Gonorrhea

Causes Of Gonorrhea

Gonorrhea is caused by an obligate pathogen, Neisseria gonorrhoeae. Obligate pathogens are the bacteria that transmit disease from one host to another. These bacteria cannot survive outside the host body. 

The bacteria is mainly present in the discharge of penis & vagina. The disease can be transmitted through:

• Unprotected vaginal, anal & oral sex

• Sharing of contaminated vibrators & sex toys

• Infected mother to baby during childbirth 

Neisseria gonorrhoeae cannot survive on the surfaces outside the body. Due to which, the infection of gonorrhea does not spread by kissing, hugging, or sharing swimming pools, toilet seats, towels, or utensils. 

Types of Gonorrhea

Gonorrhea can be classified as either uncomplicated or complicated. 

Uncomplicated gonorrhea

This type is much more common and causes urogenital, anogenital, or pharyngeal infections. 

Complicated gonorrhea

The infection that leads to the spread of bacteria to joints and other tissues is considered as complicated gonorrhea. 

Symptoms Of Gonorrhea

The incubation period of gonorrhea (the time between exposure to the infection and the appearance of symptoms) is 10 days in women and 1-3 days in men. The various symptoms are listed below:

A. Symptoms of uncomplicated gonorrhea in men

• Urethral discharge

• Dysuria (painful urination)

• Urgency

• Frequent urination

• Urinary itch

• Painful erection

B. Symptoms of uncomplicated gonorrhea in women

• Dysuria

• Hematuria (blood in urine)

• Inflammation of the anus

• Increase in vaginal discharge

Here’s more on the common causes & treatment of vaginal discharge.

C. Symptoms of complicated gonorrhea in men

1. Epididymitis: It refers to inflammation of epididymis(a coiled tube attached to each of the two male reproductive organs, the testes). The typical symptoms include: 

• Swelling of the epididymis 

• Severe pain in epididymis, groin and lower abdomen

• Discharge from the urethra

2. Seminal vesiculitis: It refers to the inflammation of the tube that produces fluid for the semen known as the seminal vesicles. The typical symptoms include: 

• Dysuria (painful urination)

• Frequent urination

• Hematuria (passage of clear urine with blood)

• Hemospermia (blood in semen)

• Lower abdominal pain

3. Prostatitis: It refers to the inflammation of the prostate gland. The typical symptoms in gonorrhea include: 

• Chills

• Fever

• Frequent urination

• Pain or discomfort in the pubic region

D. Symptoms of complicated gonorrhea in women

1. Pelvic inflammatory disease: It refers to the inflammation of the female genital tract). It is characterized by the following symptoms:

• Chills

• Fever

• Anorexia (loss of appetite)

• Nausea 

• Vomiting

• Lower abdominal pain

• Irregular vaginal bleeding

• Abnormal vaginal discharge

2. Perihepatitis: It refers to the inflammation of the liver capsule. It is characterized by: 

• Sudden pain in the upper abdomen

• Fever

• Nausea 

• Vomiting

E. Symptoms of gonorrhea at other sites

1. Oral gonorrhea: It is also known as pharyngeal gonorrhea. Oral contact with either penis or vagina can cause oral gonorrhea. Usually oral gonorrhea remain asymptomatic but can cause following symptoms: 

• Sore throat

• Difficulty in swallowing food

• Redness of the throat

• White spots on the throat

• Swollen lymph nodes in the neck

• Fever

These symptoms are common for men and women and usually take 7-21 days to appear after oral contact with the infected genitals. Kissing does not spread oral gonorrhea as bacteria do not infect the mouth and tongue. 

2. Gonococcal conjunctivitis (GC): GC infects the eyes and spreads through the direct contact of the eye with the infected secretions of the genitals. 

