A recent study suggests that rather than "surf" on wiggling sperm, "N. gonorrhoeae" bacteria use pili to anchor onto proteins in the sperm and move through coital liquid. For "N. gonorrhoeae", the first step after successful transmission is adherence to the epithelial cells found at the mucosal site that is infected. The bacterium relies on type IV pili that attach and retract, pulling "N. gonorrhoeae" toward the epithelial membrane where its surface proteins, such as opacity proteins, can interact directly. After adherence, "N. gonorrhoeae" replicates itself and forms microcolonies. While colonizing, "N. gonorrhoeae" has the potential to transcytose across the epithelial barrier and work its way in to the bloodstream. During growth and colonization, "N. gonorrhoeae" stimulates the release of cytokines and chemokines from host immune cells that are pro-inflammatory. These pro-inflammatory molecules result in the recruitment of macrophages and neutrophils. These phagocytic cells typically take in foreign pathogens and destroy them, but "N. gonorrhoeae" has evolved many mechanisms that allow it to survive within these immune cells and thwart the attempts at elimination. Transmission can be reduced by using latex barriers (e.g. condoms or dental dams) during sex and by limiting sexual partners. Condoms and dental dams should be used during oral and anal sex, as well. Spermicides, vaginal foams, and douches are not effective for prevention of transmission. The current treatment recommended by the CDC is a dual antibiotic therapy. This includes an injected single dose of ceftriaxone (a third-generation cephalosporin) along with azithromycin administered orally. Azithromycin is preferred for additional coverage of gonorrhea that may be resistant to cephalosporins but susceptible to macrolides. Sexual partners (defined by the CDC as sexual contact within the past 60 days) should also be notified, tested, and treated. It is important that if symptoms persist after receiving treatment of "N. gonorrhoeae" infection, a reevaluation should be pursued. Antibiotic resistance in gonorrhea has been noted beginning in the 1940s. Gonorrhea was treated with penicillin, but doses had to be progressively increased to remain effective. By the 1970s, penicillin- and tetracycline-resistant gonorrhea emerged in the Pacific Basin.