 Gonorrhea, gonorrhea, also spelled gonorrhea, is a sexually transmitted infection STI caused by the bacterium NICERIA gonorrhoea. Many people have no symptoms. Men may have burning with urination, discharged from the penis, or testicular pain. Women may have burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. If untreated, gonorrhea can spread to joints or heart valves. Gonorrhea is spread through sexual contact with an infected person. This includes oral, atonal, and vaginal sex. It can also spread from a mother to a child during birth. Diagnosis is by testing the urine, ureter in males, or cervix in females. Testing all women who are sexually active and less than 25 years of age each year as well as those with new sexual partners is recommended. The same recommendation applies in men who have sex with men MSM. Gonorrhea can be prevented with the use of condoms, having sex with only one person who is uninfected, and by not having sex. Treatment is usually with seftriaxone by injection and azithromycin by mouth. Resistance has developed to many previously used antibiotics and higher doses of seftriaxone are occasionally required. Retesting is recommended three months after treatment. Sexual partners from the last two months should also be treated. Gonorrhea affects about 0.8% of women and 0.6% of men. In estimated 33 to 106 million new cases occur each year, out of the 498 million new cases of curable STI, which also includes sythilis, chlamydia, and trichomagnosis. Infections in women most commonly occur when they are young adults. In 2015, it caused about 700 deaths. Descriptions of the disease date as far back as the Old Testament.