Modes of transmission of gonorrhea

What Is Gonorrhea?

Gonorrhea is a very common sexually transmitted disease, especially among 15- to 24-year-olds.

Gonorrhea is a sexually transmitted disease (STD) with about 820,000 new cases reported in the United States each year, according to the Centers for Disease Control and Prevention (CDC).

The disease is caused by the gonorrhea bacteria Neisseria gonorrhoeae, and is sometimes called “the clap” — for reasons unknown — or “the drip” — because of the vaginal, penile, or rectal discharge it can cause.

Gonorrhea is highly contagious. You can get it by having unprotected vaginal, anal, or oral sex with someone who has it. It can spread even if a man doesn’t ejaculate (cum) during sex.

You cannot get gonorrhea from sitting on a toilet seat, however.

Both men and women can get gonorrhea in the mouth, urethra, eyes, and anus, and in women it can also infect the cervix, uterus, and fallopian tubes.

Untreated gonorrhea can increase a person’s risk of getting or transmitting HIV.

Gonorrhea can also spread to the blood and cause a life-threatening infection, which is marked by arthritis, tendon inflammation, and skin rash.

Gonorrhea Symptoms in Women and Men

In women, gonorrhea often doesn’t cause symptoms. If it does, symptoms are often so mild they are misdiagnosed as a urinary tract infection.

Symptoms in women may include:

  • Strong-smelling vaginal discharge
  • Pain and burning while peeing
  • Peeing more often than usual
  • Pain during vaginal sex
  • Sore throat
  • Fever and severe lower abdominal pain, if the infection has spread to the fallopian tubes and stomach area

Symptoms in men might include:

  • Pain and burning while peeing
  • Peeing more often than usual
  • White, yellow, or green discharge from the penis
  • Red or swollen urethral opening
  • Sore throat

Rectal gonorrhea can cause anal discharge, itching, pain, bleeding, as well as painful bowel movements.

Gonorrhea in the throat can cause a sore throat (pharyngitis), but it usually doesn’t lead to any other symptoms. However, in rare cases, it can be passed on to other people through kissing and oral sex.

How Do You Test for Gonorrhea?

If you think you may have gonorrhea, visit your primary care doctor or gynecologist. They can conduct gonorrhea tests to see if you have the infection. Healthcare providers at health clinics and Planned Parenthood can also perform gonorrhea tests.

How much the tests cost will depend on which tests you need, where you have them done, whether or not you have health insurance, and in some cases what your income is.

Under the Affordable Care Act, many insurance plans cover STD testing, and if you have Medicaid or other government assistance, the testing may free or cost a minimal amount. Plus, some clinics, such as Planned Parenthood health centers give free or low-cost STD tests, depending on your income.

Your doctor will most likely have you give a urine sample to test for gonorrhea. The results from a urine test are usually found quickly. However, your doctor may also take samples from your throat and rectum with a swab if you’ve had anal or oral sex. Swabs may also be used to collect samples from a man’s urethra and a woman’s cervix. Results from swabs may take a little longer than a urine test.

Is Gonorrhea Curable?

Gonorrhea is curable. But since some strains of gonorrhea have become resistant to antibiotics, your doctor may give you two antibiotics to treat it, one as a shot and another as a pill.

The CDC currently recommends a shot of the antibiotic Rocephin (ceftriaxone) and an oral dose of the antibiotic Zithromax (azithromycin), given at the same time, to treat gonorrhea.

Be sure to tell those who you have sex with that you are being treated for gonorrhea so they can be treated too. This will help you avoid passing it back and forth to each other.

You should not have sex for 7 days after treatment, and you should refrain from having sex with partners who have not been treated for gonorrhea until after they have been tested and, if necessary, treated.

The cost of antibiotics to treat gonorrhea varies. Most health insurance plans will cover it with a possible copay, depending on your plan. If you don’t have health insurance, look for affordable treatment at an STD clinic or Planned Parenthood health center.

What Happens if Gonorrhea Is Not Treated?

Women with untreated gonorrhea are at risk for serious complications, such as pelvic inflammatory disease (PID). PID may cause no symptoms or may cause pain in the pelvis, lower abdomen, or lower back. If left untreated, PID can lead to serious complications, including:

  • Chronic pelvic pain
  • Infertility (inability to get pregnant)
  • Ectopic pregnancy, in which the fertilized egg implants outside the uterus, possibly leading to internal bleeding or a ruptured fallopian tube

Pregnant women can pass gonorrhea to their baby during childbirth, which can cause blindness, a joint infection, or a deadly blood infection in their infant.

Complications of gonorrhea in men may include epididymitis, an inflammation of the epididymis, a long coiled tube at the back of the testicles that stores sperm and carries it between the testicles and the vas deferens. Epididymitis can cause testicular or scrotal pain, and, in rare cases, infertility.

