Edit concept Question Editor Create issue ticket

Gonorrhea

Gonorrhea is a common sexually transmitted infection caused by the gram-negative diplococcus Neisseria gonorrhoeae. Symptoms of gonorrhea in women include vaginal discharge, dysuria, intermenstrual bleeding, dyspareunia and abdominal pain. In men, gonorrhea causes anterior urethritis.


Presentation

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

Females

Fever
  • You should seek medical attention if you feel sick, have a fever or pelvic pain, or experience pain during sex.[stdcheck.com]
  • Fever with abdominal pain , pelvic pain , and vaginal discharge can be symptoms of this disease. Men: Fever, discharge from the penis, and painful urination may signal an infection, especially involving inflammation of the testicles.[emedicinehealth.com]
  • If gonorrhea spreads through the bloodstream, it may cause fever, pain and swelling in several joints, and a characteristic rash.[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]
Prostitute
  • There are a few theories behind why gonorrhea is referred to as The Clap : Theory #1: From the old French word for brothel: “ Clapier. ” The fastest results possbile - available in 1 to 2 days Get Tested Today Prostitutes were housed in clapiers (brothels[stdcheck.com]
  • He noted that the disease was common in prostitutes and homosexuals in large cities.[en.wikipedia.org]
  • Depressed socioeconomic areas typically have the highest incidence, particularly where illicit drug use and prostitution are common. Gonorrhea occurs more frequently in men who have sex with men than in heterosexual men.[healthcommunities.com]
  • Nature has set her stand of disapproval on sexual promiscuity by fixing venereal diseases as a penalty for prostitution.[blogs.plos.org]
  • The following general measures can help prevent gonorrhea (and other STDs): Avoidance of unsafe sex practices, such as frequently changing sex partners or having sexual intercourse with prostitutes or with partners who have other sex partners Prompt diagnosis[merckmanuals.com]
Reiter's 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]
  • 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, discharge, or bleeding Inflamed eye Least Common Sore throat Pain during[stdcheck.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]
  • An oral infection may cause a red sore throat How long can an infected person spread gonorrhea? A person can spread gonorrhea to others from the time they become infected (by having unprotected sex with an infected partner) until they are treated.[bphc.org]
Abdominal Pain
  • Side effects include nausea, mild abdominal pain, and diarrhea. Pregnant women should consult their physician before taking these drugs. A follow-up examination is recommended 3 to 5 days after completing treatment.[healthcommunities.com]
  • 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]
  • It can cause infertility, scarred fallopian tubes (a risk of tubal pregnancy in women) and chronic (long-lasting) abdominal pain.[drugs.com]
Rectal Pain
  • Gonorrhea Symptoms in Men Most Common Silent or no symptoms (50% of the time men do not show signs) Yellow-white, or green-white discharge from the penis Painful, frequent urination Rectal pain, discharge, or bleeding Inflamed eye Less Common Testicular[stdcheck.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]
  • Rectal pain or discharge can be a sign of infection of the prostate and is transmitted through anal intercourse.[emedicinehealth.com]
Rectal Discharge
  • When symptoms occur, they commonly include rectal pain or itching, a rectal discharge that contains blood, mucus, pus or a persistent urge to move the bowels.[drugs.com]
  • The disease is caused by the gonorrhea bacteria Neisseria gonorrhoeae, and is sometimes called “the clap” — for reasons unknown — or “the drip” — because of the vaginal, penile, or rectal discharge it can cause. Gonorrhea is highly contagious.[everydayhealth.com]
Vaginal Discharge
  • 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]
  • Women infected with gonorrhea often experience a burning sensation during urination, as well as unusual or discolored vaginal discharge.[news.vice.com]
  • Symptoms of gonorrhea in women include vaginal discharge, dysuria, intermenstrual bleeding, dyspareunia and abdominal pain. In men, gonorrhea causes anterior urethritis. Eyes Gonorrhea causes conjunctivitis.[symptoma.com]
Pelvic Pain
  • Advertisement Pelvic pain and pain in the testicles should start to improve quickly but may take up to two weeks to go away. If you have pelvic pain, pain during sex or other symptoms that do not improve, go back to your medical provider.[thebody.com]
  • 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.[symptoma.com]
  • Girls who have had a pelvic infection with gonorrhea are more likely to have a pregnancy in the tube (“ectopic pregnancy”) or pelvic pain.[youngwomenshealth.org]
  • PID involves a severe infection of the uterus, fallopian tubes, and ovaries which may lead to infertility , tubal pregnancies, and chronic pelvic pain. It is also easier to transmit or get infected with HIV if you are infected with gonorrhea.[americanpregnancy.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]
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]
  • This is called urethral discharge. Itching, burning or both when urinating (urethritis). Redness and swelling of the opening in the penis (the urethral meatus). A swollen penis. This is rare.[tompkinscountyny.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]
  • Men and women experience slightly different symptoms; these can include: Men: white, yellow, or green urethral discharge, resembling pus inflammation or swelling of the foreskin pain in the testicles or scrotum painful or frequent urination anal discharge[medicalnewstoday.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 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]
  • 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]
  • The initial symptoms and signs in women include dysuria, increased vaginal discharge, or vaginal bleeding between periods.[web.archive.org]
Salpingitis
  • 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]
  • […] 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]
  • Complications Complications in women may include: Salpingitis (scarring of the fallopian tubes), which can lead to problems getting pregnant or ectopic pregnancy Infertility (inability to become pregnant) Pregnant women with severe gonorrhea may pass[web.archive.org]
  • Differences in some clinical and laboratory parameters in acute salpingitis related to culture and serologic findings. Am J Obstet Gynecol, 138(7), 1017–1021 (1980). Berger R, Alexander E, Harnisch J et al.[web.archive.org]