An infected pregnant woman can also transmit the infection to the neonates during delivery. It occurs due to exposure of the neonate to the vaginal secretions which contain bacteria. When it occurs in neonates, GC is also known as gonococcal ophthalmia neonatorum. Symptoms take 24 to 28 hours following exposure to the bacteria and include: 

• Red eyes

• Thick pus in the eyes

• Swelling of the eyelid and conjunctiva

• Turbid and foggy cornea

3. Proctitis: It refers to the inflammation of the lining of the rectum. It is developed due to anal-genital intercourse. In most of the cases, it is asymptomatic. Some patients may experience symptoms such as :

• Itching and burning sensation in anus

• Discharge from the anus

• Rectal bleeding

• Blood in the stool

• Rectal pain

• Tenesmus (frequent and urgent feeling of passing the stool)

Risk Factors For Gonorrhea

You are at higher risk of gonorrhea if you: 

• Have unprotected oral, anal or vaginal sex with an infected partner

• Have low immunity 

• Have been diagnosed with gonorrhea in the past

• Are having multiple sexual partners

• Have sexual partner who has multiple partners

• Are sexually active

• Are a sex worker

• Have sex with somone from endemic are, having previous gonorrhea, having any sexually transmitted infections & having human immunodeficiency infection (HIV)

Lack of education & low socioeconomic status also increases the risk of developing gonorrhea. If the condom breaks during sex with an infected partner, it increases the risk of gonorrhea. Men who have sex with men (MSM) are more likely to cause gonorrhea.

Diagnosis Of Gonorrhea

The laboratory confirmation is done through the detection of bacteria in samples from the urinary tract, rectum, throat or eyes. In various cases, urine samples are also used. In case of any symptoms of gonorrhea, abstain from any kind of sexual activity until it is confirmed negative by the tests. The following tests helps in the diagnosis of gonorrhea: 

1. Physical examination: It includes looking for any signs of gonorrhea. Manifestations such as discharge from throat, rash, eye symptoms, and pain in abdomen are evaluated by the health-care provider. 

2. Nucleic acid amplification test (NAAT): This method detects the genetic material of the Neisseria gonorrhoeae in either urine or swab samples of the patients. The swab sample is taken from urethra for males. In females, the sample is taken from vagina or cervix. In case of rectal or pharyngeal infection, samples may be taken from rectum or throat respectively.

3. Culture: This test is one of the most widely used tests for gonorrhea as it has a specificity of 100%. The test can be done from the samples collected from the throat, urethra, vagina or rectum except the urine in both men and women. 

4. Smear test: This test is usually used to diagnose uncomplicated gonorrhea in men. It involves examination of urethral smears under the microscope. 

Prevention Of Gonorrhea

Gonorrhea is a sexually transmitted disease (STD) that spreads by sharing sexual fluids. This can be prevented by following safer sex practices like: 

• Using condoms, dental dams or latex/nitrile gloves while having oral, anal or vaginal sex

• Getting tested for STDs regularly, if you are sexually active

• Avoiding sex with your partner until he/she has finished his/her treatment for any STD

• Washing hands after touching your partner’s genitals

• Washing the sex toys with soap and water regularly

• Using condoms on sex toys

• Avoiding multiple partners

Note: Washing the genitals, urinating, or douching after sex will not prevent gonorrhea.

Are you using condoms in the right way? Here’s 9 condom mistakes that you should avoid.
Click To Read!

Specialist To Visit

Gonorrhea can affect anyone who is sexually active. You should immediately consult the doctor if you fall under the following category: 

• If you have symptoms such as genital discharge, burning during urination, rash, unusual rash etc.

• If your partner has been recently diagnosed with any STD

The annual gonorrhea screening is also recommended, if you:

• Are young and sexually active 

• Are old but have risk factors such as multiple sex partners etc. 

Pregnant women should also be tested for any STD including gonorrhea as a part of routine examination. This will help in reducing complications in the fetus. 

In most cases, the best place to visit is a sexual health clinic also called a genitourinary medicine clinic (GUM). The specialists who can help treat this infection include:

• General physician

• Infectious disease specialist

• Gynecologist

If you are falling into any of the categories mentioned above, seek advice from our professionals. 
Book Now!

Treatment Of Gonorrhea

Gonorrhea can be treated by antibiotics. The various treatment options for different symptoms or types of gonorrhea are discussed as follows:

Urogenital infections

The following antibiotics are prescribed for managing urogenital infections:

• Ceftriaxone 

• Doxycycline 

If a person is allergic to ceftriaxone other antibiotics can be used such as:

• Azithromycin 

• Gemifloxacin

• Gentamicin 

Gonococcal conjunctivitis

Newborns who developed gonococcal conjunctivitis are treated with ceftriaxone as per their body weight. The eyes should be washed every hour with normal saline. Mothers of infected newborns should be examined, and those with gonorrhea should be treated. 