Disseminated Gonococcal Infection

Gonorrhea can also spread throughout the body, a condition called systemic, or disseminated, gonococcal infection (DGI).

Symptoms of DGI commonly include joint or tendon pain, a skin rash, and fever. More advanced stages of DGI cause septic, or infectious, arthritis, in which the bacteria directly invade the joint space.

Rare complications of DGI include bacterial meningitis, pericarditis, and endocarditis— inflammation of the membranes covering the brain and spinal cord, the membrane surrounding the heart, and the inner lining of the heart, respectively.

How Can I Protect Myself From Gonorrhea?

The only way to absolutely keep yourself safe from catching gonorrhea is to avoid having vaginal, anal, or oral sex. However, since most people have sex at some point in their lives, that may be unrealistic.

But there are ways you can lower your risk of getting the disease while still being sexually active, such as the following:

  • Using a condom during vaginal or anal sex
  • Using a condom (for men) or a dental dam, which is a thin square of latex, (for women) when performing oral sex
  • Thoroughly washing sex toys — or changing the condom on them — before a new person uses them

Also, having sex with fewer partners can help reduce your risk of getting gonorrhea.

Are Gonorrhea and Chlamydia the Same Thing?

No. While gonorrhea and chlamydia are both sexually transmitted bacterial infections, they are caused by different bacteria. Still, the two diseases have many similarities: They can both affect reproductive organs in men and women, as well as the urethra, throat, and rectum. Also, both infections are spread the same way, have symptoms that resemble each other, and are treated with antibiotics.

Using condoms correctly each time you have sex can help to prevent gonorrhea and chlamydia.

It’s possible to have herpes for years and not know it. The virus may spread even when an infected person doesn’t have genital sores. However, the virus can’t survive outside the body, so it’s nearly impossible to contract from toilets, towels, or other objects.

Can you get HPV from a toilet seat?

You can’t catch human papillomavirus (HPV) from a toilet seat. HPV infections are skin conditions that affect different parts of the body, such as the cervix, anus, and mouth. Some strains of HPV have symptoms including warts on the genitals, hands, face, or scalp. One of the most common strains cause genital warts, which are highly contagious, and spread from skin-to-skin contact.

HPV can’t be killed with disinfectants, and people can be infected by medical tools harboring the virus. Pregnant women may pass the virus to unborn children. But you won’t catch it from a toilet seat.

Can you get chlamydia from a toilet seat?

Chlamydia in women can also be passed from a mother to their baby during delivery. However, chlamydia isn’t spread by toilet seats, bed linens, kissing, doorknobs, hot tubs, swimming pools, silverware, or clothes.

Chlamydia is a tiny parasitic bacterium that requires the biochemical mechanisms of a living cell to reproduce. It causes conditions like trachoma — a roughening of the inner surface of the eyelid that can lead to blindness — and urethritis, which causes painful urination. Chlamydia also causes cervicitis, vaginitis, and pelvic inflammatory disease.

Chlamydia is transmitted during unprotected sexual activity. The bacteria are found in the genital secretions of infected people. Wearing a condom during sex can greatly decrease the risk of getting chlamydia.

What infections can you get from sitting on a toilet seat?

Although the chances of getting an STI like chlamydia or gonorrhea from a toilet seat are slim to none, there are other infections you can get from a toilet seat.

The truth is, many disease-causing organisms only live a short time on the toilet seat. In order to get the infection, the germs need to be transferred into your urethral or genital tract or via a sore or cut on the thighs or buttocks.

Let’s look at some of the infections that you may need to worry about.

  • Escherichia coli, or E. coli, can be found in fecal matter. Toilets are the perfect breeding ground for this bacteria. E. coli is found in your intestines, but if you’re exposed to it from contaminated food, water, or nonporous toilet seats, you could suffer from diarrhea, abdominal cramps, and vomiting.
  • Gastrointestinal viruses like norovirus, often mistaken for “food poisoning,” cause stomach issues similar to E. coli. They are easily transmitted and can live on contaminated nonporous surfaces such as toilet seats for up to two weeks, even if the toilets were cleaned.
  • Shigella bacteria is passed from person to person, especially when people don’t wash their hands properly. Shigella infections are similar to E. coli and spread when an infected person’s feces contaminate a surface, including toilet seats, handles, and lids.
  • Streptococcus is a bacteria that causes strep throat and bronchial pneumonia. It can also cause contagious skin infections such as impetigo. Many bathrooms harbor this bacteria.

Q: Can you contract an STI from a toilet seat?

A: Well… it depends on what you’re doing on the toilet seat. Sorry – couldn’t resist.

