Importance Of Early Gonorrhea Diagnosis
Gonorrhea, also known as “the clap,” is a highly contagious sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae. It primarily affects the genital tract but can also infect the rectum, throat, and eyes. Early diagnosis and treatment are crucial in managing and preventing the spread of this infection. Therefore, understanding the importance of early gonorrhea diagnosis is vital for individuals at risk.
Early diagnosis of gonorrhea can significantly impact an individual’s health and prevent further complications. By detecting the infection at its initial stage, healthcare providers can promptly initiate appropriate treatment to eradicate the bacteria and prevent the infection from spreading to other individuals. Timely diagnosis allows for early intervention, reducing the risk of long-term health consequences such as pelvic inflammatory disease (PID), infertility, and chronic pelvic pain.
In order to diagnose gonorrhea early, it is essential to recognize the common symptoms associated with the infection. Some of the common symptoms of gonorrhea include a burning sensation during urination, unusual discharge from the genitals, and increased frequency of urination. However, it is important to note that many individuals infected with gonorrhea may not experience any symptoms, especially in the early stages of the infection. This is why regular screenings and diagnostic tests are important, even for individuals who do not exhibit any symptoms.
- Importance Of Early Gonorrhea Diagnosis:
- Prevents the spread of infection to other individuals
- Reduces the risk of long-term health consequences
- Allows for early intervention and prompt treatment
- Enables healthcare providers to provide necessary education and support
|Bacterial Culture||High accuracy; can determine antibiotic resistance||Takes time; requires specialized laboratory|
|Nucleic Acid Amplification Tests (NAATs)||Highly sensitive and specific||Expensive; requires specialized equipment|
|Rapid Gonorrhea Tests||Quick results in minutes||May have lower sensitivity compared to other tests|
In order to ensure early diagnosis, it is crucial for individuals at risk to undergo regular screenings and tests for gonorrhea. Individuals who engage in risky sexual behaviors, have multiple partners, or have previously been diagnosed with a gonorrhea infection should consider regular screenings as a part of their healthcare routine. This is especially important for high-risk populations, such as men who have sex with men (MSM) and young adults.
Gonorrhea is a significant public health concern, and its early diagnosis plays a crucial role in preventing its spread and managing its long-term consequences. By understanding the importance of early gonorrhea diagnosis, individuals can take proactive measures to protect their health, seek appropriate treatment, and contribute to the overall public health efforts in controlling this sexually transmitted infection.
Common Symptoms Of Gonorrhea To Watch For
Gonorrhea is a sexually transmitted infection that is caused by the bacteria Neisseria gonorrhoeae. It is one of the most common sexually transmitted infections in the world, particularly among young adults aged 15 to 24 years. Many people with gonorrhea may not experience any symptoms, which makes it important to be aware of the common symptoms to watch for. Early detection and treatment of gonorrhea are crucial to prevent complications and further spread of the infection.
There are several common symptoms of gonorrhea that individuals should be aware of. It is important to note that not everyone infected with gonorrhea will experience these symptoms, and some individuals may only exhibit mild symptoms that go unnoticed. However, for those who do experience symptoms, they can vary depending on the site of infection. In men, common symptoms of gonorrhea include a burning sensation while urinating, white, yellow, or green discharge from the penis, and swollen or painful testicles. Women may experience similar symptoms, including pain or a burning sensation while urinating, increased vaginal discharge, and abnormal vaginal bleeding between periods.
It is important to be aware that gonorrhea can also infect other parts of the body, not just the genitals. If the infection spreads, it can lead to more severe symptoms and complications. Rectal gonorrhea can cause symptoms such as itching, discharge, and pain or bleeding during bowel movements. Gonorrhea of the throat can cause a sore throat, difficulty swallowing, and swollen lymph nodes in the neck. Gonorrhea can also infect the eyes, resulting in redness, itching, discharge, and sensitivity to light.
|Burning sensation while urinating||✓||✓|
|Swollen or painful testicles||✓||N/A|
|Increased vaginal discharge||N/A||✓|
|Abnormal vaginal bleeding between periods||N/A||✓|
If you are experiencing any of these symptoms or have engaged in high-risk sexual behaviors, it is important to seek medical attention for testing and diagnosis. Gonorrhea can be diagnosed through various tests, including urine tests, swabs, or blood tests. It is important to get tested even if you do not have symptoms, as early detection and treatment can prevent complications and the spread of the infection to others. Remember, practicing safe sex by using condoms consistently and correctly can greatly reduce the risk of contracting gonorrhea and other sexually transmitted infections.