Gonorrhea during pregnancy

Erythromycin or amoxicillin are the drug of choice for treating gonorrhea during pregnancy. 

Follow-up

• Usually follow-up testing is not recommended for rectal and genital infections. However, if the symptoms persist even after getting treatment for a few days, he/she should consult the doctor.

• Re-evaluation after 7-14 days of treatment is recommended for throat infection.

• Re-test is advised after 3 months of treatment to check re-infection.

Sexual partner management

• If you are diagnosed with gonorrhea, it is important to test the sexual partner, if you had sex before the onset of symptoms or within two months of the diagnosis. 

• Any kind of sexual activity should be avoided before the completion of treatment. 

• The mother of a neonate diagnosed with gonococcal conjunctivitis should be tested for gonorrhea alongwith her sexual partner. 

Complications Of Gonorrhea

Untreated gonorrhea usually spread to other part of the body leading to several complications: 

1. Pelvic inflammatory disease (PID)

Gonorrhea can spread from vagina to the other reproductive parts of the female such as the fallopian tubes & uterus. The symptoms of PID include fever & abdominal pain and can lead to reproductive complications such as: 

•  Long term pelvic pain
•  Infertility
•  Internal abscesses
•  Endometritis
•  Ectopic pregnancy

2. Pregnancy related complications

Gonorrhea in pregnant women increases the chances of miscarriages, premature labor, and first trimester abortion. 

A pregnant woman can also pass the infection to the fetus. It can develop several abnormalities in the baby such as conjunctivitis, joint pain, blindness, and blood infections. 

However, early treatment of the pregnant woman can reduce the chances of these complications.

3. Infertility in men

Gonorrhea can cause a painful infection in the testicles and prostate gland. It can also cause inflammation of the epididymis. All these changes can affect the fertility in men. 

4. Disseminated gonococcal infection (DGI)

DGI occurs as a result of untreated gonorrhea over a long period of time. In DGI, infection spreads through the bloodstream and can cause sepsis. It can also lead to conditions such as 

• Septic arthritis (inflammation of the joints)

• Tenosynovitis (inflammation of a tendon and its sheath)

• Endocarditis (inflammation of the inner lining of the heart's chambers and valves)

• Dermatitis (inflammation of the skin)

5. Fitz- Hugh-Curtis Syndrome

It is also known as perihepatitis. It is developed due to PID and is characterized by inflammation of the liver capsule. It causes formations of adhesions in the liver that results in persistent pain. 

Home-care For Gonorrhea

Home remedies

Gonorrhea can be easily treated with antibiotics. However, the following home remedies can be used as an adjunct to the antibiotics: 

1. Garlic (lehsun): It possesses antibacterial properties and can be used to combat bacterial infections like gonorrhea. 

2. Apple cider vinegar: It is well known for its antibacterial properties. It is consumed every morning using a metal straw as it can abrade the teeth.

3. Aloe-vera gel: It moisturizes the skin and fastens the recovery of wounds due to its antibacterial and antiinflammatory properties.

4. Goldenseal: This plant is also known for its antimicrobial properties. It is available in capsule and cream form. It is advised to take recommendation from the doctor for the right dosage before taking or applying it. 

5. Echinacea: This plant is used to reduce inflammation in the genitals due to its anti-inflammatory properties. It is available in the form of creams and gels.

Living With Gonorrhea

Though gonorrhea can be managed with antibiotics a few important points are to be kept in mind:

Avoid sexual activity

Patient diagnosed with gonorrhea should avoid any kind of sexual actvity for atleast 1 week following antibiotic treatment. It is advised to resume the sexual activity only after the symptoms subside. 

Retesting for gonorrhea

It is advised to test for the infection after the completion of the therapy or if symptoms persist for a long period of time. Retesting helps in identifying any antibiotic resistance and avoiding further treatment failure. 

Testing for other sexually transmitted infections(STIs)

Infected patients with gonorrhea are also at increased risk of contracting other STIs, including HIV. So, it is necessary for the patients to get themselves tested for other STIs such as HIV infection.