Assuming that you’re using the toilet for its intended purpose, it’s extremely unlikely that you could catch an STI from a toilet seat. The most common organisms responsible for sexually transmitted infections cannot survive long outside the human body. Chlamydia, Gonorrhea, Syphilis, Herpes, Trichomonas, HPV and HIV all require direct skin-to-skin or body fluid contact for transmission.

If an infected individual did happen to leave semen, vaginal secretions, blood and/or saliva on a toilet seat, the organisms would then have to be present in sufficient numbers to cause infection – again, very unlikely. But even if you did sit on the porcelain throne from Hell and even if there were enough organisms left on the seat, you would also have to have some type of open wound on your backside for them to infect you since it is practically impossible for them to penetrate intact skin.

One theoretical exception might be pubic lice or “crabs.” These critters can live outside the body for up to 24 hours on sheets, clothes, towels, etc. But they really prefer to snuggle up in warm places – and their feet are not designed to walk on smooth hard surfaces – so it is highly unlikely that they would leave the cozy environment of someone’s bits and pieces for the chilly skating rink of a toilet seat.

For more information about STD prevention, look here. And please, look before you sit!

Angie Walker, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)


How is gonorrhea treated?

Gonorrhea can be cured with the right treatment. It is important that you take all of the medication prescribed by a healthcare provider to cure your infection. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not undo any permanent damage caused by the disease.

It is becoming harder to treat gonorrhea because drug-resistant strains of gonorrhea are increasing. If symptoms continue for more than a few days after receiving treatment, it will be necessary to return to a healthcare provider to be checked again. Repeat infection with gonorrhea is possible. Repeat testing for gonorrhea three months after treatment ends is recommended, even if sex partners are treated.

I was treated for gonorrhea. When can I have sex again?

You should wait seven days after finishing all medication used to treat gonorrhea before having sex. To avoid getting infected with gonorrhea again or spreading gonorrhea, you and your sex partner(s) should avoid having sex until you have each completed treatment. If you have had gonorrhea and were treated in the past, you can still get infected again if you have unprotected sex with a person who has gonorrhea.

Even if you do not have any symptoms, you can still infect your sex partners. Using condoms may help lower this risk but it will not get rid of the risk completely. If you have gonorrhea, you should tell your sex partner(s) and let him or her know so they can get tested and treated, if necessary.

What happens if I don’t get treated?

Untreated gonorrhea can cause serious and permanent health problems in both women and men. In women, untreated gonorrhea can cause pelvic inflammatory disease (PID). Some of the complications of PID are:

  • Formation of scar tissue that blocks fallopian tubes.
  • Ectopic pregnancy (pregnancy outside the womb).
  • Infertility (inability to get pregnant).
  • Long-term pelvic/abdominal pain.

In men, gonorrhea can cause a painful condition in the tubes attached to the testicles. In rare cases, this may cause a man to be sterile, or prevent him from being able to father a child. Untreated chlamydia in both men and women can also increase risk for contracting or spreading HIV, the virus that causes AIDS.

Rarely, untreated gonorrhea can also spread to your blood or joints. This condition can be life-threatening.

Common cold germs, like most viruses, die rapidly, and thus may be less of a threat than you think. “Even if you come into contact with particular viruses or bacteria, you’d have to contract them in amounts large enough to make you sick,” says Judy Daly, PhD, professor of pathology at the University of Utah in Salt Lake City.

Germs in feces can be propelled into the air when the toilet is flushed. For that reason, Philip Tierno, MD, director of clinical microbiology and diagnostic immunology at New York University Medical Center and Mt. Sinai Medical Center, advises leaving the stall immediately after flushing to keep the microscopic, airborne mist from choosing you as a landing site. “The greatest aerosol dispersal occurs not during the initial moments of the flush, but rather once most of the water has already left the bowl,” he says.

Other hot zones in public bathrooms include sinks, faucet handles, and towel dispensers. Picture someone emerging from a bathroom stall, and turning on the faucet with dirty hands, and you’ll know why faucet handles are a potentially troublesome surface. Studies at the University of Arizona in Tucson found that sinks are the greatest reservoir of germ colonies in restrooms, thanks in part to accumulations of water that become breeding grounds for tiny organisms.

“Your own immune system is your first line of defense against contracting diseases in public restrooms,” says Daly. But hand washing is a very important adjunct. Yet a survey that was part of ASM’s Clean Hands Campaign revealed this dirty little secret: Though 95% of men and women claim that they wash after using a public toilet, observations made by researchers discovered that only 67% actually do.

“Many people are unconcerned about microorganisms because you can rush out of an airport bathroom without washing your hands, and lightning won’t strike you,” says Salyers. “So these people may think that handwashing is not all that important.”