Diagnostic Tests For Detecting Gonorrhea
Gonorrhea is a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae. It is one of the most common STIs worldwide, with millions of new cases reported each year. Early and accurate diagnosis of gonorrhea is crucial for effective treatment and prevention of complications. There are several diagnostic tests available for detecting gonorrhea, each with its own advantages and limitations.
One commonly used diagnostic test for gonorrhea is a nucleic acid amplification test (NAAT). This test detects the genetic material of the bacteria in a urine sample or swab from the affected area. NAATs are highly sensitive and specific, meaning they can accurately identify the presence of the bacteria. They are also capable of detecting gonorrhea even in the early stages of infection when symptoms may not be apparent. This makes NAATs a reliable method for diagnosing gonorrhea.
An alternative diagnostic test for gonorrhea is a bacterial culture. This involves taking a sample from the affected area and culturing it in a laboratory to grow the bacteria. Once the bacteria have grown, they can be identified and tested for antibiotic susceptibility. Bacterial culture is considered the gold standard for diagnosing gonorrhea as it provides definitive evidence of infection and allows for further analysis. However, it can take several days to get the results from a bacterial culture, which may delay treatment.
|Nucleic Acid Amplification Test (NAAT)||Highly sensitive and specific||May be expensive|
|Bacterial Culture||Definitive diagnosis||Results take longer|
In addition to NAATs and bacterial cultures, there are also rapid diagnostic tests available for gonorrhea. These tests provide results within a short period of time, usually within 30 minutes. Rapid tests are convenient and can be performed in various settings, such as clinics or community health centers. However, their accuracy may vary, and false negative or false positive results can occur. Therefore, confirmatory testing is often recommended if a rapid test is positive or if there is a high suspicion of gonorrhea.
It is important to note that while diagnostic tests play a crucial role in detecting gonorrhea, they should always be accompanied by a comprehensive sexual health assessment. This includes discussing symptoms, sexual history, and risk factors with a healthcare provider. Regular screening for gonorrhea is recommended for individuals at a higher risk of infection, such as those who have multiple sexual partners or engage in unprotected sex.
There are various diagnostic tests available for detecting gonorrhea, each with its own advantages and limitations. Nucleic acid amplification tests (NAATs) are highly sensitive and specific, allowing for early and accurate diagnosis. Bacterial cultures provide definitive evidence of infection but may take longer to obtain results. Rapid diagnostic tests offer convenience but may have variable accuracy. It is important to consult with a healthcare provider for proper testing and screening to ensure timely detection and treatment of gonorrhea.
The Role Of Bacterial Culture İn Gonorrhea Diagnosis
When it comes to diagnosing gonorrhea, there are several methods that healthcare professionals use to determine if a person has been infected. One of these methods is bacterial culture. Bacterial culture involves taking a sample from the infected area, such as the urethra, cervix, rectum, or throat, and growing the bacteria in a lab setting. This allows the healthcare provider to identify the specific bacteria responsible for the infection.
Using bacterial culture for diagnosing gonorrhea offers several advantages. First and foremost, it can provide highly accurate results. By isolating and growing the bacteria, healthcare professionals can confirm if a person has gonorrhea and differentiate it from other similar infections. This precision is essential for effective treatment planning, as different bacteria respond to different antibiotics.
Bacterial culture allows healthcare providers to test for antibiotic resistance. Some strains of gonorrhea have become resistant to certain antibiotics, making treatment more challenging. By performing a bacterial culture, healthcare professionals can determine if the strain of gonorrhea is resistant to specific antibiotics, enabling them to prescribe the most effective treatment.
- Bacterial culture plays a crucial role in the diagnosis of gonorrhea. It offers highly accurate results and aids in determining the most appropriate treatment. it allows healthcare providers to test for antibiotic resistance, ensuring that patients receive the most effective medications. If you suspect you may have gonorrhea or have been exposed to the infection, it is important to seek medical attention promptly and discuss the possibility of bacterial culture testing with your healthcare provider.
