Gonorrhea: Symptoms, Testing, and Transmission Risks

Q: Gonorrhea: Symptoms, Testing, and Transmission Risks

Hello： I found that 90% of men infected with gonorrhea will show symptoms, while the remaining 10% may resolve on their own. <br>However, other sources state that it does not self-resolve but rather becomes asymptomatic carriers. <br>I would like to ask the physician which is cor

Questions related to gonorrhea?

Hello Dr.
Du, I would like to ask some questions about gonorrhea:
1.
I found that 90% of men infected with gonorrhea will show symptoms, while the remaining 10% may resolve on their own.
However, other sources state that it does not self-resolve but rather becomes asymptomatic carriers.
Which one is correct?
2.
If gonorrhea can self-resolve, does that mean that testing methods for gonorrhea (which I found to be DNA testing) would not indicate past infections? Additionally, is there a way to test for antibodies through a blood test for gonorrhea?
3.
I noticed in previous Q&A that you often use the presence or absence of symptoms to determine whether someone has gonorrhea, HPV, chlamydia, or herpes.
If someone has been asymptomatic for a long time (over six months), is it unnecessary to test for these STIs (as it may lead to inaccurate results and unnecessary worry or may not detect anything)?
4.
Is the infectiousness of asymptomatic individuals with gonorrhea, HPV, chlamydia, and herpes significantly lower than that of symptomatic individuals?
I apologize for the many questions, and thank you for your assistance!

Niming, 20~29 year old female. Ask Date: 2021/09/03

Dr. Du Shixi reply Urology

Hello: I found that 90% of men infected with gonorrhea will show symptoms, while the remaining 10% may resolve on their own.
However, other sources state that it does not self-resolve but rather becomes asymptomatic carriers.
I would like to ask the physician which is correct? --> Self-resolution is rare, and becoming a carrier should be even less common, but testing cultures should be able to detect it; it is just that those without obvious symptoms may not receive treatment.
2.
If gonorrhea can self-resolve, then through the testing methods for gonorrhea (which I found to be DNA testing), is it impossible to know if one has had gonorrhea in the past? Additionally, is there a way to test for antibodies through a blood draw? --> Diagnosis must rely on clinical symptoms and signs, and specimens must be collected from the urethra, cervix, anus, rectum, and throat to perform Gram staining to identify Neisseria gonorrhoeae.
It is best to use selective culture media, such as Thayer-Martin agar, incubated in a carbon dioxide environment, followed by various biochemical or fluorescent antibody methods to confirm the diagnosis, identify bacterial strains, and perform antibiotic susceptibility testing.
3.
After reviewing previous Q&A, I noticed that physicians seem to rely on the presence or absence of symptoms to confirm infections such as gonorrhea, HPV, chlamydia, and herpes.
If someone has been asymptomatic for an extended period (over six months), is it unnecessary to test for these STDs (as it may lead to inaccurate results causing unnecessary worry or may not detect anything)? --> These diseases are generally not easy to detect.
Therefore, we can only rely on symptoms; clinically, those with symptoms are more likely to be tested successfully.
4.
Is the infectiousness of asymptomatic individuals with gonorrhea, HPV, chlamydia, and herpes significantly lower than those with symptoms? --> Transmission usually occurs over a period of time; asymptomatic gonorrhea can still be contagious for several months.
Please refer to https://www.cdc.gov.tw/File/Get/1qBP9dhsIpua_eQ99YooTg.
Wishing you good health.

Reply Date: 2021/09/03

More Info

Gonorrhea, caused by the bacterium Neisseria gonorrhoeae, is a common sexually transmitted infection (STI) that can affect both men and women. Understanding its symptoms, testing methods, and transmission risks is crucial for effective management and prevention. Let's address your questions one by one.

1. Symptoms and Self-Healing: It is true that approximately 90% of men infected with gonorrhea will exhibit symptoms, such as painful urination, pus-like discharge from the penis, and swollen testicles. However, the remaining 10% may be asymptomatic. While some asymptomatic cases may resolve without treatment, this is not the norm for gonorrhea. The concern with untreated gonorrhea is that it can lead to serious complications, including infertility and increased risk of HIV transmission. Therefore, it is more accurate to say that while some individuals may not show symptoms, they are unlikely to "self-heal" in the traditional sense and may instead become carriers, potentially spreading the infection to others.

2. Testing for Gonorrhea: The most common testing method for gonorrhea is nucleic acid amplification tests (NAATs), which can detect the DNA of the bacteria in urine or swabs from infected areas. If a person has had gonorrhea in the past and has since cleared the infection, a current test would not show a positive result. There is no standard blood test for gonorrhea antibodies, as the infection is typically diagnosed through direct detection of the bacteria rather than through antibody response. Therefore, if you are looking to determine past infections, a history of positive tests or symptoms would be more indicative than current testing.

3. Testing Without Symptoms: If an individual has been asymptomatic for an extended period (e.g., six months or more), it does not necessarily mean that testing for STIs is unnecessary. Asymptomatic infections can still pose risks, including transmission to sexual partners and potential complications. Regular screening is recommended for sexually active individuals, especially those with multiple partners or those who engage in unprotected sex. While the concern about unnecessary anxiety from testing is valid, the benefits of early detection and treatment often outweigh these concerns.

4. Transmission Risks: The transmission risk of STIs can vary based on whether an individual is symptomatic. Generally, symptomatic individuals may have higher bacterial loads and thus a higher risk of transmission. However, asymptomatic individuals can still transmit the infection, albeit potentially at a lower rate. Gonorrhea, chlamydia (often referred to as "衣原體"), and herpes can all be transmitted even when symptoms are not present. Therefore, it is essential to practice safe sex and consider regular STI screenings, regardless of symptom presence.

In summary, gonorrhea is a significant public health concern, and understanding its symptoms, testing methods, and transmission dynamics is vital for prevention and treatment. Regular screenings, especially for those at higher risk, are crucial in managing STIs effectively. If you have further questions or concerns about gonorrhea or other STIs, consulting with a healthcare provider is always advisable for personalized advice and treatment options.

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