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

• Fever

  Symptoms may include fever, swelling, joint pain and stiffness, rash, and skin sores. [stanfordhealthcare.org]

  Tick-borne Rickettsia rickettsii Rocky Mountain spotted fever Rickettsia conorii Boutonneuse fever Rickettsia japonica Japanese spotted fever Rickettsia sibirica North Asian tick typhus Rickettsia australis Queensland tick typhus Rickettsia honei Flinders [en.wikipedia.org]

  Feeling like you need to urinate more frequently than usual Pain or burning when you urinate Pain in your lower abdomen, penis, or vaginal area Pain when you have sex Thick, yellow-green discharge coming from your penis or vagina Fever How is gonorrhea [drugs.com]

  Abdominal or scrotal pain -- especially if associated with a fever -- requires immediate medical evaluation. People taking antibiotic dual therapy for chlamydia and gonorrhea sometimes experience an allergic reaction. [livestrong.com]

  Onset is often acute, usually with fever, severe joint pain, and limitation of movement. Infected joints are swollen, and the overlying skin may be warm and red. [merckmanuals.com]

• Chills

  You have chills, a cough, or feel weak and achy. You have questions or concerns about your condition or care. Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated. [drugs.com]

  PID is characterized by pain in the pelvis and lower abdomen, as well as nausea, vomiting, fevers, chills, cramping, and a foul-smelling discharge. [verywellhealth.com]

  HealthGrove This week the United Kingdom's top doctor penned a letter warning about the rise of " super gonorrhea ," and the chilling report has spread across the internet faster than, well, gonorrhea. [fusion.net]

  Photo Credit Dolly Faibyshev for The New York Times Work Out and Chill? Cool temperature workouts may be the answer for those who want to exercise without becoming a hot mess. [nytimes.com]

  Signs and Symptoms of Gonorrhea No symptoms at all Burning during urination Abnormal menstrual bleeding Discharge from the penis or vagina Discharge from the throat or rectum Females may have pain in the lower belly with fever, chills and vomiting. [nationwidechildrens.org]

• Reiter Syndrome

  These include pelvic inflammatory disease, infertility, ectopic pregnancy (pregnancy that occurs outside the womb), chronic pelvic pain, inflammation of the testicles and Reiter syndrome. Image Content Provider: CDC/ Dr. [gov.mb.ca]

  Arthralgia, arthritis and tenosynovitis of the ankles, wrists, hands and feet ( Reiter's syndrome ). Meningitis, endocarditis or myocarditis, with risk of death or permanent sequelae (extremely rare). [patient.info]

• Malaise

  Very rarely, the infection can settle in the heart and cause inflammation of the heart valves (endocarditis), manifesting with symptoms of malaise, fever, chills, and a heart murmur. [verywellhealth.com]

• Sore Throat

  […] infection symptoms other than sore throat. [ncbi.nlm.nih.gov]

  Symptoms Men Discharge from penis Pain or burning sensation when urinating Sore throat (if performing unprotected oral sex) Discharge in stools and rectal itching (if receiving unprotected anal sex) Men who have gonorrhea that is left untreated can result [dchealth.dc.gov]

  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 [symptoma.com]

  Symptoms in men include: Burning and pain while urinating Increased urinary frequency or urgency Discharge from the penis (white, yellow, or green in color) Red or swollen opening of penis (urethra) Tender or swollen testicles Sore throat (gonococcal [web.archive.org]

• Abdominal Pain

  […] when passing urine low abdominal pain sometimes with nausea Gonorrhea Symptoms in Men white, yellow or green thick discharge from the tip of the penis inflammation of the testicles & prostate gland irritation or discharge from the anus urethral itch [std-gov.org]

  Gastrointestinal tract Gonorrhea may cause lower abdominal pain as well as pain in bowel movements. Urogenital tract Genitals are red, sometimes painful and swollen. [symptoma.com]

  Also, men may have itching around the opening of the penis, abnormal discharge from the penis, and painful or swollen testicles. Women may have lower abdominal pain, painful sex, increased vaginal discharge, or vaginal bleeding between periods. [gov.mb.ca]

  Fever usually accompanies this extension, and lower abdominal pain is a prominent symptom. Pelvic abscess or peritonitis may result. The symptoms can be confused with those of appendicitis. [britannica.com]

