Gonorrhea, caused by Neisseria gonorrhoeae, is the second most common bacterial STI and results in substantial morbidity and economic cost worldwide. Gonorrhea is spread by having unprotected vaginal, anal, or oral sex with someone who has gonorrhea, or from mother-to-child during childbirth. Correct and consistent use of condoms significantly decreases the risk of sexual transmission.

Gonorrhea is often asymptomatic in women. If untreated, gonorrhea infection may lead to serious complications. Infants of mothers with gonorrhea can contract neonatal conjunctivitis (eye infection), which may lead to scarring and blindness. Diagnosis are preferably made through a laboratory test. However, since laboratory diagnostic tests are not available in many countries, diagnosis is often made based on the presence of symptoms such as vaginal and urethral discharge.

The World Health Organization (WHO) estimates that in 2012, 78 million new cases occurred among adolescents and adults aged 15–49 years worldwide with a global incidence rate of 19 per 1000 females and 24 per 1000 males. The estimated 27 million prevalent cases of gonorrhea in 2012 translates to a global prevalence of gonorrhea of 0.8% among females and 0.6% among males aged 15–49 years. Co-infection with Chlamydia trachomatis is detected in 10–40% of people with gonorrhea worldwide.

Of all the STIs, gonorrhea is the most antibiotic-resistant. Increased resistance to most antibiotics used to treat gonococcal infections has been reported worldwide, raising concerns about the eventual development of untreatable gonococcal infections with serious sexual and reproductive health consequences. To the extent possible, countries should update their national guidelines for the treatment of gonococcal infection based on recent antimicrobial resistance (AMR) surveillance. If local ARM surveillance in not yet functional, PAHO urges countries to adopt the latest WHO treatment guidelines for N. gonorrhoeae.

Key facts

  • In 2012 there were around 4.6 million new cases among females and 6.4 million new cases among males in the Region of the Americas
  • In 2012, there were around 1.9 million existing cases of gonorrhea among females, and 1.6 million existing cases among males in the Region of the Americas
  • While there are documented increases in gonococcal resistance to antimicrobial drugs, only 36% of the countries in the Americas systematically monitor this resistance to support treatment decisions
  • According to the Latin American AMR Surveillance Network (ReLAVRA), ciprofloxacin resistance has steadily grown, with isolates increasing from 35% in 2009 to 62% in 2015. Moreover, reduced sensitivity to broad spectrum cephalosporins and macrolides is beginning to emerge in Latin America and the Caribbean (LAC).
  • In 2017, only 8% of the countries in LAC reported the use of ceftriaxone plus azithromycin, as recommended in the WHO treatment guidelines.

PAHO/WHO response

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