Gonorrhea; Diagnosis

Gonorrhea; Diagnosis

What makes gonorrhea so harmful is that a person can be infected for months and never know it. When symptoms occur, they often are mild, usually a burning sensation when urinating or vaginal discharge. Women may also experience pain in the pelvic area or discomfort during sex. If these symptoms are ignored and the infection goes untreated, the bacteria often spread from the cervix into the uterus, fallopian tubes and ovaries, causing pelvic inflammatory disease (PID), characterized by inflammation and scarring, primarily of the fallopian tubes, that leads to infertility or tubal pregnancies.

PID is comprised of various inflammatory disorders of the upper genital tract, including endometritis and tubo-ovarian abscess. PID is difficult to diagnose. Its signs and symptoms vary widely and many women have only subtle symptoms. Other women experience severe pelvic pain, especially during intercourse. Diagnosis is most frequently based on clinical presentations, such as lower abdominal pain and physical findings like tenderness on palpation of the pelvic organs during a pelvic exam. These findings can be supplemented with laboratory detection of chlamydia and /or gonorrhea from genital specimens. Rarely, diagnosis requires laparoscopy, during which a scope is inserted near or through the belly button to examine the pelvic area. The procedure, however, is expensive and not done routinely.

Because gonorrhea is often present in women without recognizable symptoms, more health care professionals are routinely testing young women for gonorrhea and chlamydia, particularly if they have a history of high-risk behaviors, which include having unprotected sex and multiple sex partners. Routine testing for gonorrhea also is recommended for pregnant women because infection can cause harm to both the mother and infant. However, don’t assume your provider will automatically test you. To be on the safe side, you should ask specifically to be tested for sexually transmitted diseases (STDs).

Gonorrhea is diagnosed using three techniques:

Gram stain

Culture

NAATs (nucleic acid amplification tests) using swab specimens from the cervix or urine

Often, two of these tests are used together to confirm a positive diagnosis. A Gram stain involves taking a cervical specimen with a swab during a pelvic exam, placing it on a slide, and staining it with dye. Examining the slide under a microscope can detect the presence of bacteria. Another approach is to culture a cervical specimen for at least 48 hours to identify the presence of gonorrhea. Specimens from the throat and rectum may also be tested.

The NAATs detect the DNA material of the gonorrhea and /or the chlamydia organisms. The tests are rapid, meaning you can get your results back in 24 hours or less. The advantage of these tests is that urine specimens can be used instead of cervical specimens.

In 2001,the U.S. Food & Drug Administration (FDA) approved a NAAT test called the Hybrid Capturer 2 (Digene Corp.) that can use either urine or cervical specimens to diagnose both gonorrhea and chlamydia. As DNA tests become more accurate, fewer healthcare professionals are relying on the Gram’s stain, which is reliable in only about half of all women, and culture testing, which can delay diagnosis by several days.

References

Centers for Disease Control and Prevention. “STD Facts: Gonorrhea.” December 2003. Accessed June 12, 2004.

Centers for Disease Control and Prevention. “Sexually Transmitted Diseases Treatment Guide.” May 10, 2002. Vol. 51. No. RR-6.

Centers for Disease Control and Prevention. “Increasing Cases of Drug-Resistant Gonorrhea Prompt New Treatment Recommendation for Gay and Bisexual Men.” Press Release. April 29, 2004. http://www.cdc.gov. Accessed June 14, 2004.

National Institute of Allergy and Infectious Diseases. “Health Matters: Gonorrhea.” May 2002. http://www.niaid.nih.gov. Accessed June 14, 2004.

“FDA Proposes New Warning for Over-the-Counter Contraceptive Drugs Containing Nonoxynol-9.” FDA Talk Paper, January 16, 2003. http://www.fda.gov. Accessed March 2003.

“Introduction to STDs, gonorrhea.” American Social Health Association. Copyright 2001. http://www.ashastd.org. Accessed 2002.

“1998 Guidelines for Treatment of Sexually Transmitted Diseases.” Centers for Disease Control and Prevention. MMWR, 1998;Vol. 47;No. RR-1. http://www.cdc.gov. Accessed Jan. 2002.

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002:51 (No. RR-6)

“What you need to know about gonorrhea.” Connett, H. STD Advisor, 1999; Vol. 2. Insert.

The Hidden Epidemic: Confronting Sexually Transmitted Diseases.” Institute of Medicine. Washington, D.C.: National Academy Press, 1997.

“Gonorrhea Fact Sheet” JAMA Women’s Health. Updated Jan. 2000. http://www.ama-assn.org. Accessed Jan. 2002.

“Facts About Drug-Resistant Gonorrhea” Centers for Disease Control and Prevention. Sept. 2000. http://www.cdc.gov. Accessed Jan. 2002.

“Research in Progress” Canadian Institutes of Health Research. http://www.cihr.ca. Accessed Jan. 2002.

“Safer Sex (WSM) for Women who Have Sex with Women” Igbthealth Channel. Modified Nov, 8, 2002. http://www.gayhealthchannel.com. Accessed Nov. 2002.

Digene Corporation Announces FDA Clearance for CT/GC Test Rapid Capture System Application. News Release. Oct. 2001. http://www.digene.com. Accessed Dec. 2002.

Current and Future Treatment of Child Arthritis. Hospital for Special Surgery. July 2002. http://www.rheumatology.hss.edu. Accessed Dec. 2002.

Keywords: gonorrhea, pelvic inflammatory disease, pid, symptoms, chlamydia, diagnosis

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