Gonorrhea is the second most frequent bacterial STI after Chlamydia with more than 800,000 cases expected this year. Unfortunately protective immunity does not exist so recurrences appear common. Teens and young adults bear the brunt of the disease.
Risk factors include having a new sex partner, a partner who has other partners, exchanging sex for money or drugs and of course having multiple partners. While men having sex with men accounted for about 4% of cases in 1990, this group now represents in excess of 40% of infections. Worse yet gonorrhea appears to facilitate transmission of HIV/AIDS.
After a very brief incubation, men generally promptly develop symptoms of urethral discharge and pain on urination. More than 50% of infected women remain asymptomatic with gonorrhea primarily targeting the cervix. Some may experience urethritis, dysuria or bleeding between periods. PID and infertility may result without adequate treatment.
After establishing the diagnosis, treatment includes a combination of an extended spectrum cephalosporin and Azithromycin. In the past few years the bacteria responsible for gonorrhea seem to be increasingly resistant to standard treatments. Oropharyngeal infection regularly resists treatment.