gonorrhoea, the clap, the drip
Gonorrhea is sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae (Pic. 1). Gonorrhea is formed in the warm, moist area of the reproductive tract such as the cervix, uterus and the fallopian tubes in women and in the urethra in both women and men. The bacterium also grows in the mouth, throat, eyes and anus. The infection is transmitted from one person to another through vaginal, oral, or anal sex. The usual symptoms in men include a burning with urination and discharge from the penis. Women have no symptoms about half the time or have vaginal discharge and pelvic pain.
The incubation period of the disease is approximately 10 days in women and 2 to 5 days in men, but in rare cases, there can be as long as 30 days in which the infective is asymptomatic.
The diagnosis is established by identification of the bacteria in genital, rectal, ocular or pharyngeal secretions. N. gonorrhoeae is detected by culture, gram stain test or by nucleic acid amplification (NAATs). It could be also visualized on microscopy (Pic. 2).
Testing all women who are sexually active and less than 25 years of age each year is recommended. This same recommendation applies in men who have sex with men.
Gonorrhea treatment can be achieved through a positive diagnostics, followed by the administration of antibiotics in adolescents and adults. However, drug-resistant strains of the bacterium has recently awakened public health bodies on the area of finding an alternative drugs for the treatment of the disease.
Symptoms
When women have the symptoms, they tend to be mild or similar to other infections, making them more difficult to identify. Half of women with gonorrhea are asymptomatic while others have vaginal discharge, lower abdominal pain or pain with intercourse, frequent urination and uneasy sensation while urinating.
First noticeable signs from the infection in men are often urethritis associated with burning with urination, pains in the testicles and discharge from the penis.
Either sex may also acquire gonorrhea of the throat from performing oral sex on an infected partner. Such infection is asymptomatic in 90% of cases, and produces a sore throat in remaining 10%.
Associated diseases
Complications
Gonorrhea if left untreated may last for weeks or months with higher risks of complications. One of the complications of gonorrhea is systemic dissemination resulting in skin pustules or petechia, septic arthritis, meningitis, or endocarditis. This occurs in between 0.6 and 3% of infected women and 0.4 and 0.7% of infected men.
In women these infections may cause asymptomatic vulvovaginitis (infection of the vulva and vagina) and cervicitis (inflammation of the uterine cervix) in 80% of the cases. Prolonged infection may evolve to pelvic inflammatory disease and cause sterility, ectopic pregnancy and chronic pelvic pain. Fitz-Hugh-Curtis syndrome consists in peritonitis, pelvic abscesses or perihepatitis due to gonococcal dissemination secondary to acute salpingitis.
In addition to the possible alterations during pregnancy already mentioned, gonococcal infection may also affect the newborn and may cause conjunctivitis, septicemia, arthritis, abscesses in the hair scalp, pneumonia, meningitis, endocardititis and stomatitis.
In men, inflammation of the epididymis, prostate gland, and urethra can result from untreated gonorrhea. Men who have had a gonorrhea infection have a significantly increased risk of having prostate cancer.
Rarely, gonorrhea may cause skin lesions (Pic. 3) and joint infection (pain and swelling in the joints) after traveling through the blood stream. Very rarely it may settle in the heart causing endocarditis or in the spinal column causing meningitis (both are more likely among individuals with suppressed immune systems, however).
Risk factors
Gonorrhea is sexually transmitted, with a risk of transmission of 50% through the unprotected sex.
Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. Extragenital gonorrhea and chlamydia are highest in men who have sex with men. Women have a 60-80% risk of getting the infection from a single act of vaginal intercourse with an infected man. A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant´s eyes, it is referred to as ophthalmia neonatorum (Pic. 4). This type of transmission of gonorrhea infection contaminates baby´s eyes during passage through the birth canal from an infected mother.
Prevention
As with most sexually transmitted diseases, the risk of infection can be reduced significantly by the correct use of condoms and can be removed almost entirely by limiting sexual activities to a mutually monogamous relationship with an uninfected person. The infection cannot be spread by toilets or bathrooms.
Like the bacteria that cause syphilis, these fragile, "fastidious" bacteria cannot sustain themselves outside the body and will rapidly die within minutes to hours. Soap and water can effectively remove the bacteria from the hands, and washing bedding and clothing is seldom necessary. The chlorine of most swimming pools destroys it immediately.
Screening for gonorrhea in women at increased risk of infection is recommended, which includes all sexually active women younger than 25 years. Additionally, the routine screening is recommended in women who have previously tested positive for gonorrhea or have multiple sexual partners and individuals who use condoms inconsistently, provide sexual favors for money, or have sex while under the influence of alcohol or drugs.
Infection of the genitals in females with Neusseria gonorrhoeae can result in pelvic inflammatory disease if left untreated, which can result in infertility. Infertility is a risk to 10 to 20% of the females infected with N. gonorrhoeae. Pelvic inflammatory disease results if N. gonorrhoeae travels into the pelvic peritoneum (via the cervix, endometrium and fallopian tubes). Infertility is caused by inflammation and scarring of the fallopian tube.
Gonorrhea in pregnancy may be associated with a higher risk of prematurity, premature rupture of membranes, fetal losses, delayed intra-uterine growth, and fever in the puerperium. Postpartum bartholinitis, peri-hepatitis, arthritis, endocartitis and endometritis may occur. About 25% of women with gonorrhea or Chlamydia become infertile.
In men, gonorrhea may cause painful testicles or infertility by blockage of the epididimis or tubes.
Early treated gonorrhea doesn´t have any long term complications and following fertility and pregnancy outcome. Without effective treatment there is lower chance other reproductive organs weren´t affect and fertility is achieved.
Gonorrhea treatment can be achieved through a positive rapid diagnostics and nuclei test, followed by the administration of antibiotics in adolescents and adults. However, drug-resistant strains of the bacterium have recently awakened public health bodies on the area of finding alternative drugs for the treatment of the disease.
The individuals who have been diagnosed and treated for gonorrhea may avoid sexual contact with others until at least one week past the final day of treatment in order to prevent the spread of the bacterium. Also, previous infection does not confer any immunity, and a person who has been infected can easily become infected again by exposure to someone who is a carrier for the bacterium, whether or not that person has any infectious signs or symptoms of their own.
Newborn babies coming through the birth canal are given erythromycin ointment in the eyes to prevent blindness from infection. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow. Adults may also have eyes infected with gonorrhea and require proper personal hygiene and medications.
