Gonorrhea

Gonorrhea is a bacterial infection transmitted during sexual contact.

Gonorrhea is a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae, also called gonococcus (GC) It can only transmitted by sexual contact, with either oral, vaginal, or anal intercourse.

Other STIs may be transmitted along with gonorrhea including chlamydia, syphilis and HIV. In  women with gonorrhea, there may be a 40% chance of also having chlamydia.

• In men with gonorrhea there is a 25% chance
• In young adults with gonorrhea, chlamydia may also be present 50% of the time

Gonorrhea can only be transmitted by unprotected oral, vaginal, or anal sex.

• The gonorrhea bacteria can only survive outside the body for a few seconds, and it cannot live on the skin, arms, hands, or legs. Gonorrhea cannot be transmitted from toilet seats, countertops, or sinks.

Symptoms of gonorrhea depend on where the infection occurs; the throat, the urethra the tube that drains the bladder when you urinate, the anus, and the vagina.

Many people who are infected with gonorrhea may be symptomatic and have no symptoms at all and may not know that they have an infection.

Genital gonorrhea symptoms

• Urethritis (inflammation of the urethra)
  • In males, there is often a pus discharge from the urethra. The discharge often appears as a thick, yellow, or green pus coming from the urethra at the tip of the penis Burning with urination and an increased urge to urinate may be present. The penis may also swell.
  • Women are more likely to have no symptoms but occasionally may have burning with urination and increased urge to urinate. Other signs of gonorrhea in females include:
    • Pain during sexual intercourse
    • Pain in the lower abdomen and pelvis
    • Abnormal vaginal  discharge
• Cervicitis (inflammation of the cervix)
  • The cervix is the most common site of gonorrhea infection in women, but 70% may have no symptoms.
  • Common symptoms include vaginal discharge and vaginal itching.
  • Less commonly, there may be atypical vaginal bleeding between menstrual periods, or heavier menses.
• Pelvic inflammatory disease (PID)
  • Because women may be initially asymptomatic, the gonorrhea infection may spread from the cervix to the uterus, tubes, and ovaries. PID may also be caused by chlamydia and other bacteria. Symptoms may include lower abdominal pain, heavy menses, and painful intercourse. A fever may also be present.
• Lymphadenitis
  • Symptoms include swelling and tenderness of the lymph nodes (swollen glands in the groin in both males and females.
• Bartholinitis
  • In women, Bartholin’s glands sit just beneath the labia majora at the opening of the vagina and help with lubrication. Inflammation of these glands may cause swelling and pain in the glands and the labia of the vagina and may include a discharge.

What does gonorrhea look like?

Gonorrhea may lead to skin rash if the infection has spread from the initial site to other body parts through the bloodstream. There may be abnormal discharge from the urethra or vagina, as well as swelling and redness in the genital area. Some types of skin lesions induced by gonorrhea include:

• Micro abscesses: Pus accumulated underneath the skin
• Macules: Discolored areas of the skin that may appear lighter or darker than your usual skin tone. It may also appear pink or red.
• Papules: Small raised bumps with flat tops that may sometimes appear inwards
• Pustules: Small bumps filled with pus
• Vesicles: Small blisters filled with clear fluid
• Hemorrhagic blister: Blisters containing blood
• Erythema: Redness of the skin

Gonorrhea of the throat

• Gonorrhea infections of the throat usually have no symptoms.
• If present, symptoms may include sore throat, pus in the back of the throat, and swollen glands.

Gonorrhea of the anus

• In males, infection of the anus and rectum is most often transmitted by sexual intercourse with other males.
• In women, because of the short distance between the vagina and anus, gonorrhea infection may also occur without anal intercourse.
• Usually, anal gonorrhea has no symptoms.
• When proctitis (inflammation of the rectum) occurs, symptoms may include rectal pain and fullness, the urge to have a bowel movement (tenesmus), rectal bleeding, and rectal discharge.

Symptoms of gonorrhea may develop  from 2 to 14 days after exposure but most often will occur within a week.

Many people with gonorrhea are asymptomatic, have no symptoms  and do not know that they are infected.

The diagnosis of gonorrhea can be made clinically in males, based on history and the presence of urethral discharge. However. The diagnosis is confirmed in the laboratory. In women, the diagnosis is made by lab testing.

Swabs from the throat, cervix, rectum, or urethra are tested for the Neisseria gonorrhoeae bacteria using nucleic acid amplification test (NAAT) that detects the genes of the bacteria.

Swabs may be taken by medical personnel during physical examination but can also be collected at home by the patient and brought to the lab.

First voided urine in the morning can be tested for the presence of gonorrhea.

Often, treatment is started before the results have returned.

Testing for other STIs is often done because they are also often transmitted and present as a co-infection. These include chlamydia, syphilis, and HIV.

Historically, cultures were used to make the diagnosis of gonorrhea, where the bacteria were grown from the swab in the microbiology lab. There are limited uses for cultures as compared to PCR/NAAT. Cultures are considered if treatment has failed and antibiotic resistance is being considered.

Gonorrhea is a curable sexually transmitted infection and is treated with antibiotics.

Recommended treatments are routinely updated based on the effectiveness of an antibiotic regimen in the community.

