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Gonorrhea

Introduction

Gonorrhea is a sexually transmitted disease (STD) that is caused by the bacterium Neisseria gonorrhea, which causes a purulent (made of pus) infection of membranes (surfaces) of the urethra, rectum, or mouth. It is transmitted during sex and affects both males and females. The newborn baby can get the disease during birth. In females, it infects the vagina, urethra, cervix and can go up to involve the pelvic organs. In males, it infects the urethra and can go up to the epididymis. It can co-exist with other STDs. It is treated with antibiotics and is prevented by having safe sex using condoms and with a single partner.

Causes

Gonorrhea is a contagious disease caused by a gram-negative bacterium, Neisseria gonorrhea. It is transmitted from one person to another during vaginal, oral, or anal sex. It affects the membranes of genital organs, anus, or mouth and causes a suppurated (pussy) infection.

Risk Factors and Epidemiology

Gonorrhea is a widespread infection and a burden on public health. It is equally prevalent in sexually active males and females, although the condition is increasingly seen in males. All females under age 25 are recommended to be screened for gonorrhea annually.

Risk factors of getting an infection are described below:

  • Young and sexually active
  • Having multiple sex partners
  • By having unsafe sex
  • By having sex with a partner who has multiple sex partners
  • Having other STDs or a history of STDs
  • Male homosexuality

Signs and Symptoms

The incubation period, that is, the period between the inoculation with bacteria and appearance of symptoms, for gonorrhea is 2-7 days. However, some people may not show symptoms until 30 days. Many people show no signs and symptoms of the disease, especially females.

In Females:

  • Vaginal discharge initially clear, later having pus
  • Pain during intercourse (dyspareunia)
  • Burning pee (dysuria)
  • Bleeding between periods (intermenstrual bleeding)
  • Mild lower abdominal pain
  • Sore throat
  • Pelvic inflammatory disease (PI means the infection of pelvic reproductive organs, including the uterus, fallopian tubes, and ovaries. All the above symptoms will increase in severity along with fever. If left untreated, it can cause fibrosis of the fallopian lines resulting in ectopic pregnancy or infertility.

In Males:

  • Burning pee
  • Discharge through the  penis (yellow/green)
  • Pain in the testis
  • Swollen testis
  • Sore throat

In Neonates:

  • Red-eye (conjunctivitis)
  • Pharyngitis
  • Corneal involvement- if untreated, can lead to blindness
  • Spread of infection throughout the body (disseminated gonococcal infection)

If the anus is involved, you may have:

  • Bleeding
  • Itching
  • Pain
  • Discharge

Disseminated gonococcal infection (DGI) happens when the infection spreads throughout the body via bacteria in the blood. It affects the joints causing arthralgia/arthritis, skin rashes (dermatitis), heart causing endocarditis, muscles and tendons (tenosynovitis), brain (meningitis).

Diagnosis

After taking a history of your symptoms and doing a physical examination, your doctor may advise laboratory tests which include testing for bacteria in the discharge of urine by simple staining method and by growing bacteria in the lab (culture). Urine may be collected, and Swabs of other affected areas may be taken. You may be tested for other STDs if you have risk factors, especially chlamydia and HIV.

For DGI cultures, any body fluid can be taken like vaginal, conjunctival, anal secretions, skin, Cerebrospinal fluid, and blood. For blood culture, three samples should be taken.

Recent CDC guidelines recommend nucleic acid amplification tests (PCR) to diagnose and screen gonorrhea. It can be done on swabs and urine.

Differential Diagnosis

Treatment

It is recommended to test and treat sexual partners. After being cured, you can again get infected by an untreated partner.

  • Gonorrhea is effectively treated with antibiotic medicines, which include,
  • Third generation Cephalosporin (ceftriaxone by injection)
  • Azithromycin by mouth
  • Combination therapy: In recent days, the bacteria seem to be resistant to the antibiotics, so a combination of both antibiotics is recommended now. Injection of ceftriaxone plus azithromycin was given by mouth.
  • To treat the co-existing chlamydia infection, your doctor may prescribe another doxycycline antibiotic given by mouth.
  • For people who are allergic to cephalosporin, a gentamicin injection is an option along with azithromycin.
  • If you have corneal involvement (cornea of the eye), your doctor may advise a hospital admission for antibiotics to be given by injections.
  • To prevent the infection of the eyes of a newborn baby, the application of silver nitrate or antibiotic (erythromycin, gentamycin), eye ointments, or eye drops is recommended at birth.

Prognosis

Gonorrhea is a curable disease and results in complete healing if treated on time. If left untreated can result in male and female infertility. It can cause ectopic pregnancy in females when the fertilized egg is not attached to the uterus, instead moves outside the womb, and is implanted somewhere else in the pelvis, usually in one of the fallopian tubes. The fallopian tubes connect the ovaries to the uterus. It grows and can burst the fallopian tubes resulting in serious health issues. It makes you more susceptible to having HIV/AIDS. It can cause blindness in babies if the eye’s cornea is involved.

Prevention

You can prevent yourself from getting infected with gonorrhea by;

  • Adapting safe sex (using condoms)
  • Having limited sexual partners
  • Regular screening for gonorrhea
  • Not having sex with someone suffering from STD
  • Avoid sex until completing your entire course of antibiotics