Gonorrhea is a sexually transmitted disease (STD), caused by bacteria known as Neisseria gonorrhoeae (gonococci). It is a very common STD in the United States, along with genital herpes. Gonorrhea is often seen as a disease that causes recurrent urinary tract infections (UTI) and genital discharge, and while these are the common clinical features, other signs, symptoms and complications of gonorrhea infection may develop over time.
How is gonorrhea spread?
Transmission of Gonorrhea
Gonorrhea is mainly spread through sexual contact with an infected person. Following unprotected sex, the chance of disease transmission is higher from infected men to women than infected women to men. Majority of the infections are transmitted by asymptomatic patients and the partner is usually unaware of any sexually transmitted disease.
Gonorrhea can also be transmitted from infected pregnant women to her baby as the child passes through the birth canal at the time of delivery.
What are the symptoms of gonorrhea?
Signs and Symptoms of Gonorrhea
Most women having gonococcal infection in the urethra remain asymptomatic or have trivial symptoms, while majority of the men having the infection show clinical disease. Most rectal and pharyngeal gonococcal infections are asymptomatic.
Gonorrhea usually presents with urethritis (infection of urethra). It is among the more common cause of a recurrent UTI due to sexual transmission. Women can also present with cervicitis (infection of cervix). Other sites of infection can include the rectum, vagina (in sexually immature girls), pharynx (throat), and conjunctiva.
In men, gonococcal urethritis is characterized by pain while passing urine and a purulent urethral discharge. Women may have vaginal discharge, abnormal bleeding (between the menstrual cycles and after intercourse), increased menstrual bleeding and pain on passing urine.
Rectal infections can result in anal itching, mucus discharge with feces, pain, and bleeding. Rectal symptoms are more common in homosexual men than in women with rectal gonorrhea. Pharyngeal gonorrhea is mostly asymptomatic.
Gonorrhea in children may affect the eyes (ophthalmia neonatorum), resulting in pus discharge. It can lead to blindness. Children may also suffer from vaginal or rectal gonorrhea and in these cases, sexual abuse has to be considered.
In disseminated gonococcal infection, fever, skin lesions, and multiple joint pains are common symptoms.
What are happens if gonorrhea is not treated?
Complications of Gonorrhea
Common complications of gonorrhea are acute salpingitis (infection of fallopian tube), pelvic inflammatory disease (PID), and subsequent infertility. Other complications include epididymitis, urethral stricture, Bartholin gland abscess and disseminated infection. Neonatal conjunctivitis (ophthalmia neonatorum) can lead to blindness.
How is gonorrhea diagnosed?
Diagnosis of Gonorrhea
Medical history would reveal the unprotected sexual encounter(s), a recurrent or peristent UTI (urinary tract infection) and penile or vaginal discharge. Upon a gynecological examination, the cervix can be swollen and can bleed easily.
Gonorrhea may be diagnosed with simple microscopy. A smear from the infected person is sent to a laboratory and evaluated under a microscope to identify the pathogen. A bacterial culture is not necessary but may be done to confirm the diagnosis and test the sensitivity of the microorganism. This will assist with deciding the upon the treatment regimen.
Routine investigations can show raised white blood cell count and erythrocyte sedimentation rate (ESR).Nucleic acid amplification tests (NAATs), which are more expensive than a culture, is becoming increasingly common.
How is gonorrhea treated?
Treatment of Gonorrhea
Gonococci are resistant to the commonly used antimicrobials like penicillins and tetracyclines, and they are avoided as a first choice option. Single-dose of intramuscular ceftriaxone or oral cefixime can cure most cases of uncomplicated gonorrhea. Single-dose oral ciprofloxacin, or levofloxacin is highly effective for gonococcal infections acquired in the United States.
Gonorrhea patients should also be routinely treated for co-existing Chlamydia trachomatis infections, with azithromycin single dose or doxycycline twice daily for 1 week.
Disseminated gonococcal infection patients are treated with injectable formulations such as ceftriaxone, cefotaxime, ciprofloxacin, or levofloxacin for 1-2 weeks. Other complicated gonorrhea infections may be treated orally for 1-2 weeks. All partners in the past 60 days should also be treated.
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