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- [Voiceover] Of the many sexually transmitted infections, or STIs, gonorrhea is the second most common. The most common STI is chlamydia. Chlamydia, and we'll talk more about chlamydia later. Right now, let's focus on gonorrhea and why these two happen together. These two diseases often occur together for two reasons. First, they have similar risk factors, which include things like having multiple sexual partners and/or having frequent unprotected sex. The other reason is that infection with one of these bugs makes your body susceptible to a second infection by dampening the immune system. So I promise we'll go into more detail about chlamydia later, but for now let's talk more about gonorrhea. It's caused by a bug referred to as neisseria gonorrhoeae, and the reason why we call gonorrhea a sexually transmitted infection is because it undergoes this process referred to as transmission where it moves from one person to another by several mechanisms. Most commonly, gonorrhea will be transmitted through sex, which can include oral sex, vaginal sex, or even anal sex. Another important mechanism of transmission includes childbirth and we'll talk more about the outcomes of that in a minute, so these are the main ways that gonorrhea can be transmitted. Let's move this off to the side and let's focus instead on my poor friend over here who's going to have all the different signs and symptoms a person can get with gonorrhea. Now because we said the main way gonorrhea spreads from one person to the other is by sex, let's start by focusing on signs and symptoms at our sexual organs. So here you can see on the left I have female genitalia drawn out and on the right side, we have male genitalia drawn here. If we were to imagine our gonorrhea infection, so I'll use this as sort of a way to mimic gonorrhea as it spreads, perhaps you can have a female infecting a male with gonorrhea and so, because the penis is used during sex, that can actually seed or spread up the urethra. This yellow line here, that is your urethra. We'll go into this in more detail in another video but the gonorrhea bacteria will latch on to the walls in your urethra. Your urethra is lined by epithelial cells, and so this bacterium will enter those cells. That will trigger an immune response. Your white blood cells will detect that something is wrong and they'll come up to the urethra through the blood stream to attack wherever the gonorrhea has spread. So if the gonorrhea has only entered a single epithelial cell in your urethra, it'll cause that cell to die in a process that's referred to as apoptosis. Maybe you've heard of it. It's where the body specifically decides to kill a cell because it's doing something wrong or it's been infected like in this case. Now in the ideal world, the white blood cell will kill off this one epithelial cell in the urethra that's been infected and we'd be done with the infection, but often times there are multiple organisms that kind of spread along the urethral tract, which cause more white blood cells to come from the blood stream to attack the bacteria or the cells that are infected and as a result you get inflammation. Inflammation of the urethra causing things like pain when you urinate, maybe some burning that's there as well, and general discomfort. Because of the bacterium, your urethra will cause you a lot of pain and you've got what's referred to as urethritis. If the gonorrhea spreads up here to your prostate, this pink thing is your prostate, you can get what's called prostatitis, and this inflammatory process that's occurring along the way causes white blood cells that may die and epithelial cells that will also go undergo apoptosis with some of the gonorrheal bacteria to sluff off and fall through and come out from the urethral meatus or the end of the penis. And you can actually see pus coming out of the penis. Now just like the epithelial cells within your urethra, gonorrhea can also effect the epithelial cells that line the anus or even higher up here in the rectum. As a result, you might not see pus coming out from the anus, and instead you might see infections of the cells that line the anus or of the anus. So this skin infection you'd see here are referred to as pustules. Pustules. Again, that's from the gonorrheal bacteria infecting the epithelial cells of the anus. You can also have pustules occur in the female, so let's label that right here as well as urethritis, but because of the difference in anatomy between the male and the female, you may also see an infection of the vagina, or vaginitis. More commonly though, infected women will have pain during sex because of pressure that's put on the cervix due to the gonorrhea that's spread there causing cervicitis. Cervicitis. Gonorrhea can spread even further up from the cervix through the uterus and actually come out the fallopian tubes to cause an infection within the pelvic cavity, which is why it's called pelvic inflammatory disease. Pelvic inflammatory disease, or PID. Now from the genital tract, gonorrhea can spread into the blood stream and go elsewhere in the body and quite classically, it goes to your joints like the knee over here to cause arthritis by infecting the joint capsule, so down below here you can see the joint capsule. Here's bone, here's articular cartilage, and this is sonovial fluid or just some fluid in between the two bones in the joint. So if gonorrhea spreads here, think about what else is gonna come right after it. White blood cells. Remember, they're going to come chasing after the gonorrhea and they're going to cause inflammation and if you notice in this picture, there's not a lot of space between the two sets of articular cartilage and the bones here. If too many white blood cells get into the sonovial cavity, and cause inflammation, you're going to have a more difficult time using that joint which leads to pain in the knee and difficulty walking. Left untreated, gonorrhea can also spread to the central nervous system. Gonorrhea can infect the lining around the brain and the spinal cord. This lining is referred to as the meninges; the meninges. An infection of the meninges is referred to as meningitis. Menigitis. Unfortunately, gonorrheal menigitis is more common in children than it is adults. Speaking of children, I mentioned earlier that you can spread gonorrhea through childbirth. An infected mother can spread the infection if undetected to her child and very early on, you would know if a child is infected with gonorrhea if they look like this. You'll notice that the baby may have this very signature crusting of the eyes that's referred to as gonococcal opthalmia, which is just to say that you have an opthalmic or an eye infection of gonorrhea. This baby can also have a variety of other issues related to the gonorrhea, such as menigitis, as we talked about or even pneumonia, which is why neisseria gonorrhoeae or gonococcus as one of the bugs pregnant women are often screened for and treated for before they give birth to decrease the odds of this sort of thing happening.

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Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment.

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Gonorrhea is caused by the bacteria Neisseria gonorrhoeae.

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Gonorrhea is transmitted during vaginal, anal, and oral sex (performing or receiving).
It can also be passed from mother to newborn as the baby passes through the infected birth canal.

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In men, symptoms are usually obvious enough that they will cause a man to seek medical treatment before complications occur. But some men have mild or no symptoms and can unknowingly transmit gonorrhea infections to their sex partners. Symptoms may include:

Abnormal discharge from the penis (clear or milky at first, and then yellow, creamy, and excessive, sometimes blood-tinged).

Painful or frequent urination or urethritis.

Anal itching, discomfort, bleeding, or discharge.

Sore throat (rare).

Pinkeye (conjunctivitis) (rare).

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In women, the early symptoms are sometimes so mild that they are mistaken for a bladder infection or vaginal infection. Symptoms may include:

Painful or frequent urination.

Anal itching, discomfort, bleeding, or discharge.

Abnormal vaginal discharge.

Abnormal vaginal bleedingduring or after sex or between periods.

Genital itching.

Irregular menstrual bleeding.

Lower abdominal (belly) pain.

Fever and general tiredness.

Swollen and painful glands at the opening of the vagina (Bartholin glands).

Painful sexual intercourse.

Sore throat (rare).

Pinkeye (conjunctivitis) (rare).