Fri | Sep 30, 2016

Gonorrhoea: live and deadly

Published:Sunday | March 28, 2010 | 12:00 AM

Heather Little-White, PhD, Contributor

While sexually transmitted infections (STIs) continue to spread, the focus is on HIV. But 'older' diseases like gonorrhoea are still dominant and easily transmitted through unsafe sex.

I recently counselled two young men who were concerned about certain symptoms they were having on their genitals. After encouraging them to visit their clinic/doctor, the subsequent tests confirmed that they had gonorrhoea.

Gonorrhoea is not a disease of the past. People are just not paying attention to it as much as they used to. Gonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoea, which multiplies rapidly in the warm, moist areas of the reproductive tract, including the vagina, cervix (opening to the womb), uterus, fallopian tubes and in the urethra (urinary canal). The bacterium can also grow in the mouth, throat, eyes, and anus.

Women at risk

Gonorrhoea is spread through unprotected sexual contact with the penis, vagina, mouth (not kissing) or anus. Ejaculation does not have to occur for gonorrhoea to be transmitted or contracted. Women are more vulnerable to the gonorrhoea bacterium than men. According to George Schmid, MD, a clinical researcher at the Centers for Disease Control and Prevention (CDC), a man only has a 25 per cent chance of contracting the disease after one encounter with an infected female, while a woman has a 50 per cent chance of contracting gonorrhoea after having sex with an infected male partner. People who have had gonorrhoea and received treatment may get infected again if they have sexual contact with a person infected with gonorrhoea.

Ectopic pregnancy

If gonorrhoea is not treated, the consequences are serious. Women may develop pelvic inflammatory disease (PID), which results when the gonococcus bacterium travels past the cervix to the fallopian tubes and is attacked by white blood cells that want to kill it. However, the process causes inflammation, which may cause scars in the tubes that eventually lead to infertility or increase the risk of life-threatening ectopic pregnancy, which is a fertilised egg growing outside the uterus, usually in a fallopian tube. In men, gonorrhoea can cause epididymitis, a painful condition of the ducts attached to the testicles that may lead to infertility if left untreated.

When bacteria invade the blood, arthritis or meningitis may occur. Gonorrhoea can spread to the blood or joints. This condition can be life threatening. In addition, people with gonorrhoea are more susceptible to contracting HIV, the virus that causes AIDS. HIV-infected persons with gonorrhoea can transmit HIV more easily to someone else than if they did not have gonorrhoea.

Pregnant women

Pregnant women who have gonorrhoea may infect the baby as it passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection. If pregnant women with gonorrhoea are treated as soon as it is detected, the risk of these complications to the child will be reduced. Pregnant women should consult a health-care provider for appropriate examination, testing and treatment.

Diagnosis

Gonorrhoea is fairly easy to detect in both males and females, and is also easy to treat once the person follows the prescribed regimen. Several laboratory tests are available to diagnose gonorrhoea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected like the cervix, urethra, rectum, or throat. The samples are sent to a laboratory for analysis. If gonorrhoea is present in the cervix or urethra, it can be diagnosed by testing a urine sample. A quick laboratory test for gonorrhoea that can be done in some clinics or doctor's offices is a Gram stain. This is a sample from a urethra or a cervix that allows the doctor to see the gonorrhoea bacterium under a microscope. However, this test works better for men than women. Persons with gonorrhoea should be tested for other STIs.

Treatment

Several antibiotics can successfully cure gonorrhoea in adolescents and adults. However, with drug-resistant strains of gonorrhoea increasing all over the world, successful treatment is becoming more challenging. Up to one third of women with gonorrhoea may also have chlamydia, another STI. The CDC recommends that antibiotics be given for both infections. It is important to take all the dosages of medication prescribed to cure gonorrhoea.

Although medication will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhoea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhoea. If the symptoms continue even after receiving treatment, the infected person should return to a doctor to be re-evaluated. It is good to visit the doctor after the first treatment is completed to retest to ensure that all traces of the disease have disappeared.

Prevention

Abstaining from sex is the guaranteed way of not contracting gonorrhoea. In addition, being in a long-term mutually monogamous relationship with one partner who has been tested and is known to be uninfected is another effective method. However, the physical-barrier method, of wearing a latex condom, consistently and correctly, is the most effective way of reducing the risks of contracting gonorrhoea. Research has shown that women on the contraceptive pill, diaphragm, foam or gel may be less susceptible to contracting gonorrhoea compared to women who go without protection.

Any genital symptoms such as discharge or burning during urinating or unusual sore or rash should be a signal to stop having sex and see a doctor immediately. If a person has been diagnosed and treated for gonorrhoea, he or she should notify all recent sex partners so they can see a health-care provider and be tested. This will reduce the risk that sex partners will develop serious complications from gonorrhoea and will also reduce the person's risk of becoming reinfected. This person and all their sex partners must avoid sex until they have completed their treatment for gonorrhoea (CDC)

Anyone who is sexually active can contract gonorrhoea. Young adults are at the highest risk because they are more likely to have more than one sexual partner and are usually more careless about using condoms and other types of barrier protection.

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Symptoms of gonorrhoea

When women contract the infection, they may not experience any immediate symptoms but those who do will notice them within 10 days. The symptoms can disappear after the first few weeks.

Women may experience the following symptoms:

Cloudy vaginal discharge

Painful urination

Mild pelvic discomfort

Occasional vaginal bleeding

Men with gonorrhoea may have no symptoms at all. However, some men have signs of gonorrhoea that appear two to five days after infection while others take as long as 30 days to appear. Symptoms include:

A burning sensation when urinating.

White, yellow, or green discharge from the penis within two weeks of exposure.

Some men with gonorrhoea may get painful or swollen testicles.

Discharge of pus from the penis within two weeks of exposure.

Throat: In cases where gonorrhoea is in the throat, men and women will experience mild sore throat.

Anus: Symptoms of rectal infection in both men and women may include pain, discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection may not show any symptoms.