Gonorrhea, also called “the clap,” is a type of sexually transmitted disease (STD) caused by bacteria. The bacteria that cause gonorrhea (Neisseria gonorrhoeae) thrive in moist areas of the body in both women and men. Gonorrhea can be spread through any kind of sexual contact (vaginal, oral or anal) with an infected person. Ejaculation is not necessary to spread gonorrhea. Other physical contact with an infected area may lead to spread of the disease (e.g., touching one’s genitals and then touching an eye or the inside of the mouth). However, it cannot be spread through kissing.

In women, the gonorrhea bacteria frequently enter the body during vaginal intercourse. Tissue types in two areas provide good receptors for the bacteria and are the primary infection sites. The cervix (entrance to the uterus) is the most likely site of gonorrhea infection. It may cause an inflammation of the cervix called cervicitis. The bacteria from vaginal intercourse may also reach the tube that leads to the bladder (urethra) and cause an inflammation there called urethritis.

Gonorrhea may also lodge in the vagina and glands near the entrance to the vagina (Bartholin glands). This can result in painful, enlarged swelling of the gland usually unilaterally. The structure of vaginal membranes undergoes changes from the hormone estrogen as part of puberty. The gonorrhea bacteria cannot readily adhere to these membranes in adults. As a result, gonorrheal inflammation of the vagina is uncommon in adult women. However, in girls who have not reached puberty, the gonorrhea bacteria can adhere to these vaginal membranes and cause an infection of the vagina called vulvovaginitis. The appearance of this condition, which may be the result of sexual activity in a preadolescent girl, may indicate sexual abuse.

Gonorrhea may spread through the cervix and infect the upper reproductive organs (uterus, fallopian tubes and ovaries). If left untreated in those organs, gonorrhea may cause pelvic inflammatory disease (PID). PID may scar the reproductive organs and make it difficult or impossible for a woman to become pregnant (infertility) or to carry the pregnancy to term (miscarriage). The scarring also increases the possibility of an ectopic pregnancy, a dangerous condition where a pregnancy develops outside the uterus, frequently in a fallopian tube. Like gonorrhea, PID may produce no symptoms but can cause serious damage.

In addition, gonorrhea can occur in the anus, either from anal sex or by spreading there from the genitals. People may also contract gonorrhea in the throat from having oral sex with an infected partner. If a person touches an infected area and then touches their eyes, gonorrhea may spread to the eyes, a condition called gonococcal conjunctivitis. However, the gonorrhea bacteria can only live briefly away from a moist surface. It cannot survive or be transmitted from inanimate objects or surfaces.

In extreme cases that are left untreated, gonorrhea can spread to other parts of the body and infect the brain and spinal cord (meningitis), heart (endocarditis) or joints (arthritis).

Gonorrhea presents more complications for pregnant women. A woman with gonorrhea may transmit the disease to her child while giving birth. The baby may first be infected in the eyes, a condition called ophthalmia neonatorum. This can result in blindness. If the infection is not treated, it can spread and cause joint infection or a life-threatening blood infection.

People with gonorrhea frequently have chlamydia at the same time, another STD that may have few symptoms. Gonorrhea has fewer complications for men, most commonly infecting the urethra.

More than 339,500 cases of gonorrhea were reported to the Centers for Disease Control and Prevention (CDC) in 2005, the last year for which figures are available. However, the CDC estimates that this number accounts for only half of the nation’s gonorrhea cases since many often go unreported. African-Americans remain the group most affected by the disease with 18 times the incidence than found in white Americans. Although there has been a slight decline since 2000, the CDC estimates that 119 per 100,000 women contracted gonorrhea in 2005. For the past five years, the gonorrhea rate has been uncharacteristically higher in women than men.