Table Of ContentGONORRHEA
Anthrax Meningitis
Campylobacteriosis Mononucleosis
Cholera Plague
Escherichia coli
Polio
Infections
SARS
Gonorrhea
Smallpox
Hepatitis
Streptococcus
Herpes
(Group A)
HIV/AIDS
Syphilis
Influenza
Toxic Shock
Lyme Disease
Syndrome
Mad Cow Disease
Tuberculosis
(Bovine Spongiform
Encephalopathy) Typhoid Fever
Malaria West Nile Virus
GONORRHEA
Linda Kollar
and
Brian R. Shmaefsky
CONSULTING EDITOR
The Late I. Edward Alcamo
Distinguished Teaching Professor of Microbiology,
SUNY Farmingdale
FOREWORD BY
David Heymann
World Health Organization
®
COVER: Neisseria gonorrhoeae,the bacterium that causes gonorrhea,is shown
here.This image was taken with a transmission electron microscope and is
magnified 45,000 times.
Dedication
We dedicate the books in the DEADLYDISEASESANDEPIDEMICSseries to Ed Alcamo,
whose wit,charm,intelligence,and commitment to biology education were
second to none.
CHELSEA HOUSE PUBLISHERS
VP,NEWPRODUCTDEVELOPMENT Sally Cheney
DIRECTOROFPRODUCTION Kim Shinners
CREATIVEMANAGERTakeshi Takahashi
MANUFACTURINGMANAGER Diann Grasse
Staff for Gonorrhea
EXECUTIVEEDITORTara Koellhoffer
ASSOCIATEEDITORBeth Reger
EDITORIALASSISTANTKuorkor Dzani
PRODUCTIONEDITORNoelle Nardone
PHOTOEDITORSarah Bloom
SERIESDESIGNERTerry Mallon
COVERDESIGNER Keith Trego
LAYOUT21st Century Publishing and Communications,Inc.
©2005 by Chelsea House Publishers,
asubsidiary ofHaights Cross Communications.
All rights reserved.Printed and bound in the United States ofAmerica.
®
http://www.chelseahouse.com
First Printing
1 3 5 7 9 8 6 4 2
Library ofCongress Cataloging-in-Publication Data
Kollar,Linda.
Gonorrhea / Linda Kollar and Brian Shmaefsky ;foreword by David Heymann.
p.cm.—(Deadly diseases and epidemics)
Includes bibliographical references and index.
ISBN 0-7910-7593-1 (hardcover)—ISBN 0-7910-8377-2 (pbk.)
1.Gonorrhea.I.Shmaefsky,Brian.II.Title.III.Series.
RC202.K64 2005
616.95'15—dc22
2005003284
All links and web addresses were checked and verified to be correct at the time
ofpublication.Because ofthe dynamic nature ofthe web,some addresses and
links mayhave changed since publication and may no longer be valid.
Table of Contents
Foreword
David Heymann, World Health Organization 6
1. A Teen’s Experience With Gonorrhea 8
2. History of Gonorrhea and
Sexually Transmitted Diseases 14
3. What Is Gonorrhea and How Does
It Affect the Body? 29
4. Symptoms and Diagnosis 49
5. Treatments and Complications
of Gonorrhea 67
6. Gonorrhea in the World Today 81
7. The Future of Gonorrhea 91
Glossary 99
Bibliography 103
Further Reading 107
Websites 108
Index 109
Foreword
In the 1960s, many of the infectious diseases that had terrorized
generations were tamed. After a century of advances, the leading
killers ofAmericans both young and old were being prevented with
new vaccines or cured with new medicines.The risk ofdeath from
pneumonia, tuberculosis (TB), meningitis, influenza, whooping
cough,and diphtheria declined dramatically.New vaccines lifted the
fear that summer would bring polio,and a global campaign was
on the verge of eradicating smallpox worldwide. New pesticides
like DDT cleared mosquitoes from homes and fields,thus reducing
the incidence of malaria,which was present in the southern United
States and which remains a leading killer of children worldwide.
New technologies produced safe drinking water and removed the
risk of cholera and other water-borne diseases. Science seemed
unstoppable.Disease seemed destined to all but disappear.
But the euphoria ofthe 1960s has evaporated.
The microbes fought back. Those causing diseases like TB
and malaria evolved resistance to cheap and effective drugs.The
mosquito developed the ability to defuse pesticides.New diseases
emerged, including AIDS, Legionnaires, and Lyme disease. And
diseases which had not been seen in decades re-emerged, as the
hantavirus did in the Navajo Nation in 1993. Technology itself
actually created new health risks. The global transportation
network, for example, meant that diseases like West Nile virus
could spread beyond isolated regions and quickly become global
threats.Even modern public health protections sometimes failed,
as they did in 1993 in Milwaukee,Wisconsin,resulting in 400,000
cases of the digestive system illness cryptosporidiosis. And,
more recently,the threat from smallpox,a disease believed to be
completely eradicated, has returned along with other potential
bioterrorism weapons such as anthrax.
