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When symptoms do occur, they are often within two to ten days after exposure, but can take up to thirty days.

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, and infects the urethra in men. Gonorrhea and her sister chlamydia are closely related organisms and are the most common causes of curable STDs in men. Also known as the "clap," gonorrhea can infect the rectum, the throat, and, rarely, the conjunctiva, the membrane that lines the eyelid and eye surface. Once a person is infected with gonorrhea, he can transmit the organism even without having symptoms. People are considered contagious until they have been treated. About half of those infected don't even have symptoms. When symptoms do occur, they are often within two to ten days after exposure, but can take up to thirty days and include the following:

* painful urination

* anal itching or bleeding

* sore throat

* greenish yellow or whitish discharge from the urethra.

* painful or swollen testicles

Risk factors include multiple sex partners and unprotected sex. Gonorrhea is a very common infectious disease. In the United States each year, about 700,000 people are infected with gonorrhea, and about 75 percent of all reported cases are found in younger persons aged fifteen to twenty-nine. Diagnosing gonorrhea can be made by swabbing the urethral discharge and having it sent to the lab for analysis. Most patients wince at the idea of having their urethra swabbed, but now there is a special urine test to detect the presence of both gonorrhea and chlamydia.

In the 1980s, gonorrhea became resistant to penicillin and tetracycline. As a result, the CDC recommended fluoroquinolone antibiotics as the treatment for gonorrhea. The oral medication ciprofloxacin revolutionized the treatment of gonorrhea; however, the number of cases of fluoroquinolone-resistant gonorrhea has more than doubled between 2002 and 2003.

"The drug-resistant strain is a rapidly emerging health concern for gay and bisexual men," said Dr. John Douglas, the CDC's STD prevention director. This was an alarming statement made in April 2004 because the rates of drug- resistant gonorrhea in gay and bisexual men were twelve times higher than in straight men. The number of drug- resistant cases increased from 1.8 percent in 2002 to 4.9 percent in 2003. This was in contrast to the increase in cases in straight men from 0.2 percent to 0.4 percent.

The increased prevalence of this strain appears to be concentrated in the Pacific Islands (Hawaii) and California; however, the New York City health department reported twenty-two cases of fluoroquinolone-resistant gonorrhea from January to July 2003 after identifying only eight cases in 2002. Officials theorized that infected men from the West Coast had then traveled to other areas. More proof that resistant strains were making their way across the U.S. emerged when a cluster of twelve patients with decreased susceptibility to azithromycin, another commonly used drug, was found in Kansas City.

"There is mounting evidence these increasing STD rates are fueled by a variety of factors," said Dr. Douglas, "including relaxed safe- sex practices, substance abuse, crystal methamphetamine use, and the availability of the Internet for meeting sex partners." This claim is supported by parallel increases in syphilis and HIV. The CDC recommends that doctors not use a fluoroquinolone antibiotic in gay and bisexual men but recommends using an injectable antibiotic like ceftriaxone. The drug resistant strain appears to still be sensitive to this form of injectable antibiotic. In routine cases, treatment can include the oral medication, azithromycin, which is also acceptable.

If unsuccessfully treated gonorrhea can cause epididymitis, a painful condition of the testicles that can sometimes lead to infertility. Without prompt treatment, gonorrhea can also affect the prostate (prostatitis) and lead to scarring inside the urethra, making urination difficult. In some cases, gonorrhea can spread to the blood or joints. This condition can be life- threatening. It has also been suggested that men with recurrent gonorrhea are at higher risk for contracting HIV, and those men who have both HIV and gonorrhea are likelier to transmit HIV.

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