Gonorrhea

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Gonorrhea : Background Gonorrhea : Treatment
Gonorrhea : Risk Factors Gonorrhea : Prevention
Gonorrhea : Signs and Symptoms Gonorrhea : Prognosis
Gonorrhea : Complications Gonorrhea : References
Gonorrhea : Diagnosis

Background

GonorrheaGonorrhea is a sexually transmitted bacterial infection that can cause serious health complications if left untreated. Caused by the Neisseria gonorrhoeae bacteria, gonorrhea is transmitted from person to person during vaginal, oral, or anal intercourse. The infection can also be transmitted from a pregnant woman to her baby during childbirth. Contrary to popular myths, the infection cannot be spread by sharing toilet seats, hot tubs, or swimming pools.

Gonorrhea has been documented in history since medieval times. In 1611, a law was enacted by the English Parliament forbidding brothels from housing women with the disease. A similar decree was enacted in France in 1256 during the reign of Louis IX. This decree went one step further, banishing infected prostitutes from the kingdom. There are also historical reports of symptoms among the Crusaders at the siege of Acre. Following these outbreaks, cities began to hire public health physicians who were required to treat not just the common man with gonorrhea, but also prostitutes. These physicians were known as “Kings of Whores”.

Gonorrhea is often referred to as “the clap”. Some historians believe that this name comes from “les clapiers”, the French word for brothels, which were a common source of infection. Others contend that the name originated because infected persons experienced a sudden clapping sensation when urinating. Still others say that “clap” refers to the fact that the penis had to clapped on both sides in order to remove the pus-like discharge.

It wasn’t until 1870 that Albert Niesser, a young German physician, discovered the bacteria that causes gonorrhea. (Because of his discovery, he received the dubious honor of having the bacteria named after him.) Initial treatments for gonorrhea focused on injecting mercury into the tip of the penis. Other metals such as silver nitrate, protargol, arsenic, antimony, bismuth, and gold were also used.

In the 1940’s, treatment with penicillin began and became the mainstay of therapy until the 1970’s. However, penicillin-resistant strains began occurring and other treatments such as tetracycline and fluoroquinolones were introduced. Currently, a group of antibiotics known as cephalosporins appears to be the most effective treatment.

One of the common myths about gonorrhea is that it doesn’t exist anymore. This is certainly not the case. Although the rate of gonorrhea has been declining for the last two decades, it is now on the rise again. About 820,000 new cases of gonorrhea occur in the U.S. each year, according to an analysis published by the Centers for Disease Control (CDC) in February 2013. On a global level, it is estimated that there are over 62 million infections each year. Especially alarming is the skyrocketing incidence in teenagers and young adults; approximately 70% of new cases are reported in the age group 15-24.

Risk Factors

Both men and women are susceptible to the disease, although the infection is transmitted more efficiently in women. The odds of a man becoming infected after one unprotected encounter with an infected woman are about 25%, while the odds of a woman becoming infected after one unprotected encounter with an infected man are about 50%. Women are at higher risk since the lining of the vagina is thinner and more delicate than the skin on the penis, making it easier for bacteria to penetrate.

Men and women under the age of 25 are at highest risk of becoming infected, especially those with multiple sex partners. Additionally, African Americans and men who have sex with men have a higher prevalence of infection than the general population. Lower socioeconomic class also appears to be a risk factor.

People with HIV or other sexually transmitted diseases are more susceptible to the disease, as well as people with a previous gonorrhea diagnosis.

Signs and Symptoms

Initially, most infected women have very mild symptoms or do not experience any symptoms at all. Infected men are more likely to have symptoms. The usual symptoms in men are burning with urination and an unusual discharge from the penis. Symptoms in women may include pain with urination, vaginal discharge, and bleeding between menstrual periods. These symptoms usually develop within 10 days after sexual intercourse with an infected person.

In men and women who practice anal sex, symptoms include discharge, soreness, painful bowel movements, and bleeding from the rectum. With oral sex, the most common symptom is a sore throat.

Complications

If untreated, gonorrhea infections can spread to other portions of the reproductive tract, causing bacterial prostatitis and epididymitis in men and pelvic inflammatory disease in women.

Prostatitis is an inflammation of the prostate gland (a walnut-sized gland located below the bladder and in front of the rectum). It is characterized by chills, fever, painful urination, painful ejaculation, blood in the urine or semen, foul-smelling urine, and decreased urinary stream. Acute prostatitis usually responds well to antibiotic therapy, but if left untreated, it can become a chronic condition.

Epididymitis is an infection of the epididymis, the coiled tube that carries sperm from the testicles. Symptoms may include pain in the scrotum and testicles, an accumulation of fluid in the scrotum, an abnormal discharge from the penis, fever, chills, and burning with urination. These symptoms may occur several months after the initial gonorrhea infection. In rare cases, epididymitis can cause sterility.

