GONORRHEA: Cause, Modes of Transmission, Signs and Symptoms, Treatment with Antibiotics and Prevention

OVERVIEW:

Gonorrhea is a Sexually Transmitted Disease (STD) caused by the bacteria* Neisseria gonorrheae. It is also known as "the clap" or "the drip" and can be transmitted through any kind of sex. Infected pregnant women can also transmitted it to their babies during childbirth. Women are more at risk, than men, of getting the disease during an act of vaginal sex. Most times, women with gonorrhea present no symptoms, while men does. Signs and symptoms of gonorrhea common to both men and women include burning/painful sensation when urinating, pus-like discharge from the penis, vagina or anus, increased/urgent urination, anal itching and bleeding, painful/difficult bowel movement, conjuctivitis, sore throat and swollen lymph nodes in the neck. Gonorrhea can be effectively treated with antibiotics such as ceftriaxone, azithromycin and doxycycline

*Singular: Bacterium; Plural: Bacteria. We will/use the term "Bacteria" in this context because the disease condition is caused by numerous N.gonorrheae organisms and not just an individual organism*

Pus-like discharge from the penis and vagina. The discharge may be white, yellow or green in colour and may also be foul-smelling. This is the most common symptom of gonorrhea

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CAUSES/TRANSMISSION

Gonorrhea is a Sexually Transmitted Disease (STD) caused by the bacteria, Neisseria gonorrheae.
It is also known as "the clap" or "the drip" and is transmitted from one person to another through

• Unprotected vaginal, oral or anal sex
• Sharing sex toys with body fluids on them

The disease can not be spread through kissing, hugging, sharing baths or towels, swimming pools, toilet seats or sharing cups, plates and cutlery because the bacteria cannot survive outside the human body for long

Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman, while the risk for men that have sex with men is higher. Women, on their part, have a 60-80% risk of getting the infection from a single act of vaginal intercourse with an infected man.

Also, gonorrhea can be transmitted from mothers to their babies during childbirth. It majorly affects infants' eyes and is referred to as Ophthalmia neonatorum

N.gonorrhea, also known as Gonococci (plural) or Gonococcus (singular) is a bean-shaped bacteria that occur in pairs. It grows in warm and moist body cavities of both men and women. These include the:

• Cervix (the entrance to the womb)
• Urethra (the tube that carries urine out of the body)
• Rectum (the terminal part of the large intestine, just before the anus)
• Fallopian tube or Oviduct
• Uterus (the womb)
• Mouth
• Penis
• Vagina
• Eye
• Throat

Neisseria gonorrheae, the bacteria that causes gonorrhea. It is bean-shaped and occur in pairs

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SIGNS AND SYMPTOMS

Signs and symptoms of gonorrhea usually appear between 2-14days after exposure (i.e. entry of the bacteria into the body) and are sometimes so mild that they are mistaken for something else. Also, it is important to know that most women with gonorrhea shows no symptoms (about 80%) and are said to be asymptomatic, while most infected men shows symptoms (about 90%).

Symptoms of Gonorrhea differ depending on the site of infection. For the purpose of clarity, we will list these symptoms based on these sites of infection.

GONORRHEA AFFECTING THE GENITAL TRACT
Signs and Symptoms in Men

• Urethritis (inflammation of the urethra) which causes a burning/painful sensation while urinating
• Pus-like discharge from the penis. The colour of the discharge may be yellow, green or white
• Pain or swelling of the testicules
• Need to urinate urgently or more often

 Signs and symptoms in women

• Burning/painful sensation while urinating
• Yellow, green or white vaginal discharge which may be foul smelling
• Pain in the pelvic or abdominal region
• Increased urination
• Painful sexual intercourse
• Vulvitis (Inflammation of the vulva)
• Vaginal bleeding in between periods, such as after vaginal intercourse

GONORRHEA AT OTHER SITES IN THE BODY

• Rectum: Anal itching, pus-like discharge from the anus, anal bleeding, pain and difficulty when defecating
• Eyes: Conjuctivitis which may cause eye pain, redness of the eye, sensitivity to light and pus-like discharge from one or both eyes
• Throat: Sore throat and swollen lymph nodes in the neck. Both males and females can acquire gonorrhea of the throat when they perform oral sex on an infected partner, usually a male

Difficulty/pain during defecation. This symptom occurs when the rectum is infected with gonorrhea

Gonorrheal conjuctivitis.

 

COMPLICATIONS

Because of its often asymptomatic nature, Gonorrhea usually goes unnoticed in both men and women. As a result, they do not seek treatment. Untreated gonorrhea can lead to significant complications, such as:

• Infertility in men. Men with untreated gonorrhea can experience epididymitis — inflammation of a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis). Epididymitis is treatable, but if left untreated, it may lead to infertility. Prostatis (inflammation of the prostate gland) and Urethral stricture may also occur
• Infertility in women. Untreated gonorrhea can spread into the uterus and fallopian tubes, causing Pelvic Inflammatory Disease (PID), which may result in scarring of the tubes, greater risk of pregnancy complications and infertility. PID is a serious infection that requires immediate treatment.
• Infections that result when the bacteria spreads to the bloodstream: N.gonorrhea can spread through the bloodstream and infect other body parts. This may result in
  
  • Fever
  • Skin lesions
  • Joint infection (pain and swelling of the joints)
  • Endocarditis (inflammation of the lining of the heart cavity [Endocardium] and valves)
  • Meningitis
• Increased risk of HIV/AIDS. Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners.
• Blindness: Conjuctivitis caused by gonorrhea, if left untreated, can lead to blindness

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TREATMENT

Because gonorrhea is a bacterial disease, it can be treated with antibiotics. Uncomplicated gonorrhea can be effectively treated with the antibiotics: Ceftriaxone (Rocephine), a 3rd generation Cephalosporin - which is given as an injection - in combination with either Azithromycin or Doxycycline - two antibiotics that are taken orally.

This combination is essential because Gonorrhea may occur along with Chlamydia (another STD) which Ceftriaxone is not effective against.

Many antibiotics that were once effective against Gonorrhea, such as Penicillin, Tetracycline, Fluoroquinolones etc, are no longer recommended because of high rate of resistance acquired by N.gonorrhea

Also, to prevent being re-infected, ensure your sexual partner(s) is/are notified immediately, tested and treated for gonorrhea even if they don't have any signs or symptoms yet.

PREVENTION

As with all Sexually Transmitted Diseases, gonorrhea is best prevented by

• Being faithful to a healthy and faithful partner
• Using a condom when having sex with someone whose sexual history you know little about

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