Benefits And Limitations Of Nucleic Acid Amplification Tests (NAATs)
Nucleic Acid Amplification Tests (NAATs) have revolutionized the field of diagnostic testing for various diseases, including gonorrhea. These tests use a technique called polymerase chain reaction (PCR) to amplify and detect specific genetic material from the bacteria Neisseria gonorrhoeae, which causes this sexually transmitted infection. NAATs offer several advantages over traditional methods of gonorrhea diagnosis, but they also have certain limitations that need to be considered.
One of the key benefits of NAATs is their high sensitivity and specificity. These tests can detect very small amounts of gonorrhea DNA or RNA, making them extremely accurate in diagnosing the infection. They have been shown to be more sensitive than other diagnostic methods, such as culture or microscopy. This means that NAATs can identify cases of gonorrhea that may have been missed by other tests, leading to improved diagnosis and appropriate treatment.
In addition to their accuracy, NAATs also offer another significant advantage – they can be performed on various types of samples. While traditional methods like culture require specific sample types, such as swabs from the site of infection, NAATs can be conducted using urine, vaginal, or rectal samples, making them more convenient and less invasive for patients. This flexibility in sample collection allows for easier screening and testing of individuals who may be asymptomatic but at risk for gonorrhea.
|Benefits of NAATs||Limitations of NAATs|
Despite their numerous benefits, NAATs also have certain limitations. One of the main concerns is their cost. These tests tend to be more expensive compared to traditional methods like culture or microscopy. The requirement of specialized equipment and trained personnel further adds to the overall expenses. The availability of NAATs may be limited in certain healthcare settings due to resource constraints.
Another limitation of NAATs is the possibility of false-positive results. Although highly accurate, there have been instances where NAATs have produced positive results for gonorrhea in individuals who were not infected. This can lead to unnecessary anxiety and potential overtreatment. Therefore, confirmatory testing or re-testing is often recommended to ensure accurate diagnosis.
Nucleic Acid Amplification Tests (NAATs) offer numerous benefits in the diagnosis of gonorrhea. Their high sensitivity, ability to detect small amounts of genetic material, and flexibility in sample collection make them invaluable tools in detecting and treating this sexually transmitted infection. However, it is important to consider their limitations, such as cost and the possibility of false-positive results, in order to make informed decisions regarding their use. NAATs have significantly contributed to the advancement and accuracy of gonorrhea diagnosis.
How To Prepare For A Gonorrhea Diagnostic Test
When it comes to protecting our health, it is important to take proactive measures. One such measure is getting tested for sexually transmitted infections (STIs), including gonorrhea. Gonorrhea is a common STI caused by the bacteria Neisseria gonorrhoeae. It can be easily transmitted through sexual contact, and if left untreated, it can lead to serious health complications. Getting tested for gonorrhea is essential for early diagnosis and treatment. In this blog post, we will discuss the importance of preparing for a gonorrhea diagnostic test and how you can take the necessary steps to ensure an accurate result.
Before going for a gonorrhea diagnostic test, it is important to be well-informed about the process and what to expect. Knowing what to do beforehand can help you be prepared and ease any anxiety or discomfort you may have. Here are some key steps to follow when preparing for a gonorrhea diagnostic test:
- Consult With a Healthcare Provider: Schedule an appointment with your healthcare provider to discuss your concerns and to determine which type of gonorrhea test is suitable for you. They will ask about your medical history, sexual activities, and any symptoms you may be experiencing.
- Get Tested: Your healthcare provider will perform a diagnostic test to check for the presence of the gonorrhea bacteria in your body. The test may involve a urine sample, a swab from the genital area, or a blood sample. It is important to follow any instructions provided by your healthcare provider for collecting the sample accurately.
- Abstain From Sexual Activities: Before the test, it is essential to abstain from any sexual activities, including vaginal, anal, and oral sex. Engaging in sexual activities prior to the test can interfere with the accuracy of the results.
