Dr Tariq Jagnarine
Family Medicine, Endocrinology and Diabetes
Gonorrhoea is a common sexually transmitted infection (STI), and it can pass on during any kind of sexual contact. Once diagnosed early, it can be treated effectively. However, if a person does not receive treatment, gonorrhoea can result in long-term complications. For example, pelvic inflammatory disease (PID) occurs in females when gonorrhoea affects the uterus or fallopian tubes. It can lead to infertility.
Possible complications in males with gonorrhoea include epididymitis, which is inflammation of the tube that carries sperm. This, too, can result in infertility.
It tends to target warm, moist areas of the body, including the:
* urethra (the tube that drains urine from the bladder)
* eyes
* throat
* vagina
* anus
* female reproductive tract (the fallopian tubes, cervix, and uterus)
Gonorrhoea passes from person to person through oral, anal, or vaginal sex without a condom or other barrier method. The best protections against transmission are abstinence and proper condom or barrier method usage.
CAUSES
N. gonorrhoeae bacteria are responsible for gonorrhoea. These bacteria thrive in warm, moist environments, and the infection can develop in any of the body’s mucous membranes, including those in the genitals, mouth, throat, eyes, and rectum. Gonorrhoea can pass from person to person through sexual contact that involves the penis, vagina, anus, or mouth. Males do not need to ejaculate to transmit or contract gonorrhoea.
It can also pass to a baby during delivery.
All sexually active people can develop gonorrhoea.
SYMPTOMS
Many people with gonorrhoea have no symptoms. Those who do, often experience a burning sensation during urination.
Males may also notice:
* white, green, or yellow discharge from the penis
* pain or swelling in the testicles
* inflammation or swelling of the foreskin
Females may also experience increased vaginal discharge and bleeding between periods.
Rectal symptoms may also occur if a person has anal sex. These may include:
* discharge
* itching around the anus
* soreness
* bleeding
* pain during bowel movements
If gonorrhoea results from oral sex, the person may have a throat infection, but they might not notice any symptoms.
Gonorrhoea is a bacterial infection, and if semen or vaginal fluid that contains these bacteria enters the eye, the person may develop conjunctivitis, commonly called pinkeye.
DIAGNOSIS
A person might receive a diagnosis of gonorrhoea if they see a healthcare provider because they have had symptoms or because they suspect that they have been exposed to the infection. A physical exam and lab test may be needed.
If one person has a diagnosis of gonorrhoea, their sexual partner or partners should also receive testing.
TREATMENT
Anyone with gonorrhoea needs treatment to stop the infection from progressing. The treatment typically involves antibiotics.
It cannot repair any problems that the infection has already caused, so it is important to receive treatment as soon as possible.
The Centres for Disease Control and Prevention (CDC) recommend a single dose of 250 milligrams of intramuscular ceftriaxone (Rocephin) and 1 gram of oral azithromycin (Zithromax). These are different types of antibiotics.
The CDC urge people to take all the medication that is prescribed and to avoid sharing it with anyone else.
However, Neisseria gonorrhoeae, the bacteria that cause gonorrhoea, have developed resistance to nearly all the antibiotics that doctors have traditionally used to treat it.
This resistance is making gonorrhoea increasingly difficult to treat. If a person does not notice any improvement in their symptoms after several days, they should return to their healthcare provider. They may need further testing to determine whether the treatment is working.
A person should also attend any follow-up appointments and avoid having sex until a healthcare provider says that it is safe to do so.
If gonorrhoea occurs during pregnancy, it is essential to let the healthcare team know. The infection can pass on to the baby during delivery, so the newborn will usually need antibiotics right away.
Some newborns develop conjunctivitis, and gonorrhoea is one possible cause. The symptoms usually appear 2-4 days after birth and include red eyes, thick pus in the eyes, and swollen eyelids.
If any of these symptoms arise, seek medical attention immediately. They can also result from a more serious condition, such as meningitis or bacteraemia.
COMPLICATIONS
There are a number of severe complications of gonorrhoea. For this reason, it is important to receive treatment as soon as possible.
In females, gonorrhoea can lead to:
* PID
* chronic pelvic pain
* infertility
* ectopic pregnancy, which can be a medical emergency
Further complications of the infection can occur during pregnancy and delivery. Without treatment, it causes an increased risk of preterm labour or stillbirth.
Gonorrhoea can also pass to the newborn, who can develop a joint infection, loss of vision, or bacteraemia — a life threatening blood infection — as a result.
In males, gonorrhoea can lead to epididymitis, which can cause problems with fertility.
In everyone, untreated gonorrhoea can lead to a disseminated gonococcal infection. This can be life-threatening. Some signs and symptoms include:
* dermatitis, which usually involves a rash or itchy, dry skin
* fever
* arthritis
* inflammation and swelling around the tendons
People with gonorrhoea also have a higher risk of contracting or transmitting HIV. One reason is that either infection can cause open sores, which make it easier for viruses and bacteria to enter the body.
PREVENTION
Ways of avoiding gonorrhoea include:
* Avoiding sexual activity if there is the possibility of infection.
* Using a barrier method of protection, such as condoms, during vaginal or anal intercourse.
* Using condoms or dental dams during oral intercourse.
* Only having sexual activity with a mutually monogamous partner who does not have the infection.
