Gonorrhea

Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae, and has remained a significant public health concern for centuries. This comprehensive guide aims to shed light on the various aspects of gonorrhea, including its causes, symptoms, diagnosis, treatment options, and preventive strategies.

What Are the Risk Factors for Contracting Gonorrhea?

Gonorrhea is primarily transmitted through unprotected sexual contact. The causative bacterium, Neisseria gonorrhoeae—commonly referred to as gonococcus—is a Gram-negative diplococcus with a coffee bean-like shape, first isolated by Albert Neisser in 1879. The bacterium can infect mucous membranes of the genital tract, and transmission can occur even without ejaculation or the presence of visible genital secretions.

Contact with infected bodily fluids, such as semen, vaginal secretions, or saliva, can result in infection. However, superficial contact such as handshakes or kissing does not transmit the bacteria. Risk behaviors that increase susceptibility to infection include:

• Having unprotected sex with an infected partner.
• Engaging in sex with multiple partners or frequent partner changes.
• Lack of routine STI screening, leading to inadequate prevention awareness.

Signs and Symptoms of Gonorrhea

Gonorrhea can present with a variety of symptoms—or in some cases, none at all—making early diagnosis critical for effective treatment. Common signs and symptoms include:

Abnormal Discharge

A hallmark sign of gonorrhea is abnormal genital discharge. Women may experience unusual vaginal discharge (leukorrhea), while men often have pus-like discharge from the penis.

Painful or Burning Urination

A burning sensation or pain during urination is commonly reported. Any such symptom should prompt immediate medical evaluation.

Genital Inflammation

Men may develop swollen testicles or penile inflammation, while women can experience vaginal or pelvic inflammation.

Sore Throat

Oral gonorrhea may occur following oral sex with an infected partner, leading to persistent sore throat or tonsillitis.

Rectal Pain

Anal gonorrhea may cause pain, discomfort, or discharge in individuals who engage in receptive anal intercourse. Women may also experience lower abdominal or pelvic pain.

Possible Complications

Untreated gonorrhea can lead to serious health issues such as:

• Pelvic inflammatory disease (PID): Infection may spread to the uterus, fallopian tubes, and ovaries.
• Septic arthritis: Bacteria can invade the joints, causing inflammation and pain.
• Meningitis: Rarely, the bacteria can infect the meninges, leading to headaches, nausea, and neurological symptoms.
• Conjunctivitis: Eye infections caused by gonorrhea can result in red, painful eyes and impaired vision.

Diagnostic Methods for Gonorrhea

Diagnosis involves a combination of clinical history, physical examination, and laboratory tests. Physicians typically assess symptoms such as urethral or vaginal discharge and dysuria. Further diagnostic tests may include:

Urine Test

Urine samples are analyzed for the presence of Neisseria gonorrhoeae using Gram stain or Nucleic Acid Amplification Tests (NAATs).

Swab Samples

Samples collected from genital secretions (e.g., semen, vaginal fluid, or discharge) are examined microscopically or via molecular methods to detect the pathogen.

Blood Test

In cases where urine or swab results are inconclusive, blood tests may be used to detect antibodies or confirm infection.

• Gram stain is a quick in-clinic method, but its sensitivity may be lower due to similarities with other bacteria.
• NAAT is more sensitive and specific, though it typically requires processing in specialized laboratories.

Gonorrhea Treatment

Gonorrhea is curable with the appropriate use of antibiotics. Treatment regimens are selected based on the severity and nature of the infection and may include oral or intravenous antibiotics administered over 1–2 weeks.

Commonly Used Antibiotics

Antibiotic Classes and Use

• Cephalosporins (3rd generation): Includes Ceftriaxone, Cefazolin, Cefotaxime, Ceftazidime, known for broad-spectrum coverage.
• Macrolides: Includes Azithromycin, Clarithromycin, effective but prone to resistance.
• Quinolones: Includes Ciprofloxacin, Levofloxacin, inhibits bacterial DNA replication.

Possible Side Effects

Antibiotic therapy may cause nausea, vomiting, diarrhea, headache, or muscle pain. Severe allergic reactions should be addressed by a doctor immediately.

Self-Care After Treatment

• Abstain from sexual activity for at least 7 days after completing antibiotics.
• Inform sexual partners so they can be tested and treated.
• Repeat STI screening in 3–6 months to monitor for reinfection.

Preventing Gonorrhea

• Always use condoms: When used correctly, condoms reduce the risk of gonorrhea by up to 99%.
• Avoid sexual contact with infected individuals or those with an STI history.
• Maintain good genital hygiene by cleaning with mild soap and water after intercourse.
• Seek medical advice promptly if experiencing abnormal discharge or urinary symptoms.

Conclusion

Though gonorrhea has existed for centuries, it continues to pose public health challenges, particularly in Thailand and other countries with rising STI rates. By understanding its causes, symptoms, diagnostic processes, and treatment methods, individuals can protect themselves and others more effectively. Ongoing research and public health programs remain crucial in the fight against gonorrhea, offering hope for reduced transmission rates and improved sexual health for all.