Everything about Gonorrhea totally explained
Gonorrhea (also
gonorrhoea) is amongst the most common
sexually transmitted diseases in the world, caused by
Neisseria gonorrhoeae.
Non-genital sites in which it thrives are in the
rectum, the
throat (
oropharynx), and the
eyes (
conjunctivae). The
vulva and
vagina in women are usually spared because they're lined by
stratified epithelial cells—in women the
cervix is the usual first site of infection.
Gonorrhea spreads during
sexual intercourse. Infected women also can pass gonorrhea to their
newborn infants during delivery, causing eye infections (
conjunctivitis) in their babies (which if left untreated, can cause blindness). Doctors have often attempted to treat this immediately by applying small amounts of
silver nitrate or other antibiotic to the eyes of all newborn babies.
Symptoms of gonorrhea
The incubation period is 1 to 10 days with most symptoms occurring between the second and fifth days after being infected. A small number of people may be
asymptomatic for up to a lifetime. Between 30–60% of monkeys with gonorrhea are
asymptomatic or have disease. The woman may complain of
vaginal discharge, difficulty urinating (
dysuria), projectile urination, off-cycle
menstrual bleeding, or bleeding after sexual intercourse. The cervix may appear anywhere from normal to the extreme of marked cervical inflammation with pus. Possibility of increased production of male hormones is common in many cases. Infection of the urethra (
urethritis) causes little dysuria or pus. The combination of urethritis and cervicitis on examination strongly supports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients. Gonorrhea is caused by the
Neisseria gonorrhoeae bacteria. The infection is transmitted from one person to another through vaginal, oral, or anal sexual relations.
Men have a 20% chance of getting the infection by having sexual relations with a woman infected with gonorrhea. Women have a 50% chance of getting the infection by having sexual relations with a man infected with gonorrhea. An infected mother may transmit gonorrhea to her newborn during childbirth.
Less advanced
symptoms, which may indicate development of
pelvic inflammatory disease (PID), include
cramps and pain, bleeding between
menstrual periods,
vomiting, or
fever. It isn't unusual for men to have asymptomatic gonorrhea. Men may complain of
pain on urinating and thick, copious,
urethral pus discharge (also known as ) is the most common presentation. Examination may show a reddened external
urethral meatus. Ascending infection may involve the
epididymis,
testicles or
prostate gland causing symptoms such as scrotal pain or swelling.
Complications
In men, inflammation of the epididymis (
epididymitis), prostate gland (
prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea.
In women, the most common result of untreated gonorrhea is pelvic inflammatory disease, a serious infection of and
tenosynovitis in fingers, wrists, toes or ankles. This should be evaluated promptly with a culture of the
synovial fluid, blood, cervix, urethra, rectum, skin lesion fluid, or pharynx. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.
Treatment
The mainstay of treatment is the appropriate use of
antibiotics. While penicillin was the most common antibiotic used to treat gonorrhea up until the 1970s, an increase in antibiotic resistance has led to a decline in its use. Recommendations for first choice treatment of gonorrhea must depend on local information on resistance patterns and it isn't possible to make treatment recommendations that are applicable to all parts of the world.
The
Centers for Disease Control and Prevention (CDC) released a report on Thursday,
April 12,
2007 officially adding gonorrhea to a list of
super bugs that are now resistant to common antibiotics according to
CDC
.
Antibiotics that may be used to treat gonorrhea include:
The level of
tetracycline resistance in
Neisseria gonorrhœae is now so high as to make it completely ineffective in most parts of the world.
The fluoroquinolones (penisciprofloxacin, ofloxacin, levofloxacin) can't be used in pregnancy. It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected with gonorrhea. Patients should also be offered screening for other sexually transmitted infections. In areas where co-infection with
chlamydia is common, doctors may prescribe a combination of antibiotics, such as ceftriaxone with
doxycycline or azithromycin, to treat both diseases.
Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria within the rectum produce β-lactamases that destroy penicillin. All current treatments are less effective at treating gonorrhea of the throat, so the patient must be rechecked by throat swab 72 hours or more after being given treatment, and then retreated if the throat swab is still positive.
Although gonorrhea usually doesn't require follow-up (with the exception of rectal or pharyngeal disease), patients are usually advised to phone for results five to seven days after diagnosis to confirm that the antibiotic they received was likely to be effective. Patients are advised to abstain from sex during this time.
