Gonorrhea: An Overview of Symptoms, Treatments, and Prevention

Gonorrhea is one of the classic sexually transmitted diseases and is caused by Neisseria gonorrhoeae. This disease still presents important diagnostic and treatment problems. Its prevalence is decreasing, but in the United States about 700,000 cases are still diagnosed a year, most in young people between 20 and 24 years old, and it is more frequent in large cities and in people with low socioeconomic status. Neisseria Gonorrhoeae is a bacterium that can easily grow and multiply in moist areas of the female genital tract such as the cervix, womb, fallopian tubes, and in both the female and male urethra. This bacteria can also grow in the mouth, throat, eyes, and anus.

Clinic

Symptoms usually start 2 to 5 days after infection, but in men it can take up to more than a month to appear. Almost 80% of women have mild or no symptoms of gonorrhea despite the infection. Likewise, 10% of infected men have no symptoms.

Symptoms in women are:

• Increased vaginal discharge
• Pain and burning when urinating
• Increased frequency of urination
• Throat irritation
• pain with intercourse
• Severe pain in the lower abdomen
• Fever
• Bartolinitis

Symptoms in men are:

• pain and burning when urinating
• Increased frequency of urination
• Yellowish-white discharge from the penis
• Red or swollen urethra
• Tender or swollen testicles
• Throat irritation

Gonorrhea is frequently associated with other sexually transmitted diseases, and in 50% of cases it is associated with chlamydial infection.

Diagnosis

The doctor may perform cultures of the cervix, urethra, rectum, or pharynx in cases where a gonococcal infection is suspected. The sample is collected with a cotton ball on the tip of a toothpick and transported in the appropriate medium to the laboratory. There it is left a few days in a special culture and it is observed if the Neisseria gonorrhoeae grows.

Treatment

The treatment of gonorrhea is theoretically simple, as it is a bacterial infection it requires an antibiotic treatment. The problem is that the bacteria have developed resistance to various antibiotics such as penicillin. Currently, ceftriaxone is commonly used intramuscularly and another antibiotic, usually doxycillin, is associated with frequent simultaneous chlamydial infection. Sex partners should see a doctor for an examination and rule out an asymptomatic gonorrhea. In case of positive cultures despite not having symptoms, treatment should also be carried out. This disease does not leave residual antibodies that can prevent a new infection, so having it once does not prevent new episodes. The best prevention is always the use of a condom during sexual intercourse.

Complications

Between 15 and 20% of gonococcal infections progress to pelvic inflammatory disease. This complication usually occurs especially with menstruation when losing part of the mucous barriers. It manifests as fever, lower abdominal pain, increased vaginal discharge, and can go with abnormal vaginal bleeding. Pelvic inflammatory disease can produce abscesses in the fallopian tubes and cause infertility or risk of ectopic pregnancy due to the alteration in the normal function of the tubes. In men it can cause epididymitis and if it is not treated an obstruction in the ducts of the testicles that also cause sterility. Disseminated gonorrhea is rare, but occurs in approximately 3% of people with gonorrhea. The bacteria are no longer localized in the genital tract and spread throughout the body through the bloodstream. The symptoms of this complication are fever, chills, general ill feeling, joint pain, joint swelling, pain in the tendons of the wrists or heels, skin rash. Rarely, disseminated gonorrhea can be complicated by an infection of the heart valves (endocarditis) or the membranes that line the brain (meningitis). Pregnant women can be asymptomatic but can transmit the infection to the fetus. In these women there is an increased incidence of septic abortion, infection of the bag of waters, premature rupture of the amniotic sac from premature delivery, or postpartum infection. The most common fetal complication of gonorrhea is an eye infection, which can compromise the child's posterior vision. To avoid this, all newborns are given an antibiotic ointment in the immediate postpartum period. More rarely, it can give you a generalized infection that reaches your joints.