Gonorrhea definition

Gonorrhea is caused by the bacteria Neisseria gonorrhoeae, it is a sexually transmitted infection with symptoms such as greenish urethral discharge and painful urination. Gonorrhea in women carries a high risk of developing salpingitis and sterility. It occasionally causes conjunctivitis in adults.

What is Gonorrhea?

Gonorrhea is a sexually transmitted disease caused by Gram-negative bacteria (Gonococci) that mainly affects the sex organs but can disseminate to affect other organs such as the heart causing endocarditis and eyes causing conjunctivitis even in new born children where the baby becomes infected during birth and the eyes develop purulent discharge and may cause blindness when not treated. Gonorrhea can cause pharyngitis, salpingitis, arthritis (when the joints are affected) and the rectal mucosa can also be affected.

Gonorrhea in Men

Gonorrhea in men causes symptoms and signs in about 70 percent of men. Gonorrhea in men causes a severe urethritis, with green urethral discharge and dysuria. Primary sites of gonorrhea in men include the urethra, oropharynx and anorectum.

Gonorrhea in Women

Chronic asymptomatic infection is common; about 50% of women show no symptoms or signs of Gonorrhea. The spectrum of Gonorrhea in women is similar to that of Chlamydia. The causative agent of Gonorrhea Neisseria gonorrhoeae may be carried in the throat or cause an exudative tonsillitis. It can cause proctitis in women and homosexual men, who may present with purulent discharge, bleeding and rectal pain. Primary sites of Gonorrhea infection in women include the anorectum , endocervix, oropharynx, urethra and Bartholins gland.

Gonorrhea Transmission ( How do you get Gonorrhea? )

1. Gonorrhea is spread through sexual intercourse it is a venereal disease
2. Gonorrhea can also be transmitted during child birth

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Neisseria gonorrhoeae (gram negative intracellular diplococci) – causative agent of Gonorrhea

Gonorrhea Symptoms and Signs

1. May be asymptomatic it may not show symptoms and signs especially in a vast majority of women but infection may cause Pelvic inflammatory disease (PID) most often during menstruation.
2. Urethral discharge in men
3. Chronic Abdominal pains in women as a result of Pelvic inflammatory disease
4. Altered menstrual cycle (intermenstrual bleeding)
5. Painful sexual intercourse (dyspareunia)
6. Painful urination in both men and women
7. Conjunctivitis
8. Dermatitis
9. Arthritis

Gonorrhea Incubation period

Gonorrhea has an incubation period of 2 to 14 days with most symptoms occurring between day 2 and 5. Gonorrhea in men has incubation period of 2-5 days for men.

One of Gonorrhea symptoms is urethral discharge

Gonorrhea Diagnosis

1. Gram staining technique using methylene blue. Swabs are usually taken from the urethra and cervix and placed in Amies transport medium. Only 50% shows Gonorrhea bacteria (shows Gram-negative intracellular diplococcic)
2. Culture of organisms in special blood agar media such as the New York City medium
3. Use of Immunofluorescence or Co-agglutination methods
4. Direct detection using enzymatic immunosorbence test
5. Use of Gene probe to identify gonococcus specific DNA sequences coding for rRNA

Gonorrhea Treatment

Treatment of Gonorrhea in uncomplicated cases was initially with Penicillin G but due to resistance as a result of new strains of organisms producing penicillinase enzyme that breakdown penicillin and renders it not effective. The drugs of choice for treatment of Gonorrhea are 3^rd generation Cephalosporins such as Ceftriaxone; for those that are allergic to Cephalosporins, Spectinomycin or Ciprofloxacin is used.

Can Gonorrhea be cured?

Uncomplicated Gonorrhea can be cured using Ceftriaxone 250mg intramuscularly as a single dose or Cefixime 400 mg oral as a single dose. Antimicrobial therapy should take into account of local patterns of antimicrobial sensitivity to Neisseria gonorrhoeae. Where antibiotic use is not controlled adequately, resistant strains emerge rapidly.

Antibiotics for Gonorrhea

1. Amoxycillin 1g with probenecid 2g as a single dose (safe in pregnancy)
2. Ciprofloxacin 500mg as a single dose
3. Spectinomycin 2g as a single dose (intramuscularly) safe in pregnancy
4. Azithromycin 1g as a single dose
5. Ceftriaxone 250 mg as a single dose (intramuscularly)
6. Cefixime 400mg as a single dose

Gonorrhea Complications

1. Gonorrhea effect on baby causes Ophthalmia neonatorum (Neonatal Ophthalmia) this usually occurs 2-7 days postnatally
2. Gonorrhea may give rise to ascending infections involving the epididymis or prostate
3. Formation of Bartholin’s abscesses
4. In rare cases, it causes Peri-hepatitis (Fitzhugh-Curtis syndrome)
5. It can cause Infertility secondary to pelvic inflammatory disease (PID) in women and urethral strictures in men. Acute gonorrhea if untreated becomes chronic and causes tubal damage that leads to tubal occlusion, which is the major cause of infertility.
6. Development of urethral strictures
7. Peritonitis
8. Polyarthralgia
9. Miscarriage
10. Premature labour
11. Meningitis
12. Ectopic pregnancy

Gonorrhea Prevention

1. Use of condom during intercourse
2. Having sex with only one partner
3. Prompt treatment of infected pregnant women to prevent transmission to baby
4. All patients and present partner(s) should be offered concomitant antichlamydial therapy
5. All partners need synchronous treatment to stop the ping-pong effect
6. Give counselling education on compliance and condom use. Any partner(s) in the previous 60 days should be notified or advised to seek medical screening and therapy
7. Follow-up testing of cure is recommended, preferably in the first week, at least once