Drug resistant strains are known to exist.
United States recommendations
The United States doesn't have a federal system of sexual health clinics, and the majority of infections are treated in family practices. A third-generation
cephalosporin antibiotic such as
ceftriaxone is recommended for use in most areas. Since some areas such as Hawaii and California have very high levels of resistance to
fluoroquinolone antibiotics (
ciprofloxacin,
ofloxacin,
levofloxacin) they're no longer used empirically to treat infections originating in these areas.
Since 1993, fluoroquinolones (for example, ciprofloxacin, ofloxacin, or levofloxacin) have been used frequently in the treatment of gonorrhea because of their high efficacy, ready availability, and convenience as a single-dose, oral therapy. Beginning in 2000, fluoroquinolones were no longer recommended for gonorrhea treatment in persons who acquired their infections in Asia or the Pacific Islands (including Hawaii); in 2002, this recommendation was extended to California (2). In 2004, CDC recommended that fluoroquinolones not be used in the United States to treat gonorrhea in men who have sex with men (MSM).
On the basis of the most recent evidence, CDC no longer recommends the use of fluoroquinolones for the treatment of gonococcal infections and associated conditions such as pelvic inflammatory disease (PID). Consequently, only one class of drugs, the cephalosporins, is still recommended and available for the treatment of gonorrhea.
The Center for Disease Control has recently (April 2007) updated treatment guidelines.
http://www.cdc.gov/std/treatment/2006/updated-regimens.htm
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm?s_cid=mm5614a3_e
Antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. Because many people with gonorrhea also have chlamydia, another sexually transmitted disease, antibiotics for both infections are usually given together. Persons with gonorrhea should be tested for other STDs. It is important to take all of the medication prescribed to cure gonorrhea. Although medication will stop the infection, it won't repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they've sexual contact with persons infected with gonorrhea. If a person's symptoms continue even after receiving treatment, he or she should return to a doctor to be reevaluated.
United Kingdom recommendations
In the United Kingdom, the majority of patients with gonorrhea are treated in dedicated sexual health clinics. The current recommendation is for ceftriaxone or cefixime as first line therapy; no resistance to either drug has yet been reported in the UK. Levels of spectinomycin resistance in the UK are less than 1%, which would make it a good choice in theory, but intramuscular spectinomycin injection is very painful.
Azithromycin (given as a single dose of 2 g) is recommended if there's concurrent infection with chlamydia. A single dose of oral ciprofloxacin 500 mg is effective if the organism is known to be sensitive, but fluoroquinolones were removed from the UK recommendations for
empirical therapy in 2003 because of increasing resistance rates. In 2005, resistance rates for ciprofloxacin were 22% for the whole of the UK (42% for London, 10% for the rest of the UK).
Historically
Historically it has been suggested that
mercury was used as a treatment for gonorrhea. Surgeons tools on board the recovered English warship the
Mary Rose included a
syringe that, according to some, was used to inject the mercury via the
urinary meatus into any unfortunate crewman suffering from gonorrhea.
Silver nitrate was one of the widely used drugs in the 19th century, but it became replaced by
Protargol.
Arthur Eichengrün invented this type of colloidal silver which was marketed by
Bayer from 1897 on. The silver-based treatment was used until the first antibiotics came in use in the 1940s.
Prevalence
Gonorrhea is a very common infectious disease. The CDC estimates that more than 700,000 persons in the United States get new gonorrheal infections each year. Only about half of these infections are reported to CDC. In 2004, 330,132 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113.5 per 100,000 persons.
Slang terms
Gonorrhea is also commonly known by the slang term
the clap.
Suggested etymology:
Reference to a traditional treatment used to clear the blockage in the urethra from gonorrheal pus, where the penis would be "clapped" on both sides simultaneously.
Reference to the painful sting in the male urethra, which feels like the sting of a clap (as in clapping hands) when infected with the disease.
From the old French word "clapier", meaning "brothel".
The term the clap was replaced with the similar sounding the jack in the 1975 AC/DC song The Jack, which used the metaphor of playing cards and poker as sexual innuendo in the original LP version. However, live recordings of the song make direct references to the disease.
Further Information
Get more info on 'Gonorrhea'.
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