- Inform Sexual Partners: If you have tested positive for gonorrhea, it is crucial to inform your sexual partners so that they can also get tested and receive appropriate treatment. This will help prevent the spread of gonorrhea and protect the health of others.
|Benefits of Preparing for a Gonorrhea Diagnostic Test||Limitations of Preparing for a Gonorrhea Diagnostic Test|
|1. Increased accuracy of test results
2. Reduces anxiety and discomfort
3. Allows for early treatment and timely intervention
|1. Requires cooperation and commitment
2. Does not guarantee complete protection from gonorrhea
3. May involve some costs and inconvenience
Preparing for a gonorrhea diagnostic test is crucial for a reliable and accurate result. It helps in early diagnosis, timely treatment, and preventing the spread of the infection. Remember to consult with your healthcare provider, get tested, abstain from sexual activities, and inform sexual partners if necessary. By taking these steps, you are prioritizing your health and well-being, and contributing to the overall effort of reducing STIs in our communities.
Understanding The Accuracy Of Rapid Gonorrhea Tests
Rapid gonorrhea tests are diagnostic tests used to quickly and accurately detect the presence of the Neisseria gonorrhoeae bacterium, which is responsible for causing the sexually transmitted infection gonorrhea. These tests are designed to provide results within a short period of time, often in just minutes, allowing for immediate diagnosis and treatment if necessary. Rapid gonorrhea tests can be performed in various settings, including clinics, doctor’s offices, and even at home with the use of home testing kits.
One of the key advantages of rapid gonorrhea tests is their high accuracy. These tests use advanced technology to detect specific proteins or genetic material of the gonorrhea bacteria in a patient’s body. By targeting these markers, rapid tests are able to identify the presence of the infection with a high level of certainty. This accuracy is essential for timely and effective treatment, as it allows medical professionals to quickly initiate appropriate therapy and prevent further spread of the infection.
To understand the accuracy of rapid gonorrhea tests, it’s important to consider their sensitivity and specificity. Sensitivity refers to the test’s ability to correctly identify individuals who are infected with gonorrhea. A highly sensitive test will have a low rate of false-negative results, ensuring that individuals with the infection are not wrongly identified as negative. Specificity, on the other hand, measures the ability of the test to correctly identify individuals who do not have gonorrhea. A highly specific test will have a low rate of false-positive results, minimizing unnecessary anxiety and unnecessary treatment.
|Name of Test||Sensitivity||Specificity|
|Rapid Test A||95%||98%|
|Rapid Test B||97%||95%|
As shown in the table above, rapid gonorrhea tests typically have high sensitivity and specificity rates, ensuring reliable results. These rates may vary slightly between different test brands or methods, but rapid tests have proven to be highly accurate in diagnosing gonorrhea. However, it’s important to note that no diagnostic test is perfect, and there is always a possibility of false-positive or false-negative results.
It’s worth mentioning that rapid gonorrhea tests are not only accurate but also provide convenience and privacy. The quick turnaround time of these tests eliminates the need for multiple visits or waiting for laboratory results, allowing for immediate decision-making and treatment. Moreover, the availability of at-home testing kits further enhances privacy and accessibility, enabling individuals to take control of their own sexual health and get tested discreetly.
Rapid gonorrhea tests offer a convenient and accurate option for diagnosing this sexually transmitted infection. With their high sensitivity and specificity, these tests provide reliable results that help in early detection and prompt treatment of gonorrhea. When used in combination with other diagnostic methods and comprehensive sexual health practices, rapid gonorrhea tests contribute to the overall efforts in preventing the spread of the infection and promoting better sexual health.
Exploring Alternative Diagnostic Methods For Gonorrhea
Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It can affect both men and women and can lead to serious health complications if left untreated. Prompt and accurate diagnosis of gonorrhea is crucial in order to initiate appropriate treatment and prevent the spread of the infection. While traditional diagnostic methods such as bacterial culture and nucleic acid amplification tests (NAATs) are commonly used, there is ongoing research and exploration of alternative diagnostic methods for gonorrhea.
One alternative diagnostic method that is being explored is the use of point-of-care tests (POCTs). These tests are designed to provide rapid results, often within minutes, and can be performed at the point of care, such as a clinic or doctor’s office. POCTs for gonorrhea usually rely on detecting the presence of the bacteria or their genetic material in a patient’s urine, swab, or blood sample. While these tests offer the advantage of quick results, they may not be as sensitive or specific as traditional diagnostic methods.
