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AIDS Watch: Gonorrhea Gone Wild

There is no applause for the new clap.

by Kelly A. McCann

Kelly McCann

While the exact time of gonorrhea’s arrival on the world stage is unknown, we do know the disease has been around for a long time. A review of the Acts of the Parliament show the English enacted a law to reduce the spread of the “infirmity of burning” in 1161. Other historical records from the middle ages suggest sailors with gonorrhea were treated with mercury injections into the urinary meatus (that’s the hole in the end of the penis—yikes!). Despite Parliament’s good intentions and the work of doctors and public health officials over the last 850 years, the “burn” is still with us.

Since its onset, the disease has been known by many names, some of which describe a symptom of the infection, like “the burn” or “the drip.” Probably the most often-used slang term for gonorrhea is “the clap,” and there exists some debate as to the origins of that term. One school of thought is that the term comes from the French word for brothel, clapoir, where undoubtedly one could contract gonorrhea. The other theory as to the origin of “the clap” has to do with the treatment for the condition. Gonorrhea and its accompanying pus or discharge can cause a blockage in the penis. In order to dislodge the blockage, the old-school treatment involved striking the penis with a mallet or “clapping” it inside a large book. (We’ll now take a moment to catch our breath and uncross our legs before we continue….)

Whatever you choose to call it, gonorrhea is a very common sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae, named after Albert Neisser, the physician who discovered the organism in 1876. (Just in case you need to know for your next game of Jeopardy!, Neisser was also the co-discoverer of the causative agent for leprosy, but his partner, Hansen, got all the glory.)

According to CDC estimates, more than 700,000 Americans contract gonorrhea each year, but only about half of those infections are reported. That could be due, in part, to the fact that some people do not experience any symptoms. Typically, however, symptoms of gonorrhea appear within two to five days following infection. (This column focuses on genital symptoms of gonorrhea, but remember: one can contract the disease in the anus and the throat, as well.)

In men, symptoms may include burning during urination (and we’re not talking about a slight stinging—we’re talking about peeing razor blades) and a white, green, or yellowish discharge from the penis. Without treatment, men can develop painful and swollen testicles due to epididymitis, an inflammatory condition affecting the sperm-making structure connected to the testicle. This can lead to permanent infertility.

Most women infected with gonorrhea have no symptoms. Even if women show some symptoms, they are often so mild or unspecific they may go unnoticed or be misdiagnosed as a bladder or vaginal infection. Early symptoms of a gonorrheal infection in women may include burning sensation during urination, increased vaginal discharge, or bleeding between periods. Long-term, untreated gonorrhea infection can lead to serious complications such as Pelvic Inflammatory Disease (PID), a chronic and painful condition; infertility; and potentially life-threatening ectopic pregnancy.

Gonorrheal infection can spread to the bloodstream, causing fever, rash, arthritis-like joint pain and even problems with heart valves. And remember, as with all sexually transmitted diseases, infection with gonorrhea makes it easier for one to contract HIV. Some studies suggest a person infected with gonorrhea is three times more likely to contract HIV if exposed.

So how does one know if he has gonorrhea? And what can one do if he has it? Gonorrhea can be diagnosed using a urine test or a Gram stain, wherein a sample of the discharge is examined under a microscope. Treatment for gonorrhea involves the use of antibiotics to knock it out. Simple enough, right?

Not any more. Researchers from England, Australia, Taiwan, and the United States have all recently released disturbing reports warning of a potentially incurable form of gonorrhea.

Formerly, penicillin easily killed the gonorrhea bacteria. But the disease evolved, and by 1985 penicillin was no longer effective. Since that time, likely due to improper use of medications, gonorrhea has continued to develop resistance to other classes of antibiotics. Only one class of antibiotics, the cephalosporins, remains effective against gonorrhea.

Now some strains are even beginning to show signs of resistance to those drugs, and that is a cause for great concern. Gonorrhea could soon become a very difficult infection to treat unless new and more effective antibiotics can be developed by pharmaceutical companies.

In the meantime, prevention is the best defense against gonorrhea, and everyone knows that means condoms. Regardless of the activity one engages in (oral-genital contact, oral-anal contact, or oral/anal/vaginal intercourse), use of a condom or other effective barrier will drastically reduce the likelihood of infection with gonorrhea.

So, correct and consistent use of condoms every time you have sex should help keep you and your partner safe. Now that deserves a round of applause.

Kelly McCann is the chief executive officer of AIDS Foundation Houston. Read her blog at

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