Gonorrhea

Eyes

Gonorrhea causes conjunctivitis. In neonates, it may cause visual defects and blindness called ophthalmia neonatorium [7].

Gastrointestinal tract 

Gonorrhea may cause lower abdominal pain as well as pain in bowel movements.

Urogenital tract

Genitals are red, sometimes painful and swollen. There is a burning sensation in urinating and a greenish yellow or white discharge may be found from the vagina or penis.

Systemic symptoms

Heart

Although rare, if left untreated, gonorrhea may produce endocarditis and valvular dysfunction [6].

Skin

It may cause skin lesions and rash.

Central nervous system (CNS)

Gonorrhea may cause meningitis.

Musculoskeletal 

It may cause an infection in the joints making them swollen and painful [2].

Complications

If left untreated, gonorrhea may lead to:

Males

• Septic arthritis
• Epidydimisitis
• Oligospermia
• Sterility
• Systemic defects involving the heart, brain and joints

Females

• Pelvic Inflammatory Disease
• Septic arthritis
• Septic abortion
• Infertility
• Ectopic pregnancies
• Systemic defects involving the heart, brain and joints

The workup includes blood sampling for culture and sensitivity. A swab sample of fluids may be collected from the throat, cervix, vaginal canal and/or rectum in females and throat, penile urethra and/or rectum in males [10].

Laboratory tests 

Gram staining: Gram staining may be done to check for the organism involved.

PCR: A Polymerase Chain Reaction test maybe done for more accurate results.

C/S: Culture and sensitivity of either blood samples, urine or swab samples may be done for accurate results.

If the test results come positive, treatment is immediately started.
Other STDs are also checked.

Treatment is either oral or parenterally administered antibiotics. The common regime used these days is Ceftriaxone, Azithromycin and Doxycycline given in a combination to prevent reoccurrence as well as to treat other STDs like Chlamydia, if also present [8].

Gonorrhea is a curable disease but if it is not caught on early, it may show systemic effects like endocarditis, skin lesions or joint pain.

If treated with proper antibiotics, most commonly used are a Cephalosporin (Ceftriaxone) in combination with a macrolide (Azithromycin) and Doxycycline, the disease shows a positive response. Symptoms regress in just a few days of antibiotic treatment and completely disappear after some time. This 3-antibiotic regime is given to ensure reinfection may not occur as well as any other STD, like Chlamydia, may also be treated if present.

The causative agent of this disease is the bean-shaped coffee coloured spherical bacteria called Neisseria gonorrhoea that occurs as pairs, hence called diplococci. It is a facultative anaerobe and grows in abundance in moist, warm mucus membranes of the body. So when contracted, the bacterium quickly settles and multiplies in the vaginal canal, cervix, uterus and uterine tubes, penile urethra, rectum and/or oral cavity.

Transmission

This bacteria is transmitted in two major ways:

Sexual transmission

This is the most common mode of transmission. An individual may knowingly or unknowingly transmit the bacteria to his or her sexual partner by either oral, vaginal or anal sex [3]. Depending upon the kind of intercourse performed, the bacteria may start an infection in that area. For example, anal sex leads to development of gonorrhoea primarily in the rectum, oral sex leads to infection in the throat, etc.

Childbirth

A pregnant female may transmit this disease to her baby, particularly at the time of cord clamping, because an exchange of infected fluids may occur at that time. Or, the child may become infected when passing through the bacteria-laden birth canal during labor.

Myth

It is a common, but a completely wrong belief that gonorrhoea can be transmitted by using public toilets. This is a myth.

Gonorrhea is the second most common sexually transmitted disease in the United States as well as the rest of the world. The most common is Chlamydia.

Race

African-Americans are known to be the most susceptible, and so majority of the cases of gonorrhoea are found in people of this race.

Age

Although gonorrhea can occur at any age; neonatally if transmitted from infected mother to baby, or post-puberty via unprotected sexual activity, it is most commonly found in young individuals ranging from 15 years to 25 years.

Sex

Gonorrhea occurs in both men and women, but females have a higher rate of incidence than men.

Incidence

According to the Centre of Disease Control, more than 800.000 people in the United States get gonorrhea each year. Worldwide, it is estimated by WHO that over 62 million cases occur annually.

As discussed above, by having unprotected sex with an infected individual, one can contract this disease. The invading bacteria have specialised surface proteins called Opa proteins that possess the capability to bind with immune complex receptors. Upon binding, they render the immune complexes nonfunctional and thus they colonise the mucus membranes of the body without any opposing mechanisms. Once settled, they begin multiplying and after an incubation period of 2-14 days, symptoms present [5].

Although some people remain symptomless at first, many develop characteristic signs. Such as:

Females

• Pain and burning sensation during micturation
• Greenish-yellow or white coloured vaginal discharge
• Spotting after sexual intercourse
• Bleeding between menstrual periods
• Lower abdominal and pelvic pain, sometimes mimicking pain of pelvic inflammatory disease (PID)
• Red, itchy eyes
• Red, swollen genitals
• Sore throat (oral sex)
• Swollen glands in the throat (oral sex)
• Pain in defecation (anal sex)
• Itching and general discomfort around anus and genitals

Males

• Pain and burning sensation during micturation.
• Greenish yellow or white coloured discharge from the penis
• Swollen, painful testicles
• Red, swollen genitals
• Sore throat (oral sex)
• Swollen glands in the throat (oral sex)
• Pain in defecation (anal sex)
• Itching and general discomfort around anus and genitals

In females, it presents with milder symptoms and can be confused with pelvic inflammatory disease or yeast infections. Once infection begins, it may spread via the bloodstream to different parts of the body and may cause systemic effects.

Gonorrhea, like other STDs can be easily prevented. Preventive measures include [9]:

• Using latex condoms during intercourse
• Getting checked for STDs, at least once a year if sexually active
• Having only one sexual partner

Gonorrhea is a very common sexually transmitted disease that is caused by a bacterial infection. The culprit bacteria is Neisseria gonorrhoea.

The bacteria

N. gonorrhoea, or gonococcus, is a gram negative bacteria. It is a bean shaped diplococcus that is a facultative intracellular anaerobe. There are a total of 11 species of Neisseria known to have humans as a host, out of which only two are harmful to us. Many are a part of the normal flora of the body, except gonococci which cause gonorrhea and meningococci, which cause meningitis [1]. Easily cultured on chocolate agar, this bacteria can be easily isolated and tested.

N. gonorrhoea has special Opa proteins on its surface which bind to receptors present on the immune complexes making them non-functional [4]. This prevents both an immunological response by the host against the pathogen as well as the formation of immune memory of that particular invader.

The disease

Gonorrhea presents with characteristic symptoms in most cases, but in some patients it may be symptomless at first. The disease can occur in the throat, in the genitals and the rectum. However, gonorrhoea does have extra-urogenital manifestations which will be talked about in detail in later segments.

Definition

Gonorrhea is a sexually transmitted disease caused by a bacterium called Neisseria gonorrhoea.

Cause

It can be transmitted by having unprotected vaginal, oral or anal sex with an infected partner. It can also be transmitted by infected mother to her baby during childbirth. In this case, early detection of the disease can protect the baby.

Signs and symptoms

Common symptoms include pelvic pain, greenish yellow or white discharge, swollen genitals and burning in urination.

Treatment

Treatment is antibiotics and a sex-free period till the disease is cured.

Prevention

It can be easily prevented by taking the right precautionary measures like using latex condoms during intercourse, screening and testing for STDs once a year and not having multiple sexual partners.

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