Gonorrhea

Gonorrhea is a sexually transmitted disease caused by the Gram-negative bacteria, Neisseria Gonorrhea.

It grows well in the warm and moist reproductive tracts of both males and females.

In females, the commonest sites of infection are the cervix, the urethra, the uterus and the fallopian tubes.

It can also grow in other warm and moist areas of the body like the mouth and the anus.

It spreads by sexual contact, either vaginally or through anal or oral intercourse. Sometimes infection can also occur by use of an infected object like a vibrator if the vibrator is re-used while still moist.

Ejaculation does not have to occur for the infection to occur - simple penetration of the penis into the vagina is adequate for the bacteria to pass from one of the couple to the other.

The infection can also pass from the mother to the baby during pregnancy, either while the baby is still in the uterus, or at the time of delivery.

The symptoms of the infection show up 2 - 12 days after the sexual act.

Signs and Symptoms

The infection starts first in the urethral opening - the opening through which the urine comes out. It then spreads upwards to the cervix - the mouth of the uterus.
In 10% of patients, the infection spreads upwards to the uterus and tubes and can even infect the peritoneum in the abdomen. It can spread to the blood causing gonococcal septocaemia.
Gonorrhoea can affect the eyes, the throat and the anus and rectum after oral and anal sex, in both men and women.
There is pain and difficulty in passing urine and also a frequent desire to pass urine.
Mild fever and a general physical discomfort are common.
The lower genital organs become sore, and itching occurs both in the vulva and the vagina.
Thick whitish or creamy vaginal discharge resembling pus is seen.
On examination the entire region may be red and swollen with foul smelling pus in the vagina.
Some patients may feel no discomfort at all and may barely notice the infection. They may have only a mild vaginal itching that goes away in a few weeks time. These are the patients in the ‘carrier’ state and responsible for the spread of the disease.
Regardless of whether the infection is symptomless or toxic, the end result can be damage and closure of the fallopian tubes with future failure in conception (infertility).
In men the infection starts in the urethra - the opening on the penis through which urine comes out. It then spreads upwards to the epididymis in the scrotum. There is a thick yellow discharge from the penis and a difficulty in passing urine. There may be infertility in later life.

Diagnosis of Gonorrhoea

Gonorrhoea is diagnosed from the typical signs and symptoms with a history of sexual exposure.
Many patients are diagnosed only when their partners are investigated for the disease.
The diagnosis can only be proved by the demonstration of the gonococci under a microscope in a smear taken from the lower genital tract or from the rectum.

Treatment of Gonorrhea

Most patients can be treated in the outpatients department. Both the partners need to be treated simultaneously.
The drug of choice is penicillin in a single mega dose or in divided doses. Other drugs that are also used, singly or in combinations are spectinomycin, co-trimoxazole and cefuroxime.
In pregnancy, four drugs can be used safely, either alone or in combination - amoxycillin with probenicid, ceftriaxone, spectinomycin and cefixime.
In acute cases, the patient may need to be hospitalized for general systemic support.
The test for gonococci is repeated after 2 weeks and only then is the patient declared as cured. It is better not to have unprotected sex during this period.
The sexual partner is also treated at the same time as the patient to prevent reinfection.

Follow-up

The patient should be called back for check-up after 3 and 6 months and the tests repeated, if doubts of persistence of the infection arises. She is advised against unprotected sexual intercourse until completely cured.

Long-term Effects of Gonorrhoea

If left untreated, the infection can affect the fallopian tube in the female and cause future infertility. Chances of ectopic pregnancy are also more.

In males, the infection causes damage to the epididymis in the scrotum and may cause oligospermia (low sperm count) or aspermia (no sperm in the semen).

Sexually Transmitted Diseases

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