Content

Introduction

Gonorrhea is a sexually transmitted infection caused by a bacterium called neisseria gonorrhoeae or gonococcus. It is also called blenorrhagia.

Gonococcus in men can be found in the urethra and in women in the vaginal fluid.

Gonorrhea is easily transmitted through:

  • vaginal, oral or anal sexual intercourse not protected by a condom
  • sharing vibrators, or other sex toys that are not properly washed or covered with a new condom

Gonorrhea is not transmitted through kissing, hugging, sharing baths or towels, swimming pools, toilet seats, plates, cutlery or glasses, as bacteria need a warm, humid environment to live and cannot survive for long outside. of the human body (read the Hoax).

The gonococcus can infect the neck of the uterus (cervix), the urethra (last tract of the urinary tract), the rectum and, although less commonly, the throat and eyes.

The infection can also be passed from mother to child during delivery and cause blindness in the newborn. Therefore, pregnant women who suspect they have gonorrhea should seek immediate medical attention to initiate appropriate treatment.

Typical disorders (symptoms) caused by the disease include:

  • green or yellow discharge from the vagina or penis
  • burning when passing urine
  • bleeding between one menstrual cycle and the next

It is important to know that about 1 in 10 men and almost half of women affected by gonorrhea do not have any complaints and, therefore, do not know they have been infected (read the Hoax).

Gonorrhea can be easily ascertained (diagnosed) by analyzing a swab from the urethral or cervical secretions or a small amount of urine.

It is important to find out about gonorrhea as soon as possible because, if left untreated, it can lead to chronic health problems, including Pelvic Inflammatory Disease (PID), which is a female genital tract infection that can cause fever. , abdominal and pelvic pain, pelvic abscesses up to lead to infertility.

Gonorrhea is treated using combination antibiotic therapy, i.e. a single dose of ceftriaxone together with a single dose of azithromycin. With this therapy, most ailments (symptoms) improve within a few days.

The tests must be repeated one or two weeks after the antibiotic treatment to check if the infection is still present. Until certainty of recovery, sexual intercourse should be avoided.

Gonorrhea can affect any sexually active person, especially those who frequently change partners or do not use condoms during sexual intercourse. According to the World Health Organization (WHO), 78 million new cases of gonorrhea (Newman L. et al, 2015). In Europe, in 2014, more than 66,000 were reported; most occurred in the 15-34 age group.

Gonorrhea does not give immunity, which means that if you don't take the proper precautions you can get infected several times.

Prevention of gonorrhea and other sexually transmitted diseases can be easily achieved by using adequate contraception and taking other precautions which include:

  • use of male or female condoms whenever vaginal intercourse occurs and male condoms during anal intercourse
  • use of condoms to cover the penis, or dental dams to cover the female genitals, if engaging in oral sex
  • avoid sharing sex toys, or washing and covering them with a condom before they are used by other people

People who suspect they have a sexually transmitted infection should contact their doctor immediately to start proper treatment as soon as possible.

Symptoms

Symptoms of gonorrhea usually develop within two weeks of infection, although they sometimes appear several months later. However, about 1 in 10 men and nearly half of women have no complaints and, therefore, do not know they are. been infected.

In women, disorders caused by gonorrhea can include:

  • unusual vaginal discharge, which can be creamy or watery and green or yellow in color
  • pain or burning sensation when passing urine
  • abdominal pain or tenderness on palpation of the lower abdomen
  • blood loss between one menstrual cycle and the next, heavier menstruation, blood loss after sexual intercourse

In men, the symptoms of gonorrhea can include:

  • unusual discharge from the tip of the penis, white, yellow or green
  • pain or burning sensation when passing urine
  • inflammation and swelling of the foreskin
  • pain, swelling, or tenderness to the touch of the testicles
  • more rarely, infection of the rectum, throat or eyes

People who have anal or oral sex that are not protected by a condom may develop an "infection of the rectum, eyes or throat." Infection of the rectum can cause anal discomfort, itching, pain or discharge. The eye infection can cause irritation, pain, swelling and tearing while the throat infection does not cause any discomfort.

If there is the possibility of having been infected with gonococcus, even in the absence of obvious disorders (symptoms) and even if the disorders have disappeared spontaneously, it is important to contact your doctor to find out if you have been infected.

If the disease is undetected and untreated, it can continue to spread with the risk of serious complications, including infertility.

Gonorrhea in children

Gonorrhea can be passed from a mother to her child during childbirth. In newborns, the symptoms (symptoms) occur in the first two weeks of life in the eyes that become red and swollen with the presence of pus (conjunctivitis).