Another alternative diagnostic method being explored is the use of serological tests. Serological tests detect the presence of specific antibodies produced by the body’s immune system in response to a gonorrhea infection. These tests can be performed using a blood sample and can provide information about a person’s past or current infection status. However, serological tests have limitations in terms of their ability to accurately diagnose a current infection or distinguish between different stages of the infection.
- while traditional diagnostic methods such as bacterial culture and NAATs remain the gold standard for diagnosing gonorrhea, alternative diagnostic methods are being explored to improve the accuracy, accessibility, and convenience of testing. Point-of-care tests and serological tests show promise in providing rapid results and additional insight into a person’s infection status. However, further research and validation are needed before these alternative methods can be widely implemented in clinical practice. It is important for healthcare providers and researchers to continue exploring and evaluating new diagnostic methods for gonorrhea to improve individual and public health outcomes.
|Traditional Diagnostic Methods||Alternative Diagnostic Methods|
|Bacterial culture||Point-of-care tests|
Challenges İn Diagnosing Gonorrhea İn Certain Populations
Gonorrhea is a common sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae. While diagnosing gonorrhea may seem straightforward, there are several challenges that healthcare professionals face, especially when it comes to certain populations. These challenges can include limited access to healthcare, cultural barriers, and lack of awareness about the infection and its symptoms.
One challenge in diagnosing gonorrhea in certain populations is limited access to healthcare. This can be due to various reasons, such as financial constraints, lack of transportation, or living in remote areas with limited healthcare facilities. When individuals do not have easy access to healthcare, they may delay seeking testing and treatment for gonorrhea, leading to potential complications and further spread of the infection.
Cultural barriers also pose challenges in diagnosing gonorrhea in certain populations. In some cultures, talking about sexual health and STIs is considered taboo or shameful, making it difficult for individuals to openly discuss their symptoms and seek medical help. This can contribute to late diagnosis and increased risk of transmission within the community.
In addition to limited access to healthcare and cultural barriers, lack of awareness about gonorrhea and its symptoms can also hinder diagnosis in certain populations. Some individuals may not be aware of the signs and symptoms of gonorrhea or the importance of getting tested regularly, especially if they belong to communities with lower levels of education or limited health literacy. This lack of awareness can result in delayed diagnosis and increased risk of complications.
- Limited access to healthcare – Financial constraints, lack of transportation, or living in remote areas with limited healthcare facilities can lead to delays in seeking testing and treatment for gonorrhea.
- Cultural barriers – Taboo or shame associated with discussing sexual health and STIs in certain cultures can make it difficult for individuals to openly seek medical help and discuss their symptoms.
- Lack of awareness – Communities with lower levels of education or limited health literacy may have limited knowledge about gonorrhea and its symptoms, leading to delayed diagnosis and increased risk of complications.
|Challenges in Diagnosing Gonorrhea in Certain Populations|
|1. Limited access to healthcare|
|2. Cultural barriers|
|3. Lack of awareness|
Addressing these challenges requires a multi-faceted approach. Healthcare providers and public health agencies need to work together to improve access to healthcare services, particularly in underserved areas. This can include setting up mobile clinics, offering free or low-cost testing, and educating community members about the importance of early diagnosis and treatment.
Breaking down cultural barriers calls for culturally sensitive and non-judgmental healthcare services. It involves creating safe spaces for individuals to discuss their sexual health without fear of stigma or discrimination. Community outreach programs, partnerships with local organizations, and targeted awareness campaigns can play a significant role in raising awareness and reducing the impact of cultural barriers.
Increasing awareness about gonorrhea and its symptoms is crucial in preventing further spread and complications. Education campaigns should be tailored to the specific needs of different populations, using clear and concise language that is easily understood. This can involve distributing informational materials in multiple languages, utilizing social media platforms, and conducting workshops and seminars in community settings.
The challenges in diagnosing gonorrhea in certain populations are complex, but not insurmountable. By addressing issues related to limited access to healthcare, cultural barriers, and lack of awareness, we can work towards earlier diagnoses, better outcomes, and ultimately, reducing the burden of gonorrhea in these populations.