Pelvic inflammatory disease is an infection of a woman’s reproductive organs, such as the uterus, fallopian tubes, and ovaries. The infection can cause tissue inside the fallopian tubes to become scarred, sometimes causing complete blockage. In severe cases, the disease can lead to infertility and chronic pelvic pain. Tubal scarring may also cause the fertilized egg to be trapped inside the tube, resulting in an ectopic pregnancy (pregnancy outside the uterus). This condition is potentially fatal if the tube ruptures. Although antibiotics can usually cure the infection, the damage caused by pelvic inflammatory disease cannot be repaired.

In pregnant women, gonorrhea can increase the risk of miscarriage and preterm delivery. Pregnant women can pass gonorrhea to their babies, resulting in a severe eye infection called gonococcal opthalmia. Symptoms of gonococcal opthalmia usually appear one to four days after birth and include redness of the eyes, swelling of the eyelids, and a thick eye discharge containing pus. If untreated, babies may develop blindness, joint infections, and life-threatening blood infections.

Gonorrhea can also facilitate the transmission of other sexually transmitted infections, especially HIV.

Diagnosis

There are three types of tests for gonorrhea. If gonorrhea is present in the cervix or urethra, a urine sample can be taken and sent to a laboratory for analysis. If gonorrhea is present in the penis, rectum, or throat, a swab sample is taken from the infected part of the body and sent to a laboratory for analysis. The third type of test – the gram stain test – is usually less reliable than the other tests but produces faster results since it can be done right in the clinic or doctor’s office. A sample from the cervix or urethra is placed on a slide and stained with dye so that the bacteria will show up when observed through a special microscope.

Treatment

Because of increasing rates of antibiotic resistance, many antibiotics that were once effective for the treatment of gonorrhea (including penicillin, tetracycline, and fluoroquinolones) are no longer recommended. Probably the most common treatment today is ceftriaxone (Rocephin) given as a 125 mg intramuscular injection. However, ceftriaxone is not effective for chlamydia (which often occurs concurrently with gonorrhea), so other drugs such as azithromycin and doxycycline are usually given in combination with ceftriaxone. Some cases of ceftriaxone resistance have been reported, but are still rare.

Other treatments recommended by the CDC are ciprofloxacin (single oral dose), ofloxacin (single oral dose), levofloxacin (single oral dose), and spectinomycin (intramuscular injection).

If gonorrhea is treated quickly and correctly, recovery is usually rapid and complete. Antibiotics typically cure the infection within 10 to 14 days. However, if the infection has progressed to pelvic inflammatory disease, the damage cannot be reversed.

People can be susceptible to re-infection, so patients should be re-tested yearly after successful treatment. Patients should also be tested for other sexually transmitted diseases such as chlamydia, syphilis, and HIV.

All sexual partners of an infected individual must be treated to prevent the infection from being passed back and forth. Sexual intercourse should be avoided until all partners are cured.

Prevention

Because gonorrhea is transmitted during sexual activity, the most reliable way to prevent infection is to abstain from oral, vaginal, and anal sex or to have a mutually monogamous relationship with an uninfected sex partner.

When used consistently and correctly, male latex or polyurethane condoms can lower the risk of transmission. Condoms should be used for all types of sexual contact, even if penetration does not occur, and a new condom should be used after each ejaculation.
Most other birth control methods – including the pill, IUD, diaphragm, and spermicides – don’t protect against gonorrhea and other STDs. In addition, there is no vaccine available to prevent the disease.

If you have had sex without a condom and are worried that you may have been infected, you should see your doctor or healthcare provider even if you don’t have symptoms. If either you or your partner have had other sexual partners in the past, you should get tested before becoming sexually active. All pregnant women should be tested at their first prenatal checkup.

Prognosis

Despite the widespread availability of effective antibiotics, gonorrhea remains a public health concern. The WHO is recommending that governments and doctors increase their surveillance of antibiotic-resistant gonorrhea. They warn that the gonorrhea bug has an astonishing ability to adapt and that it may soon become a “super-bug” that is resistant to cephalosporins. The WHO also states that treatments alone are not the answer to eradicating the disease. We also need need better sex education, more persuasive prevention campaigns, and more effective drug regulations.

References:

1) Gonorrhea – CDC Fact Sheet
Source: Centers for Disease Control and Prevention

2) Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States – CDC Fact Sheet
Source: Centers for Disease Control and Prevention

3) Gonorrhea Fact Sheet
Source: Womenshealth.gov

4) Gonorrhea
Source: Aetna InteliHealth

5) Sexually Transmitted Diseases
Source: The Center for Menstrual Disorders and Reproductive Choice

6) Sexually Transmitted Diseases
Source: Male Health Center

7) History of Gonorrhea
Source: Rocketswag.com

8) Gonorrhea Is Growing Resistant To Drugs And May Soon Become Untreatable, WHO Warns
Source: The Huffington Post

Posted in STI.