Uncomplicated gonorrhea

• Ceftriaxone as a single intramuscular injection.
• Rarely, if the patient has a severe allergy to penicillin or ceftriaxone, alternative treatments include a single dose of cefixime by mouth or a combination of a single dose of azithromycin by mouth and a single IM injection of gentamicin.
• Patients are also treated with doxycycline by mouth for seven days for presumptive associated chlamydia infections
• It is recommended that sex partners be treated even without being seen. Single dose cefixime can be sent home with the patient to provide the antibiotic to their sex partner(s). If the male patient has a male sex partner, it is recommended that the partner seek medical care for evaluation because of the increased risk of HIV co-infection
• For infections of the urethra, vagina or anus, there is no need to retest for infection, except when infections have not resolved within 3-5 days
• In patients with oral gonorrhea, retesting should take place n 1-2 weeks
• Pregnant patients are treated with the same antibiotic (Ceftriaxone IM) and should be closely monitored and retested in the third trimester before delivery due to the risk of infecting the fetus.

Disseminated gonorrhea

Gonorrhea can spread through the bloodstream and cause infection of joints, and inflammation of tendons and skin. Those tenosynovitis (tendon), dermatitis (skin), and/or polyarthralgia (multiple sore joints without pus) are treated with intravenous or intramuscular antibiotics for at least one week and continue treatment until symptoms have resolved.

Patients with an infected joint with pus in it require surgery to drain the joint. This is followed by 1-2 weeks of intravenous antibiotics.

Does gonorrhea go away on its own?

The body cannot rid itself of the Neisseria gonorrhoeae bacteria on its own. Antibiotics are the only way to rid the body of the infection.

In women, pelvic inflammatory disease may develop if gonorrhea goes untreated. This may result in tubo-ovarian abscesses, fallopian tube scarring, infertility, and the risk of ectopic pregnancy.

An uncommon complication is Fitz-Hugh-Curtis syndrome or perihepatitis, where the capsule of the liver becomes inflamed.

Complications of pregnancy and risk to the fetus and newborn are possible.

Pregnancy complications

• If the pregnant mother has a vaginal gonorrhea infection, there is a significant risk of infection of the amniotic fluid, premature rupture of membranes, early labor, low birth weight, and spontaneous miscarriage.
• Neonates can also get conjunctivitis or inflammation of the clear covering of the eye (ophthalmia neonatorum). If untreated, it can lead to corneal ulcers and blindness.
• Neonates are also at risk for pharyngitis (sore throat), joint infections, and blood infections with the Neisseria gonorrhoeae bacteria.

Disseminated gonorrhea

• Both men and women can develop disseminated gonorrhea.
• This describes illnesses where the infection extends beyond the areas where the infection initially occurs (throat, vagina, urethra, or anus).
• Joint infections, tendon inflammation, skin inflammation, and eye infections are possible.

Pelvic inflammatory disease (PID)

• Infection and inflammation of the tubes, ovaries, and uterus can cause significant illness, with fever, abdominal pain and tenderness, vaginal bleeding, and pain with vaginal intercourse.
• PID may also be caused by bacteria that are not gonorrhea.
• Complications of PID include abscess formation in the tubes and/or ovary and scarring of the fallopian tubes leading to ectopic pregnancy or infertility.
• Men can develop epididymitis and with it, an increased risk of prostate cancer.

Gonorrhea is a curable infection, but it requires that patients seek care. STI screening should be done routinely in patients who are not monogamous.

Gonorrhea is a sexually transmitted infection. Prevention includes using barrier methods like condoms during oral, vaginal, and anal sex.

Post-exposure prophylaxis (PEP) for sexually transmitted diseases has been shown to decrease the risk of contracting gonorrhea, chlamydia, and syphilis. Doxycycline 200 mg taken by mouth within 24-48 hours has been shown to be effective.

Monogamous sexual relationships will not allow for gonorrhea infections. Ideally, both partners will be tested for STDs beforehand.

• How serious is gonorrhea? Gonorrhea can be serious and may lead to severe health complications if left untreated. These include pelvic inflammatory disease, pregnancy complications, scarring of the fallopian tubes, infertility, epididymitis, and urethral stricture.
• Can you be cured of gonorrhea? Gonorrhea is a treatable sexually transmitted infection. It can be cured with proper antibiotic treatment
• How can a woman know she has gonorrhea? A woman may experience a burning sensation while urinating or pain in the lower abdomen. However, these symptoms can also be mistaken for bladder or vaginal infections. It’s important to consult a physician for proper testing to confirm if it’s gonorrhea. Women may not experience any symptoms and be unaware of the infection.
• What is the 7-day antibiotic for gonorrhea? Doxycycline is a 7-day antibiotic  prescribed chlamydia, which often accompanies a gonorrhea infection. The treatment for gonorrhea is a different antibiotic regimen
• Is gonorrhea 100% treatable? Gonorrhea can be cured completely with prompt and appropriate antibiotic therapy.
• Can you live a normal life with gonorrhea? Gonorrhea, if left untreated, may lead to severe complications. With early diagnosis and treatment, gonorrhea can be cured, and a person can live a normal life.