Workup

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.

Neisseria Gonorrhoeae
  • Neisseria gonorrhoeae Antimicrobial Susceptibility Surveillance – The Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014 MMWR July 14, 2016 Antimicrobial-Resistant Gonorrhea Infographics (July 14, 2016)[cdc.gov]
  • KEYWORDS: Neisseria gonorrhoeae; drug therapy; gonorrhea[ncbi.nlm.nih.gov]
  • Neisseria gonorrhoeae detection in genital specimens was performed with NG-qPCR at the Public Health Service in Amsterdam. Antimicrobial susceptibility was investigated using the Etest.[ncbi.nlm.nih.gov]
  • KEYWORDS: Chlamydia trachomatis; Neisseria gonorrhoeae; asymptomatic; extragenital; men who have sex with men (MSM); oropharyngeal; rectal; screening[ncbi.nlm.nih.gov]

Treatment

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].

Prognosis

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.

Etiology

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.

Epidemiology

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.

Sex distribution
Age distribution

Pathophysiology

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

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.

Prevention

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

Summary

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.

Patient Information

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.

References

Article

  1. Dawe RS, Sweeney G, Munro CS. A vesico-pustular rash and arthralgia. Clin Exp Dermatol. Jan 2001;26(1):113-4.
  2. Cucurull E, Espinoza LR. Gonococcal arthritis. Rheum Dis Clin North Am. May 1998;24(2):305-22.
  3. Da Ros CT, Schmitt Cda S. Global epidemiology of sexually transmitted diseases. Asian J Androl. Jan 2008;10(1):110-4
  4. Stefanelli P. Emerging resistance in Neisseria meningitidis and Neisseria gonorrhoeae. Expert Rev Anti Infect Ther. Feb 2011;9(2):237-44.
  5. Little JW. Gonorrhea: update. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Feb 2006;101(2):137-43
  6. Kerle KK, Mascola JR, Miller TA. Disseminated gonococcal infection. Am Fam Physician. Jan 1992;45(1):209-14
  7. Lewis DA. Global resistance of Neisseria gonorrhoeae: when theory becomes reality. Curr Opin Infect Dis. Feb 2014;27(1):62-7
  8. Melville NA. Two new antibiotics show efficacy in gonorrhea treatment. Medscape Medical News [serial online]. July 16, 2013;Accessed July 22, 2013
  9. García PJ, Holmes KK, Cárcamo CP, et al. Prevention of sexually transmitted infections in urban communities (Peru PREVEN): a multicomponent community-randomised controlled trial. Lancet. Mar 24 2012;379(9821):1120-8
  10. Greer L, Wendel GD Jr. Rapid diagnostic methods in sexually transmitted infections. Infect Dis Clin North Am. Dec 2008;22(4):601-17

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2017-08-09 17:58