The İmportance Of Regular Gonorrhea Screening For High-risk İndividuals
Gonorrhea, also known as “the clap”, is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. While it can affect anyone who is sexually active, certain individuals are at a higher risk of contracting and spreading the infection. Regular gonorrhea screening for high-risk individuals is of utmost importance in preventing the spread of this STI and ensuring early detection and treatment.
High-risk individuals include those who engage in unprotected sex, have multiple sexual partners, or have a history of STIs. This includes individuals who identify as men who have sex with men (MSM) and individuals involved in sex work. These individuals are more likely to come into contact with someone who has gonorrhea and are therefore at a higher risk of infection.
Regular screening for gonorrhea allows for early detection and prompt treatment, which is crucial in preventing complications and reducing the risk of transmission. While some may feel uncomfortable or embarrassed about getting tested for STIs, it is essential to prioritize one’s sexual health and well-being. Screening involves collecting a sample, such as urine or swab, from the genital area, throat, or rectum, depending on the sexual practices and behaviors of the individual.
- Screening for gonorrhea can be done through various methods, including nucleic acid amplification tests (NAATs) and bacterial cultures. NAATs are highly sensitive and specific tests that detect the genetic material of Neisseria gonorrhoeae. These tests can be performed on urine or swab samples and provide accurate results within a short period. Bacterial cultures, on the other hand, involve growing the bacteria in a laboratory setting and are considered the gold standard for gonorrhea diagnosis.
- Regular gonorrhea screening is not only beneficial for the individuals at risk but also for their sexual partners. If left untreated, gonorrhea can lead to serious health complications, such as pelvic inflammatory disease (PID) in women, which can cause infertility and chronic pelvic pain. In men, untreated gonorrhea can lead to epididymitis, a painful condition affecting the testicles. untreated gonorrhea increases the risk of contracting and spreading other STIs, including HIV.
- It is important to note that while regular screening is crucial, prevention is equally important. High-risk individuals should practice safe sex by using condoms consistently and correctly, limiting the number of sexual partners, and avoiding sharing sex toys. Educating oneself about STIs, including gonorrhea, and its transmission can also help in making informed decisions regarding sexual health.
|Benefits of Regular Gonorrhea Screening||Limitations of Regular Gonorrhea Screening|
|Early detection and treatment of gonorrhea||False positives and false negatives may occur|
|Reduced risk of complications and transmission||Testing may be expensive and inaccessible for some individuals|
|Peace of mind and reassurance regarding sexual health||Limited availability of healthcare providers offering comprehensive STI screening|
Regular gonorrhea screening is vital for high-risk individuals to prevent the spread of the infection and ensure early detection and treatment. It is essential to overcome any feelings of embarrassment or discomfort and prioritize one’s sexual health. By practicing safe sex and undergoing regular screening, high-risk individuals can protect themselves and their sexual partners from the potential complications of gonorrhea.
Frequently Asked Questions
What is the importance of early gonorrhea diagnosis?
Early gonorrhea diagnosis is crucial because it allows for timely treatment, which can help prevent complications and reduce the spread of the infection to others.
What are the common symptoms of gonorrhea to watch for?
Common symptoms of gonorrhea include a burning sensation during urination, abnormal discharge from the genitals, pain or swelling in the testicles, and vaginal bleeding between periods.
What are the diagnostic tests for detecting gonorrhea?
Diagnostic tests for gonorrhea typically involve testing a urine sample, swabbing the affected area, or using a blood test to detect the presence of the bacteria or its genetic material.
What is the role of bacterial culture in gonorrhea diagnosis?
Bacterial culture is a traditional method used to diagnose gonorrhea by growing and identifying the bacteria in a laboratory. It helps determine the antibiotic susceptibility of the infection.
What are the benefits and limitations of nucleic acid amplification tests (NAATs)?
NAATs are highly sensitive and specific tests that can detect small amounts of gonorrhea DNA or RNA. They provide accurate results quickly, but their cost and availability may be limitations.
How should one prepare for a gonorrhea diagnostic test?
Preparing for a gonorrhea diagnostic test typically involves refraining from urinating for at least one hour before the test and avoiding any topical interventions, such as douching, before the test.
How accurate are rapid gonorrhea tests?
Rapid gonorrhea tests have high accuracy rates, but false negatives and false positives can still occur. It is important to confirm the results with additional testing if the initial test is positive or negative.