Incidences of the sexually transmitted infection (STI) gonorrhea have been steadily climbing at an alarming rate, according to the Centers for Disease Control (CDC). Not only did cases increase 18.6 percent from 2016 to 2017, with a reported 555,608 in the U.S., but incidence has also increased 75.2 percent since its record low in 2009.
Physicians should be offering STI screenings on a regular basis to their patients, regardless of age, says Brandi Adams, MD, an OB/GYN with the Holsten Medical Group in Charlotte, N.C.
“Gonorrhea is asymptomatic, similar to chlamydia. Many women would never even know they have it unless they’ve had a routine screening for it,” Adams says.
Though symptoms are rare, occasionally women may experience abnormal discharge, discomfort or frequent urination, or vaginal odor and itching. Since these symptoms often mirror other conditions such as yeast infections or urinary tract infections the gonorrhea infection could be missed without a screening.
Of course, men can also get and transmit gonorrhea. “Men are carriers of the disease, because they rarely get symptoms,” Adams explains. But men are also far less likely to suffer long term complications that women experience, she says, such as pelvic inflammatory disease, chronic pain, and fertility issues.
“If a patient is less than 25 years old, I screen them regardless of whether they are sexually active,” she says. For patients over 25, she asks about sexual activity and whether they are in a monogamous relationship with one partner. “I tend to encourage screening more in women who have new partners or multiple partners, and I don’t discriminate whether they’re married or not.”
While the conversation can be awkward, she does her part to normalize it by mentioning that she tests everyone because one can’t always be sure of their partner’s behavior, and it’s not any more invasive than any other tests or screening they are already undergoing.
When deciding to offer screening, she recommends to physicians, “Don’t make judgments whether the patient is in a relationship or not, about their age, whether they’re 20 or 70. Everyone who is sexually active is at risk.”
Older women past menopause who become sexually active with a new partner, especially if it’s after a pause in such activity, might be less inclined to think about physical prophylactics like condoms because they can no longer get pregnant. “Yet they’re at high risk of getting or transmitting an STI. It’s important to make them comfortable and normalize the discussion,” Adams says.
It’s also important to clear up the misconceptions that the only way a patient can get gonorrhea is from penetrative sex between a penis and a vagina. “You can get gonorrhea from oral sex [in the throat] and anal sex, too.”
When a patient does screen positive for gonorrhea, Adams recommends that physicians also offer treatment to the patient’s partner, to prevent re-infection and that the couple abstain from sexual activity for seven days after the last dose of medicine.
The treatment for gonorrhea has been forced to change over the years, as well, since the bacteria that causes the infection have developed resistance to the fluoroquinolone antibiotics. Now, treatment involves drugs typically given for chlamydia, in the cephalosporin family of antibiotics.
As for why gonorrhea and other STIs are at such a high, she suggests it may be partly an access to care issue exacerbated by decreases in federal funding, which impact the highest risk population, women aged 15 to 24. “A lot of them are on their parents’ insurance and don’t want them to know, so they don’t get tested.”
Another cause, she says, may be that with the more common use of long acting, reversible contraceptives like the IUD, women in particular forget about physical barriers because they are protected from pregnancy.
Adams hopes that more physicians will take the initiative to screen their patients to curb this STI’s rapid spread.