GonorrheaOverview

Gonorrhea (also known as "the clap" or "drip") is a highly contagious sexually transmitted disease, one of the most common and oldest known. It is caused by the Neisseria gonorrhoeae bacteria which is a gram-negative, intracellular diplococcus that grows best in the laboratory in an environment rich in carbon dioxide. Gonorrhea can be spread from person to person through sexual contact but also from mother to child during childbirth. The gonorrhea germs are found in the mucous areas of the body (the vagina, penis, throat and rectum).

Gonorrhea is the second most commonly reported infectious disease in the United States, after Chlamydia. There are approximately 700,000 cases reported each year in the United States. Within the United States infection rates are highly dependent on the geographical area, the racial and ethnic group, and sexual preferences. The South-Eastern States have the highest rates of infection, with the Midwest and Northeast being much lower. Disease rates are unknown for most developing countries. In much of Western Europe, rates are approximately the same as those in the United States. Also, frequency is increased in the poor and minorities of any population due to decreased access to diagnosis and treatment. Lack of adequate care (education, diagnosis, and treatment) leads to increased transmission rates. Men who have sex with men (MSM) are much more likely to acquire and carry Gonorrhea, and in addition have far higher rates of antibiotic-resistant bacteria. The highest incidence in the United States is for persons aged 15-24 years.

Gonorrhea has an incubation period of 2-7 days after exposure to an infected person, but it could take as long as 30 days for the symptoms to appear.

SIGNS AND SYMPTOMS

The first place to be infected in women is the cervix. From the cervix it moves up to the uterus and into the fallopian tubes, resulting in pelvic inflammatory disease (PID). Women are most likely to be asymptomatic, as many as 50 % of the women infected with Gonorrhea experience few or no symptoms. If they have symptoms, these include: dysuria (pain or burning sensation when urinating), vaginal discharge that is yellow or bloody, abnormal vaginal bleeding (spotting) for example, after sex, cramps, dyspareunia (painful intercourse), need to urinate more frequently, proctitis (inflammation of the rectum) and/or pharyngitis (inflammation of the mucous membrane and underlying parts of the pharynx), slow onset and progression of lower abdominal pain, nausea or vomiting and fever.

In men Gonorrhea symptoms include: dysuria accompanied by thick, copious, urethral pus-like discharge (white, yellow or green in colour), also known as "gleet". Men may also experience swollen testicles and the penis will probably look tender and redder that usual and also a swelling in the groin area.

Gonorrhea can also infect the anus and the throat. The symptoms of the anal infection include painful bowel movements, itching, discharge and bloody stool. Symptoms of the oral infection include: a sore throat, a pus-like material on the tonsils or on the back of the throat. These two last types of infection with Neisseria gonorrhoeae bacteria can easily spread to other parts of the body so treatment is compulsory.

TREATMENT

Gonorrhea is easily treated. Medical therapy requires an antibiotic with efficacy against N gonorrhoeae such as: Ciprofloxacin (Cipro), Cefixime (Suprax) and Ceftriaxone (Rocephin), Ofloxacin (Floxin), Spectinomycin (Trobicin), Erythromycin (E-Mycin), Azithromycin (Zithromax), Doxycycline (Bio-Tab, Vibramycin, Doryx).

COMPLICATIONS

Left untreated, Gonorrhea may have serious consequences.

In men it can cause epididymitis (inflammation of the epididymis, the elongated, cordlike structure along the posterior border of the testes), prostatitis (inflammation of the prostate gland which can lead to infertility) and urethritis (inflammation of the urethral structure).

Women infected with Gonorrhea can develop pelvic inflammatory disease (PID), which damages the fallopian tubes and can cause infertility. Gonorrhea increases the risk of an ectopic pregnancy. It can also cause bartholinitis (cyst and abscess formation in one or more of the greater vestibular glands) and also Fitz-Hugh-Curtis syndrome (perihepatitis).

Both sexes may develop disseminated gonococcal infection (DGI) that can lead to multiple distant sites of infection which include the brain, heart and joints.

Neonatal infection of the eyes can lead to permanent damage and blindness.

PREVENTION

Proper education can be more effective than simple instructions to avoid sex, especially for teenagers because, even though it is the most effective prevention, it is often an unrealistic expectation (where 88% of teens who pledged abstinence in middle and high school still engaged in premarital sex). Nevertheless, abstinence from sex should be explained as the best option, but a more practical solution is abstinence from sex with someone known or suspected of having an STD until treatment is obtained and completed.

It is important to stress that oral or anal sex also can transmit the disease. Another means of preventing contracting an STD is to avoid unprotected sex.