Written by : Dr.M.D.Mazumdar, MD
Gonorrhea, also known as the 'Clap', 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.
Spread of Gonorrhea
Gonorrhea spreads by exchange of semen or vaginal fluids during sexual contact, in both homosexuals and heterosexuals, 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.
It does not spread by simple kissing, sharing baths, towels, cups, or from toilet seats.
The symptoms of the infection show up 2 - 14 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 causes pain or a burning sensation when passing urine and a frequent desire to pass urine - so it is often mistaken for a simple urinary tract infection.
The infection then spreads inside the vagina and then upwards to the uterus and tubes. It can even infect the peritoneum in the abdomen. Lower abdominal pain with swelling and soreness of the vulva and vagina are common symptoms at this stage.
Thick whitish or creamy vaginal discharge resembling pus is is usually present. The color of the vaginal discharge may also be greenish yellow and foul smelling.
Abnormal vaginal Bleeding, Bleeding between periods and spotting after intercourse from the inflamed cervix and vaginal walls can occur.
Mild fever and a general physical discomfort are common.
Infection in the Eyes Gonorrhoea can affect the eyes and the throat after oral sex, in both men and women. It causes red itchy eyes, a symptom of gonococcal conjunctivitis. Burning and soreness of the throat with swollen glands may also occur.
Gonococcal infection of the Anus Infection of the anus will cause the mucus membrane to get inflamed, red and swollen. There may a whitish or greenish yellow discharge with pain while passing stool.
Septicemia In untreated cases, it can spread to the blood causing gonococcal septocaemia.
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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.
On examination the entire region may be red and swollen with foul smelling pus in the vagina.
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).
Diagnosis of Gonorrhoea
Gonorrhoea can be 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.
A swab is taken from the urethra in men or from the cervix in women and examined under a microscope for the presnece of gonococci. A throat or anal culture may also be done to see if the infection is in the throat or anus, especially if there are any symptoms at these sites. A urine sample may also be tested for the presence of the bacteria. Polymerase chain reaction (PCR) based testing methods are also available.
Treatment of Gonorrhea
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 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 should be advised against unprotected sexual intercourse until completely cured.
Long-term Effects of Gonorrhoea
If left untreated, the infection can spread inside the pelvis causing pelvic inflammatory disease (PID). It can affect the fallopian tubes causing blockage and future infertility. Chances of ectopic pregnancy are also more. Septic abortion and chorioamnionitis during pregnancy can also occur.
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). Prostatitis, urethritis with urethral stricture and epididymitis are also common effects of gonococcal infection.
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