infect the throat, producing a severe sore throat (gonococcal pharyngitis); the urethra, causing urethritis with burning, painful urination, and a discharge; it may also infect the anus and rectum, producing a condition called proctitis. In addition, the organism may spread from the urethra to other portions of the reproductive tract producing epididymitis (infection of the epididymis, a structure attached to the testicle), prostatitis (inflammation of the prostate gland), and various other conditions such as periurethral abscess (a collection of pus around the urethra).

Untreated gonorrhea may lead to urethral stricture (narrowing of the urethra caused by scarring), which can result in decreased urine flow, incomplete emptying of the bladder, urinary tract infection and ultimately kidney failure.

The average incubation for gonorrhea is approximately 2 to 5 days following sexual contact with an infected partner. However, symptoms may appear as late as 2 weeks. The most common initial symptom is a discharge from the urethra that is either mucus-like (clear or whitish discharge) or purulent (thick, yellowish, pus-like discharge). It appears at the opening of the penis and may stain the underwear. Other initial symptoms include painful urination and urethral burning. A small number of men will be without symptoms (asymptomatic).

Other sites of infection are relatively common. Gonorrhea infection of the rectal area (anorectal gonorrhea) can occur in men who have anal intercourse (it is also found in approximately 50% of women with gonorrhea). A majority of people with anorectal gonorrhea are symptom-free, but when symptoms are present they are typical of proctitis. A small percentage of people with gonorrhea have only a throat infection (gonococcal pharyngitis). Ten to 25% of homosexual men with gonorrhea also have pharyngeal infection, while 10 to 20% of women with gonorrhea have pharyngeal gonorrhea.

Gonococcal conjunctivitis (eye infection) is very rare in adults. It is normally seen only in infants delivered to mothers with gonorrhea, and is called ophthalmia neonatorum.

Gonorrhea can be transmitted simultaneously with other sexually-transmitted diseases.