42 90 Definition A bacterial sexually transmitted infection (STI) caused by the Neisseria gonorrhoeae organ- ism, which multiplies quickly in moist, warm areas of the body (e.g., the cervix, urethra, mouth, and rectum). Gonorrhea can be passed from an infected woman to her newborn infant during delivery. Characteristics Gonorrhea can be asymptomatic. The signs of gonorrhea can show up within 2 to 10 days after sexual contact with an infected person. In women, initial symptoms include pain or burning sensation during urination or an abnormal vaginal discharge that can be yellowish green. More advanced symptoms include abdominal pain, bleeding between menstrual periods, vomiting, or fever. However, approximately 60 to 80 percent of infected women have no symptoms. The most common and serious complications of infection include pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. Men usually have a purulent penile discharge with dysuria. The infection can be self-limited or might result occasionally in a chronic carrier state. Rectal infection usually is asympto- matic but can cause pruritus, discharge, and (sometimes) painful bowel movements. Oropharyngeal gonorrhea should be considered if history of oral contact/sex. Pharyngitis may be present, which usually is asymptomatic but may cause mild to severe dysphagia, sore throat, and discomfort. Systemic gonorrhea is characterized by migrating arthritis of the large joints. Policy Assess employee in the occupational health unit and support, counsel, and educate about the disease and its transmission. Refer employee to personal health care provider or local health department for treatment. Maintain employee confidentiality. Objectives Clinical Assessments and Interventions Referral for Medical Action Gonorrhea ● Signs of infection. ● Pregnancy diagnosed or suspected. Follow-up Actions ● Discuss etiology of disease and its prevention. ● Stress the importance of having all STIs treated before becoming pregnant. Determine extent of illness and em- ployee knowledge level. Educate employee about importance of early diagnosis and treatment. ● Assess employee’s subjective symptoms of infection (and objective signs if appropri- ate) and record a brief history of the illness. ● Review allergy status. ● Obtain health and reproductive history to determine presence of other STIs (e.g., chlamydia, syphilis, HIV), and the possibil- ity of pregnancy. ● Discuss transmission and signs and symp- toms of infection. Advise employee that in- fection usually is treated with a single-dose antibiotic, either by injection or orally. If gonorrhea is accompanied by chlamydial infection, a combination of antibiotics usually is prescribed. Guideline continues on next page