• Lower Abdominal Pain

  Also, men may have itching around the opening of the penis, abnormal discharge from the penis, and painful or swollen testicles. Women may have lower abdominal pain, painful sex, increased vaginal discharge, or vaginal bleeding between periods. [gov.mb.ca]

  Fever usually accompanies this extension, and lower abdominal pain is a prominent symptom. Pelvic abscess or peritonitis may result. The symptoms can be confused with those of appendicitis. [britannica.com]

  Women Discharge from vagina Lower abdominal pain Pain when urinating Sore throat (if performing unprotected oral sex) Symptoms often appear during periods Pain or discomfort during sex Discharge in stools and rectal itching (if receiving unprotected anal [dchealth.dc.gov]

  Discharge from the penis, vagina, or anus Vaginal bleeding Painful urination Pain in the testicles Pelvic or lower abdominal pain Arthritis can be caused by gonorrheal infection. [jamanetwork.com]

  Among these women, one in two of them will have abnormal (watery or creamy looking, blood like or even slightly green) vaginal discharge and a quarter of them will experience lower abdominal pain. [onlinedoctor.superdrug.com]

• Vomiting

  Mild dose-related gastrointestinal side effects (nausea, loose stools, vomiting) were common but did not limit therapy. [ncbi.nlm.nih.gov]

  […] pain, light sensitivity, or eye discharge resembling pus red, swollen, warm, painful joints Women: painful sexual intercourse fever yellow or green vaginal discharge vulvar swelling bleeding in-between periods heavier periods bleeding after intercourse vomiting [medicalnewstoday.com]

  Fitz-Hugh-Curtis syndrome is gonococcal (or chlamydial) perihepatitis that occurs predominantly in women and causes right upper quadrant abdominal pain, fever, nausea, and vomiting, often mimicking biliary or hepatic disease. [merckmanuals.com]

• Nausea

  Mild dose-related gastrointestinal side effects (nausea, loose stools, vomiting) were common but did not limit therapy. [ncbi.nlm.nih.gov]

  […] discharge that may be thin & watery or thick & yellow/green irritation or discharge from the anus abnormal vaginal bleeding possibly some low abdominal or pelvic tenderness pain or a burning sensation when passing urine low abdominal pain sometimes with nausea [std-gov.org]

  Side effects include nausea, rash headache, itching, and pain and redness at the injection site. [healthcommunities.com]

  If symptoms do occur in infected women, they may take the form of: An abnormal vaginal discharge Pain during urination An urge to urinate more than usual Pain during sexual intercourse Abdominal pain Spotting between periods Nausea and fever If symptoms [ameripath.com]

• Rectal Pain

  […] or scrotal pain Burning and itching around the opening of the penis Sore throat Gonorrhea Symptoms in Women Most Common Silent or no symptoms Less Common Unusual, increased bloody yellowish or watery green vaginal discharge Painful urination Rectal pain [stdcheck.com]

  If symptoms occur, they can include: Discharge from the vagina that is different than usual Bleeding between periods Yellow or green discharge (drip) from the penis Pain or bleeding during or after sex Pain during urination Constipation Rectal pain, bleeding [www1.nyc.gov]

  […] vagina Pain with urination Arthritis, joint pain Appearance of a rash with dark centers Lethargy Rectal pain or discharge Sore throat (pharyngitis) Sexual contact with an infected person When to go to the hospital Gonorrhea can develop into more serious [emedicinehealth.com]

  Someone with gonorrhea may have: discharge from the vagina, penis, or anus in men, pain in testicles in women, vaginal bleeding between periods pain in the lower belly pain when peeing rectal pain, especially when having a bowel movement (pooping) Many [kidshealth.org]

• Arthralgia

  Patients with DGI may present with symptoms of rash, fever, arthralgias, migratory polyarthritis, septic arthritis, tendonitis, tenosynovitis, endocarditis, or meningitis. [emedicine.medscape.com]

  Arthralgia, arthritis and tenosynovitis of the ankles, wrists, hands and feet ( Reiter's syndrome ). Meningitis, endocarditis or myocarditis, with risk of death or permanent sequelae (extremely rare). [patient.info]

• Vaginal Discharge

  If you choose not to be treated for your infection, you may continue to have symptoms such as irregular bleeding and vaginal discharge. If left untreated, gonorrhea can spread into the rest of your reproductive organs. [chop.edu]

