Gonorrhea is one of the most well known STDs. Commonly referred to as 'the clap', gonorrhea is thought to infect over one million people in the US each year. Perhaps half of these cases are never reported. The disease is caused by the bacteria Neisseria gonorrhea which causes inflammation of the glands. The bacteria grows and multiples in the warm moist areas of the body. It primarily affects the urethra in men and the cervix in women. Gonorrhea of the rectum is also possible.

The symptoms of gonorrhea depend on what part of the genital area is infected. There may, however, be no symptoms present and some individuals may unknowingly infect others. Most women experience no symptoms if gonorrhea infects the cervix. Consequently, many women will experience complications before being aware of their infection.

It will take anywhere from two days to two weeks for the gonorrhea bacteria to incubate and create noticeable symptoms after transmission through sexual intercourse. However, in some cases, people who have been infected will show no symptoms for as long as a year. Even more unique to this disease, many people infected with gonorrhea bacteria will never show symptoms until more serious complications begin. In fact, 30-60% of women, and 10% of men will be asymptomatic until complications occur. But, people who show no symptoms are at a much greater risk for developing advanced complications, and for transmitting the disease to others. This is a key reason why the disease continues to spread and why screening for gonorrhea bacteria is very important, particularly if you are a pregnant woman. This makes gonorrhea an easily contractible disease. Any form of unprotected sexual penetration (oral, anal and vaginal) can transmit gonorrhea if it is present. If a man has vaginal intercourse with an infected woman, his chances of catching gonorrhea are from 30 to 50%. A woman's risk from an infected man is higher (60-90%). If gonorrhea is not treated quickly complications may occur.

Other means of catching the disease exist but are not as common. A person with gonorrhea can infect another area of their body by touching the infected area and transferring the excretions. Gonorrhea may also spread in clothing or wash cloths. If a washcloth is used on an infected area and then soon after used by another, infection may occur. Anal infection can occur in women not only from anal intercourse but also from vaginal intercourse. Sometimes infected secretions from the vagina drip down around the anus causing infection. The bacterium must originate from a mucous membrane and be transferred to another mucous membrane. It is not transmitted through regular skin and is not viable once a secretion has dried.

In early 20th century orphanages, it was common for a child to arrive with the disease, and within months others had it. It is believed that this was because they shared bathwater and towels, and the bacterium can survive in warm water for many hours.

"International consensus guidelines state that Neisseria gonorrhoeae infection in pre-pubertal children is always, or nearly always, sexually transmitted. A systematic literature review does not concur with this. N gonorrhoea was believed to solely sexually transmitted when first identified in the 1880s. However it became recognised that when the infection was introduced into children's institutions, it rapidly spread among pre-pubertal girls. The medical literature records over 40 epidemics involving about 2000 children in Europe and the United States. Communal baths, towels or fabric, rectal thermometers and caregivers hands were identified as means of transmission. Although sensitive to heat and drying, gonorrhoea may remain viable in pus on cloth for several days. Several unusual accidental transmissions are reported, often due to contamination from laboratory samples. Indirect transmission occurs in epidemics of conjunctivitis in third world rural populations. Spread of infection can occur via contaminated hands of infected caregivers. While all paediatric cases of gonorrhoea must be taken seriously, including contact tracking and testing, forensic medical examiners should keep an open mind about possible means of transmission. Doctors and lawyers need to be cognisant of the large body of literature demonstrating both sexual and non-sexual means of transmission of gonorrhoea in children." [J Forensic Leg Med. 2008 Oct;15(7):471-2; author reply (Dr Goodyear-Smith) 473-5.]