Gonorrhea: Causes, Symptoms, Treatment

Gonorrhea is a highly contagious infectious venereal disease.

The causative agent of the disease is Neisseria gonorrhoeae, a gram-negative diplococcus. The bacterium was discovered in 1879 by Albert Neisser, a dermatovenerologist of German origin.

Sexually transmitted diseases.

Rrisk groups:

• people with multiple sexual partners,
• unprotected sex.

Gonorrhoea is most often transmitted directly through sexual contact, or between a woman and her baby, the disease is transmitted during childbirth. Sometimes an eye infection can also be a complication, but this occurs only in some very rare cases.

Transmission by contaminated wet towels or laundry is also rare but possible.

The first symptoms usually appear very briefly after just 2 to 5 days.

The incubation period is 2-10 days.

Table: overview of sexually transmitted diseases and their causative agents.

The disease is transmitted not only by conventional but also by oral sex and thus affects, for example, the nasopharynx or the mucous membrane of the anus and can also be found in the throat and mouth.

Susceptibility is general, overcoming the disease does not leave immunity.

The disease is globally widespread. It affects both sexes without distinction of age, with a higher prevalence in the sexually active part of the population. 

Gonorrhea affects about 0.8% of women and 0.6% of men. An estimated 33 to 106 million new cases occur each year, out of the 498 million new cases of curable STI – which also includes syphilis, chlamydia, and trichomoniasis. Infections in women most commonly occur when they are young adults. In 2015, it caused about 700 deaths.Descriptions of the disease date back to before the Common Era within the Old Testament. The current name was first used by the Greek physician Galen before 200 AD who referred to it as "an unwanted discharge of semen". Source: Gonorrhea - Wikipedia

Gonococcal infection affects men and younger people more often.

In the long term, the highest prevalence is in the age group of 25-34 years and 15-24 years.

Sometimes an asymptomatic course can also be observed, but this occurs in a minority of cases.

Although gonorrhoea has very little chance of spreading throughout the body, it usually rapidly reduces a person's quality of life, especially because it is an inflammation with purulent discharge, especially from the urinary tract.

It is very often associated with other venereal diseases.

In men, it mostly affects the urethra, sometimes the infection spreads to the prostate.

It manifests as a purulent discharge from the urethra - penis, a burning sensations when urinating, frequent urination or difficulty holding urine, tension or pain in the testicles. A rash appears on the head of the penis. About 10% of men have no symptoms.

In women, the symptoms of gonorrhoea tend to be less pronounced. They are manifested as vaginal discharge, pain during intercourse, pain in the lower abdomen, in some cases bleeding with varying intensity.

The finding is also on the cervix or other parts of the female reproductive system. It can also lead to the formation of intra-abdominal adhesions and subsequent sterility and chronic pelvic pain. Up to half of infected women have no symptoms.

The most common symptoms of gonorrhea:

• Burning sensation in the genitals
• Purulent discharge from the urethra
• Itching of the urethra
• Reddened penis
• Erectile dysfunction
• Painful ejaculation
• Whitish discharge from the vagina
• Odorous discharge from the vagina - purulent
• Itchy vagina
• Bleeding outside the menstrual cycle
• Frequent urge to urinate
• Frequent urination
• Pain while urinating
• Pain in the urethra
• Increased body temperature or fever
• Pain during sexual intercourse
• Bleeding after sexual intercourse
• Rectal pain
• Rectal itching
• Pain while defecating
• Swollen testicles
• Pain in the testicles
• Irritability or vomiting
• Belly ache
• Pain in the lower abdomen
• Infertility
• Swollen tonsils
• Purulent discharge from the eye
• Redness of the conjunctiva

Gonorrhea during pregnancy can result in premature birth.

Untreated gonorrhea in a child after birth can result in severe eye infection, in extreme cases permanent blindness.

Gonococcal infection, with complications and left untreated, can be transmitted (through the bloodstream) to the joints, heart and meninges.

If you observe the symptoms described above (even if only in a mild, unobtrusive form) and have had risky sexual intercourse, you should see a doctor.

The doctor will tell you (after the examination) whether it is a non-serious infection, such as a mild yeast infection in women, or whether gonorrhoea is suspected.

This disease should not be underestimated. Untreated gonorrhea can complicate and spread to nearby organs of the genital system.

The diagnosis is confirmed by:

• taking epidemiological history,
• the clinical picture, i.e. how it manifests itself,
• microscopic and culture examination of pus from the urethra in men
• microscopic and culture examination of cervical and urethral pus in women
• other specialized methods for demonstrating the presence of the bacterium, such as PRC or direct immunofluorescence.
• for the diagnosis of gonococci in the oral cavity, the typical swabbing with a cotton swab (from the tonsils) is not sufficient, so the infection may remain (for some time) unobserved.
• when a larger spread is suspected, blood is also taken for examination.

Seeing your doctor (gynecologist, urologist)

The doctor will ask about:

• the problems that led to the condition,
• the medicines you are taking,
• whether you have any allergies (to certain antibiotics),
• in the case of women, the date of the last menstruationand its regularity,
• your sex life, such as:

• what your sexual orientation is,
• whether you have been treated for any STDs, and if so, for which one and how,
• if you have multiple sexual partners,
• what problems you are currently experiencing, how long they have lasted.

Collecting information must be as detailed as possible; there is no need to withhold or be embarrassed to answer!

Sampling for examination

In addition to the interview, the doctor will need to take a sample of your secretions (men may also have their urine taken), which he or she will send for analysis.

In both men and women, the sample is taken from the urethra, in women also from the cervix.

Sometimes a sample is also taken from the anus and pharynx.

It is a good idea not to urinate for at least 4 hours before collection, and you will do best if you collect the sample before your first morning urine.

You should also not take any antibioticsfor a few days before the collection so that the results are not distorted, or if you have to take them, inform your doctor and he or she will decide on the next course of action.

Protection from gonorrhoea and prevention

Prevention of gonorrhea consists in the search, examination and treatment of sexual contacts of the sick.

Preventive measures also consist of limiting the provision and receipt of uncontrolled sexual services, the use of condoms and a preference for stable partnerships. 

There is no specific prevention of gonorrhoea by vaccination.

To protect yourself from infection, follow the basic rules of a safe sex life:

• don't change sexual partners often,
• know your partner's health status,
• if you have the slightest doubt, use a condom. 

Gonorrhoea and pregnancy

A pregnant woman who has contracted gonorrhoea is treated with the same antibiotics used to treat uncomplicated gonorrhoea.

If the person cannot take them for any reason, e.g. allergy or resistance, the doctor will prescribe others.

If the infected parent is worried that the baby might also become infected (and suffer from gonococcal conjunctivitis), the newborn is given antibiotic eye drops after birth to prevent infection.