  Women infected with gonorrhea often experience a burning sensation during urination, as well as unusual or discolored vaginal discharge. [news.vice.com]

  Gonorrhea Symptoms in Women strong smelling vaginal discharge that may be thin & watery or thick & yellow/green irritation or discharge from the anus abnormal vaginal bleeding possibly some low abdominal or pelvic tenderness pain or a burning sensation [std-gov.org]

  If symptoms occur, they may include burning or frequent urination, yellowish vaginal discharge, redness and swelling of the genitals, and a burning or itching of the vaginal area. [medicinenet.com]

• Pelvic Pain

  Women may develop chronic pelvic pain, pelvic inflammatory disease and potentially life-threatening ectopic pregnancies. Pregnant women with untreated chlamydia are more likely to give birth prematurely. [livestrong.com]

  It may also lead to long-term pelvic pain. Males with untreated gonorrhea may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. [stanfordhealthcare.org]

  In women, gonorrhea can lead to: pelvic inflammatory disease, a condition that can cause abscesses chronic pelvic pain infertility ectopic pregnancies - pregnancy where the embryo attaches outside of the uterus In men, a gonorrheal infection can lead [medicalnewstoday.com]

  Gonorrhea Symptoms in Women strong smelling vaginal discharge that may be thin & watery or thick & yellow/green irritation or discharge from the anus abnormal vaginal bleeding possibly some low abdominal or pelvic tenderness pain or a burning sensation [std-gov.org]

• Urethral Discharge

  We present here a patient who presented with painful genital ulcers and urethral discharge simultaneously acquired from a single exposure, which turned out to be chancroid and gonorrhea, respectively. [ncbi.nlm.nih.gov]

  Gram stain tests used to diagnose gonorrhea include: Gram stain of urethral discharge in men Joint fluid gram stain Cultures (cells that grow in a lab dish) provide absolute proof of infection. [web.archive.org]

  When symptoms occur, urethral discharge and painful urination are typical of genital infections. Complications include pelvic inflammatory disease in women with a risk of infertility, or epididymitis in men. [doh.wa.gov]

  The first symptoms in the male are a burning sensation upon urination and a purulent urethral discharge that may be profuse or may be so meagre as to go unnoticed. [britannica.com]

  However, since laboratory diagnostic tests are not available in many countries, diagnosis is often made based on the presence of symptoms such as vaginal and urethral discharge. [paho.org]

• Salpingitis

  […] convert 098.13 to ICD-10-CM 098.14 Gonococcal seminal vesiculitis (acute) convert 098.14 to ICD-10-CM 098.15 Gonococcal cervicitis (acute) convert 098.15 to ICD-10-CM 098.16 Gonococcal endometritis (acute) convert 098.16 to ICD-10-CM 098.17 Gonococcal salpingitis [icd9data.com]

  In 10 to 20% of women, cervical infection ascends via the endometrium to the fallopian tubes (salpingitis) and pelvic peritoneum, causing pelvic inflammatory disease (PID). Chlamydiae or intestinal bacteria may also cause PID. [msdmanuals.com]

  Ascending genital infection in women leads to the acute salpingitis, one of the most common causes of female infertility in the world. Acute epideidymitis, prostatitis and bacteremic infections are additional possible consequences. [worldcat.org]

  Sometimes gonorrhea spreads to the adnexa, causing salpingitis, or disseminates to skin and/or joints, causing skin lesions or septic arthritis. [merckmanuals.com]

• Dysuria

  While urethral gonococcal infections in men usually present with penile discharge and dysuria, pharynx and rectal infections are often asymptomatic. [ncbi.nlm.nih.gov]

  Gonorrheal cervicitis is commonly accompanied by dysuria or inflammation of Skene ducts and Bartholin glands. In a small fraction of men, ascending urethritis progresses to epididymitis. [msdmanuals.com]

  Symptoms range from mild to severe and include dysuria and vaginal discharge. [merckmanuals.com]

  Gonorrheal epididymitis may be identified by dysuria, a foul-smelling discharge, painful ejaculation, and swollen lymph nodes in the groin. As with PID, the blockage of one or both tubes can lead to functional infertility. [verywellhealth.com]

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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