The lesson is that the fight against infectious diseases will
never end.
In our constant struggle against disease, we as individuals
have a weapon that does not require vaccines or drugs, and that
is the warehouse of knowledge.We learn from the history of sci-
6
ence that “modern” beliefs can be wrong. In this series of
books, for example, you will learn that diseases like syphilis
were once thought to be caused by eating potatoes.The inven-
tion of the microscope set science on the right path.There are
more positive lessons from history.For example,smallpox was
eliminated by vaccinating everyone who had come in contact
with an infected person. This “ring” approach to smallpox
control is still the preferred method for confronting an
outbreak,should the disease be intentionally reintroduced.
At the same time,we are constantly adding new drugs,new
vaccines,and new information to the warehouse.Recently,the
entire human genome was decoded.So too was the genome
of the parasite that causes malaria. Perhaps by looking at
the microbe and the victim through the lens of genetics
we will be able to discover new ways to fight malaria,which
remains the leading killer of children in many countries.
Because ofadvances in our understanding ofsuch diseases
as AIDS, entire new classes of anti-retroviral drugs have
been developed.But resistance to all these drugs has already
been detected, so we know that AIDS drug development
must continue.
Education, experimentation, and the discoveries that
grow out ofthem are the best tools to protect health.Opening
this book may put you on the path of discovery. I hope so,
because new vaccines,new antibiotics,new technologies,and,
most importantly, new scientists are needed now more than
ever if we are to remain on the winning side of this struggle
against microbes.
David Heymann
Executive Director
Communicable Diseases Section
World Health Organization
Geneva,Switzerland
7
1
A Teen’s Experience
With Gonorrhea
Every year, Roger sees his family doctor for a physical exam before football
season begins.This year,Roger is going to be a senior in high school,and he
islooking forward to a great season as the team’s starting quarterback.After
enjoying himself over the summer, hanging out with friends, and dating
some girls he metat the beach,he’s ready to face the tough football work-
outs and academic demands that await him when school starts next week.
The doctor reviews Roger’s physical health and injuries since last
season.Other than a sprained ankle he got playing soccer in the spring,
which healed quickly,Roger has been lucky enough to remain injury-free
throughout his sports career.The doctor is happy to note this.Next,the
doctor asks Roger about his use of drugs and alcohol and questions
whether he is sexually active.Thankful that his mother has not come with
him to the appointment, Roger tells the doctor honestly that he has
never used drugs,but admits that he had sex with two girls he met at the
beachoverthe summerand used a condommost of the time—although
there were a few instances when he forgot to use protection.This raises a
red flag for the doctor. Although Roger shows no signs of any sexually
transmitted diseases (STDs), the doctor recommends that he be tested
for gonorrhea and chlamydia, two of the most common STDs in the
United States.Roger is told that he can either urinate into a cup and have
his urine tested or he can have the doctor take a specimen from his penis
with a cotton-tipped applicator. Roger chooses the urine test and heads
offtothe bathroom with the specimen cup.
8
A few days after his visit to the doctor’s office, Roger
receives a phone call at home.Again grateful that his parents
aren’t there,he listens in disbelief as the doctor explains that
his urine test has come back positive for gonorrhea.Now he
realizes that he’s probably going to have to tell his parents
about hissexual activity—and be treated for a serious illness.
Gonorrhea is one of the oldest and best-known STDs.
Caused by a bacteriumcalled Neisseria gonorrhoeae,the disease
has been described by medical experts dating as far back
as 3500 B.C. The name gonorrhea comes from Latin, and
literally means “flowing of the gonads,”a reference to the pus
that sometimes flows from the genitourinary tractof infected
individuals (Figure 1.1). Over the past 60 years or so in the
United States, gonorrhea has come to be known by a wide
variety of slang names,such as “the clap,”“the drips,”“race-
horse,” and “whites.” Despite its potential to cause serious
problems,as recently as the 1970s,some American men actually
considered getting gonorrhea a sign of manhood.
Neisseria gonorrhoeae,like other members of the Neisse-
riaceae family of bacteria, normally thrives in the mucous
membranes.This particular member is limited to the genito-
urinary system. Because of its spherical shape, Neisseria
gonorrhoeae is sometimes called gonococcus, meaning “the
round bacteria ofthe genitals”(Figure 1.2).
Gonorrhea is almost exclusively spread through sexual
contact. In men, the Neisseria gonorrhoeae bacteria enter the
urethrawhenthe penis comes in contact with infected vaginal
mucus during sexual intercourse, or other fluids during anal
intercourse. The bacteria then use special chemicals to bind
to the cells of the urethra.In women,the gonorrhea-causing
bacteria are generally found lining the cervix, urethra, and
vagina. Women typically acquire gonorrhea from sexual
contact with the semenofan infected man.
The gonorrhea bacterium can hide from the body’s
immune system for 7 to 14 days after a person is first infected.
9