Even if you wash your hands, you may not do it properly, says Tierno, author of The Secret Life of Germs. “Some individuals move their hands quickly under a flow of water for only a second or so, and they don’t use soap. That’s not going to do much good.”

Can You Get an STD From a Toilet Seat? We Asked an Ob-Gyn for the Facts

One of the earliest lessons I remember my mother teaching me wasn’t to eat my vegetables or use my manners…it was to always squat when using a public toilet. There are germs lurking on the seat, she told me, and you do not want them on your tush. So, for years without fail, I squatted, afraid of the germs might be waiting for me if I dared to sit.

But as I got older, I started to wonder, are the germs on toilet seats really that scary? Sure, squatting might be sanitary, but do I actually have to be afraid of catching an STD if my thigh muscles fail me and my bum touches the toilet?

RELATED: What Is Chlamydia?

After consulting Health Advisory Board member Christine Greves, MD, ob-gyn at the Orlando Health Winnie Palmer Hospital for Women and Babies, I finally have the answer: No, there’s really no chance of catching an STD from a toilet seat. Okay, to be fair, there could be the tiny, tiniest chance, but Dr. Greves says it’s not worth worrying about.

“STDs don’t usually survive when they fall off the human body,” she explains. “A toilet seat doesn’t offer an environment for STDs to thrive, so it can’t live there for more than 10 seconds.” They much prefer the environment that warm human tissue and fluids create, not that of cold, hard toilet seats.

Mayo Clinic also states, “Because the virus dies quickly outside of the body, it’s nearly impossible to get the infection through contact with toilets, towels or other objects used by an infected person.” The same goes for other STDs, like syphilis, HPV, HIV, and pubic lice, according to the Centers for Disease Control and Prevention.

RELATED: Where Can You Get Tested for STDs? Here Are All of Your Options

If you’re wondering why you’ve been squatting or putting toilet paper on the seat this whole time, I’m right there with you. But Dr. Greves assured me it hasn’t been for nothing. “It can make us feel better mentally,” she says. “It might not protect us from an infection, but it can protect us from worrying about what germs we might have sat on.”

One thing you should do, however, every time you make a trip to the bathroom: Wash your hands. If you pick up bacteria from the door lock, toilet flusher, or other surfaces, then touch your eyes or mouth without realizing it, you could deposit those germs right into your system. Use soap and warm water, and always make a stop at the hand dryer or paper towel dispenser.

RELATED: I’m 22 and Sexually Active—Here’s What Happened When I Finally Had My First STD Test

Can You Catch STDs From A Toilet Seat?

Research shows there’s basically no risk of contracting an STD from a toilet seat.

Let’s be honest, public restrooms can be a bit of a nightmare. But are there actual health risks associated with using public restrooms? Can you catch STDs from a toilet seat? Or is this a bit of an urban legend? We understand that the idea of using a public toilet is enough to make anyone wonder. The quick answer to this question is, no, you can’t get an STD from a toilet seat.

The question goes along with the myth that placing toilet paper on a public toilet seat helps stop you from coming into contact with germs. Viruses like herpes, chlamydia, and gonorrhea can only live outside of the body for about 10 seconds. In fact, the seat of a toilet is much cleaner than most people’s kitchen sinks. We see this question asked a lot, especially from college students living in dorm rooms with communal bathrooms or people who have to use public restrooms frequently.

Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology at Yale Medical School, states that most of the microbiological “bad guys” cannot live outside human tissue. Skin-to-skin contact and bodily fluids are way more dangerous.

Herpes is commonly thought to be transmittable through contact with infected surfaces, but the virus is incredibly unstable. Immediately after leaving the body, the herpes virus begins to die. Even the slightest temperature change renders HSV intransmissible. According to the Mayo Clinic, it’s nearly impossible to get the herpes virus through contact with toilets, towels, or other objects in a public restroom that have been used by an infected person because the virus dies so quickly.

This also goes for STIs like syphilis, HPV, HIV, and even pubic lice. None of these are not transmittable via toilet seats.

Basically, you’d have to physically try to get an STI by rubbing an open wound or mucous membrane over the fluids left on the seat by someone who used the toilets seconds before. So, while there may be multiple reasons not to use a public toilet seat, getting an STI isn’t one of them.

In short, STIs are called sexually transmitted infections for a reason: they are spread through sexual content. Catching an STD from a toilet seat is impossible.

Still concerned? That’s where we can help! You always have the option to get tested. STD/STIs are often asymptomatic, which means you may not show any signs that you are infected. With MyLab Box, you can rest easy.

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Always remember that having an STD/STI is not a death sentence. Many STIs are curable with antibiotics or manageable with treatment. As always, practice safe sex. Using a condom greatly reduces risk of exposure, especially if you are unsure of your partner’s current status.

Don’t wait, get tested anonymously.

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