The name gonorrhea, which means “flow of seed,” and its vernacular counterparts (“clap,” “dose,” “strain”), reflect a hazy comprehension of the disease. The only accurate term in common use is “drip,” which acknowledges the white-to-yellowish milky discharge from the male penis. But even this more honest description includes only the male urethral portion of a broader syndrome.
Gonorrhea is an infection of mucosal surfaces caused by a small gram-negative bacterium–the gonococcus–whose only reservior in nature is human. Its presence in the lower male or female genital tract defines the condition gonorrhea; otherwise, the adjective “gonococcal” is used to precede a generic infective syndrome (as in “gonococcal endocarditis”). Though gonorrhea is transmitted primarily to genital mucosa through sexual contact, it may cause localized abscesses or generalized dissemination, with infection of the skin, heart valves, joints, and central nervous system. It is rarely the cause of death, but, if untreated, it produces serious sequelae in both men and women.
The gonococcus, Neisseria gonorrhoeae, shares an ecological niche with other sexually transmitted pathogens such as Chlamydia trachomatis, Ureaplasma ureslyticum, and T-mycoplasmas. It depends for its survival on variable virulence, sufficient numbers of asymptomatic infectees, an ability to produce a rapid genomic response to antibiotic pressure, a symbiotic relationship with new pieces of genetic material (called plasmids), and propitious set of social and sexual mores among its hosts. As history demonstrates, this seemingly delicate balance has been universally available.