The disease can be treated with antibiotics both during pregnancy and during breastfeeding. Antibiotics do not harm the baby.

Diagnosis

The only way to ascertain (diagnose) gonorrhea is to perform a laboratory test. If you suspect you have a sexually transmitted infection, it is important not to waste time but to carry out the appropriate tests immediately.

It is possible to undergo the test even a few days after having had sexual intercourse but it is advisable to wait at least a week. The microbiological examination can be performed even if there are no complaints.

Detecting and treating gonorrhea as early as possible reduces the risk of developing complications such as pelvic inflammatory disease or testicular infection. Complications resulting from chronic infection are much more difficult to treat.

Analyzes should be performed by:

  • couples who have disorders attributable to gonorrhea
  • people who have had an unprotected relationship with a new partner
  • individuals already affected by sexually transmitted infections
  • people with a partner with a sexually transmitted disease
  • women who have vaginal discharge or inflammation of the cervix, found by the doctor during a gynecological examination
  • women who are pregnant or planning to become pregnant

The attending physician will be able to indicate the most suitable laboratory in which to perform the analyzes.

Laboratory tests

There are several ways to check for the presence of gonorrhea. In most cases, a swab is used to take a small amount of material (sample) to be subjected to microbiological examination. The tampon takes only a few seconds and is not painful.

The type of withdrawal differs between men and women:

In women, the doctor swabs from the vagina or from the cervix. In some cases, the material can also be taken from the urethra (last tract of the urinary tract). Usually in women, urine sample testing is not performed because it is unreliable.

In men, a urine sample is collected or a swab is made from the urethra.

Infections of the rectum, throat and eyes

If there is a possibility that the rectum or throat is infected, the doctor may take a swab from these areas. If eye problems such as conjunctivitis with pus are present, pus can be removed. from the eye and analyze it.

The laboratory test may consist of observing the sample under a microscope, after having colored it, to get the result quickly. If, on the other hand, we proceed with a culture examination of the samples, it is necessary to wait a longer time to obtain the results (about 1 week).

Therapy

Gonorrhea is treated with a short antibiotic therapy, which is recommended if:

  • laboratory tests have ascertained the presence of gonorrhea
  • the results of the laboratory analyzes are not yet ready but there is a real possibility of having contracted the infection
  • your partner has gonorrhea

In most cases, the recommended therapy is a combination of antibiotics: a single dose of ceftriaxone by intramuscular injection followed by a single dose of azithromycin by mouth.Disorders of gonorrhea usually improve within a few days, although it can take two weeks to completely eliminate abdominal or testicular pain. Blood loss between one menstruation and the next disappears almost immediately.

After the therapy, it is advisable to wait at least one or two weeks and then repeat the laboratory tests to ensure complete recovery.

Until you are sure you are cured, you should avoid sexual intercourse in order not to infect your partner. If your complaints do not improve after antibiotic treatment or if you think you have been infected again, you should go to your doctor again. You may need to repeat the treatment or you may need further tests to check for other types of infections. Gonorrhea is easily transmitted through sexual intercourse. Infected people should warn their partner or any recently had partners to allow them to be tested and, if infected, to start treatment right away.

Complications

If gonorrhea is cured quickly, it is unlikely to cause any permanent complications or ailments. However, without therapy, it can spread to other parts of the body and cause serious problems. If you contract the infection several times, you will be more likely to have complications.

In women, gonorrhea can spread to the reproductive organs and cause pelvic inflammatory disease (PID). This is estimated to occur in 10-20% of inadequately treated gonorrhea cases. Pelvic inflammatory disease can cause persistent pain in the lower abdomen (the pelvis), increasing the risk of ectopic pregnancy and infertility.

During pregnancy, gonorrhea can cause:

  • miscarriage
  • premature birth
  • neonatal conjunctivitis

If the child is not treated quickly with antibiotics, there is a risk of progressive and permanent vision damage.

In men, gonorrhea can cause painful infections of the testicles and prostate that can lead, albeit rarely, to impaired fertility. In rare cases, if gonorrhea is not treated, it can spread to the blood (sepsis) and cause dangerous infections in other parts of the body.

Bibliography

Newman L, Rowley J, Hoorn SV, Wijesooriya NS, Unemo M, Low N, Stevens G, Gottlieb S, Kiarie J, Temmerman M. Global estimates of the prevalence and incidence of four curable 390 sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS ONE. 2015; December 8

European Center for Disease Prevention and Control (ECDC). Gonorrhoea. ECDC. Annual Epidemiological Report 2016 

In-depth link

EpiCentro (ISS). Gonorrhea

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