This is the oldest known sexually transmitted disease. In the 14th century it became known as the clap, a name we still use today. It is also referred to as "the drip" or "the dose."

The number of cases in the United States has been declining an average of 9 percent a year since 1987, with 360,076 cases reported in 1999. However, the rate of decline appears to be slowing, and in 1999 the trend actually reversed among women, with cases showing a slight increase.

• Risk factors
• Signs and symptoms
• Cause
• Incubation period
• Possible health effects
• Diagnosis
• Treatments
• Follow-up
• Prevention
• Pregnancy

• Risk factors: You are more likely to get gonorrhea if you or your partner have casual sexual contacts with others and if you are under the age of 20. Rates of infection remain highest among adolescents, young adults, and minorities. Compared to whites, gonorrhea rates are 30 times higher among African-Americans and 10 times higher among Hispanics. People living in the South Atlantic region of the U.S. (from Delaware down the eastern seaboard) may be at higher risk because this region has the highest number of reported cases. People with limited access to health care also seem to have a higher risk for getting gonorrhea. Other groups at high risk of this or any other STD include people living in large cities, singles, those who have had past gonorrhea infections, drug users, and prostitutes. A man having unprotected sex once with a woman infected with gonorrhea has a 20 to 25 percent chance of catching the disease. A woman having unprotected sex once with an infected man has an 80 to 90 percent chance of catching it.

• Signs and symptoms: The symptoms of gonorrhea are similar to those of chlamydia. Women with symptoms usually experience increased vaginal discharge. Other symptoms include pain when urinating, lower abdominal or rectal pain, intermittent vaginal bleeding, pain or bleeding during intercourse, and fever. Half of all women with gonorrhea infections also have a gonococcal rectal infection and may have discomfort in the anal area. Up to 70 percent of infected women are asymptomatic. Only 10 percent of infected men are without symptoms. Therefore, your first warning of infection may be from your partner. He will experience painful urination and have a milky discharge from his penis. He may feel the need to urinate frequently.

• Cause: Gonorrhea infections are caused by a kidney bean-shaped bacteria scientists call Neisseria gonorrhea. These germs live in the cervix in women and inside the urethra (the tube that carries urine) in men.

• Incubation period: Symptoms usually develop within 10 days of infection.

• Possible health effects: Untreated infections can lead to Pelvic Inflammatory Disease (PID), which increases by 40 percent your chance of having a tubal (ectopic) pregnancy or becoming infertile. You also become susceptible to septicemia (blood poisoning), arthritis, or problems related to the skin, heart, or brain.

• Diagnosis: For men, a simple test called a gram stain is sufficient for diagnosis, but for women a tissue culture is often needed, since many organisms in the cervix look similar to the gonorrhea bacteria. As with chlamydia, rapid and accurate tests are now available for gonorrhea using a cervical swab or urine specimens. A blood sample may be taken to test for syphilis, and a test for chlamydia may be done. Your tissue culture should be ready within 48 hours.

• Treatments: Many strains of gonorrhea are now resistant to standard drugs such as penicillin and tetracycline. However, two newer types of drugs, the cephalosporins and the quinolones, are highly effective in treating gonorrhea. The cephalosporins include ceftriaxone (Rocephin) in a single 125-milligram intramuscular injection, and cefixime (Suprax), 400 milligrams orally in a single dose. The quinolones include ciprofloxacin (Cipro), 500 milligrams orally in a single dose, gatifloxacin (Tequin), 400 milligrams in a single dose, and ofloxacin (Floxin), 400 milligrams orally in a single dose. Other antibiotics often prescribed for this problem include azithromycin (Zithromax), 1 gram orally in a single dose, and doxycycline (Doryx, Vibramycin), 100 milligrams orally twice a day for 7 days. Resistance to these drugs is a growing problem. The first gonorrhea strains resistant to azithromycin have been reported in Kansas. And resistance to ciprofloxacin has become so common that the drug is no longer recommended for people who have acquired gonorrhea in Asia or the Pacific Islands, or for people with sex partners who have traveled to those locations. For those who are allergic to or who can not tolerate the cephalosporins and the quinolones, an injection of spectinomycin (Trobicin), is given in a single 2-gram intramuscular injection. Though spectinomycin is expensive, it will cure gonorrhea infections of the throat. Because many people with gonorrhea also have a "silent" case of chlamydia, the Centers for Disease Control and Prevention recommend treatment for both infections at the same time. There are many other drugs available to treat gonorrhea. You can discuss them with your doctor.

• Follow-up: You won't need to be retested for gonorrhea after you have finished your medication unless your symptoms continue or you have been re-exposed to the disease. If you received treatment because you had symptoms, all sex partners from the prior 30 days should also get treatment. If your infection was found incidentally, all sex partners from the last 60 days should be treated.

• Prevention: Latex condoms can protect you from the gonorrhea bacteria. Other methods, such as the diaphragm, cervical cap, and spermicides also offer some protection. It is advisable to abstain from sex during your treatment, and until all tests are negative.

• Pregnancy: Pregnant women with gonorrhea can not be treated with quinolones or tetracyclines. If you are pregnant, you may be given a cephalosporin or a single injection of spectinomycin.