Gonorrhea is one of the most frequent STDs; it causes concern in those that get it. This article explains all you need to know about it.
Gonorrhea is one of the most frequent sexually transmitted diseases (STDs) around. Transmission can occur through unprotected vaginal, anal, or oral sex.
This sexually transmitted disease is the result of infection by a bacterium whose name is Neisseria gonorrheae. The infection tends to attack the body’s mucous membranes, such as the urethra, vagina, eyes, throat, and anus.
People with several sexual partners with unprotected sex (without a latex condom) have a greater risk of suffering from the disease. Patients involved in activities like alcohol and drug abuse have an increased risk of having unprotected sex and therefore increase the risk of infection.
Gonorrhea is reasonably common; in the United States, there are approximately 900.000 new cases each year. However, experts estimate that there are many unreported cases. The real number is well over a million patients a year.
According to the CDC, it is the second most common sexually transmitted infection after chlamydia. Although the infection rates are similar, women are more likely to get tested than men.
Most cases occur between the ages of 15-44 in both men and women. The frequency of antibiotic-resistant Neisseria gonorrheae has been on the rise every year since 1945, reaching record levels this decade.
I am a medical doctor. This article will describe everything you need to know about symptoms, diagnosis, and treatment for this disease.
How long can you carry gonorrhea?
The estimated incubation period for gonorrhea is usually 3 to 5 days. However, in some cases, particularly male patients, can go up to 30 days without symptoms.
Some of them don’t ever experience symptoms at all and unknowingly pass it on to their sexual partners through unprotected sex. Asymptomatic gonorrhea patients remain infectious until they receive treatment, which can take several months due to the lack of symptoms.
What are the signs and symptoms of gonorrhea?
Gonorrhea symptoms usually appear within the first seven days of sexual contact with an infected sexual partner in women. In men, the appearance of symptoms takes a while longer. Symptoms vary between men and women.
What are the signs and symptoms of gonorrhea in women?
In women, the most common infection site is the cervix, the urethra (the duct that connects the bladder with the exterior), the rectum, and lastly the throat, respectively.
Common symptoms in women include:
- Vaginal discharge: This may appear watery, creamy, or slightly greenish.
- Urinary symptoms: Women with gonorrhea often experience urinary symptoms like a burning sensation or painful urination and the need to urinate more frequently.
- Menstrual symptoms: Such as heavy spotting and particularly heavy periods.
- Pain when engaging in other sexual intercourses.
- Abdominal pain: Particularly in lower abdominal quadrant or pelvic pain.
- Gonococcal pharyngitis: In cases where transmission occurs through oral sex, patients can present with a sore throat.
- Rectal symptoms: Rectal infection after anal sex is often asymptomatic; however, symptoms such as rectal itching, incomplete voiding sensation, pain, and bloody diarrhea can occur in some patients.
- Eye infection: Eye involvement occurs when someone touches their eyes just after touching infected genitalia. The most common presentation is purulent conjunctivitis; the condition has a quick progression and can permanently lose of sight if not treated quickly. This form of conjunctivitis is excruciating and has abundant pus secretion.
- Systemic symptoms: Symptoms like fever, nausea, and vomiting are infrequent but do occur in some cases.
What are the signs and symptoms of gonorrhea in men?
In men, the urethra is the most common infection site. Some common symptoms in men include the following.
Contrary to what happens to women, men only develop symptoms several weeks after the infection, and many do not develop symptoms at all. However, asymptomatic individuals are still capable of transmitting the disease.
Some frequent symptoms in men include:
- Urinary symptoms: Urinary symptoms tend to be the first symptoms in men. They include frequent urination and a burning sensation or pain while urinating.
- Discharge: The second most common symptom is a purulent discharge or drip from the penis, just as in vaginal discharge, this drip can be greenish, yellow, or beige. After some time, the discharge may even turn bloody.
- Swelling and redness in the opening of the penis
- Acute epididymitis: This one mainly occurs in those under the age of 35, includes testicular swelling and pain; it is usually on one side.
- Eye symptoms: Men can suffer from purulent conjunctivitis due to Neisseria just as women do. The possible outcomes are similar in both cases and can result in permanent eye loss.
- Rectal symptoms: Those that incur in anal sex can suffer from the same rectal symptoms as women.
Can neonates have gonorrhea?
The disease can be transmitted from an infected untreated mother to child during childbirth, even if the mother in question is asymptomatic. Transmission can also occur in utero before childbirth.
The eyes are the most common target of neonatal gonorrhea; it causes a severe form of purulent conjunctivitis that can lead to permanent blindness.
Neonates can also experience pharyngitis, rectal and urinary symptoms due to gonorrhea infection. Neonatal blindness due to gonorrhea is a frequent problem in underdeveloped countries. It rarely occurs in developed countries like the United States. Inadequate prenatal care and unmonitored births increase the risk of infection.
What are the complications of gonorrhea?
In women, an untreated gonorrhea infection can ascend all the way up to the uterus, the ovaries, and the fallopian tubes, causing pelvic inflammatory disease (PID).
This condition can lead to chronic pelvic pain and permanent damage to female reproductive organs, like fallopian tube scarring. Severe damage to these organs can lead to infertility and ectopic pregnancy.
An ectopic pregnancy is when an egg implants itself outside the uterus. Pelvic inflammatory disease is not unique to gonorrhea. It can also be the product of other sexually transmitted infections like chlamydia.
Men can develop urethral scarring and painful abscesses inside the urethra; both things can contribute to permanent infertility.
Rarely, Neisseria gonorrheae bacterium can slip into the bloodstream and cause disseminated gonococcal infection. In this stage, patients no longer have localized symptoms like vaginal discharge or burning sensation while urinating.
They have systemic symptoms. The classic presentation is an arthritis-dermatitis syndrome. Joint pain the earliest symptom. It usually involves big joints (such as the knees and the elbows) and migrates from joint to joint (migratory arthritis). The tendons can also suffer from this disease. A condition is known as tenosynovitis often affects the tendons in the Achilles heel; it is classically called lovers heel.
Many times joint disease develops at the same time as a skin rash. This rash often involves the upper checks, as well as the palms and soles. This rash can later evolve into pustular dermatitis; these lesions can lead to a certain degree of bleeding, are painful, and can be accompanied by a low-grade fever. The number of lesions varies between 5 and 40; they usually last for less than four days.
What is septic arthritis?
Septic arthritis is a medical emergency that, if it does not receive treatment promptly, can lead to an important degree of disability. Many different bacterial and fungal infections can cause it. Still, gonococcal infection is one of the most frequent culprits.
A few cases end up in devastating sepsis, shock, and death. Patients present with a triad of fever, joint pain, and decreased range of motion in the affected joint.
How doctors diagnose gonorrhea?
There are several ways to diagnose gonorrhea. The gold standard for diagnosis is a bacterial culture. The doctor will require a pus sample of the affected area, like the vagina or the urethra, and place it in a petri dish to make a bacterial culture. However, a bacterial culture has several drawbacks. Taking the sample, transporting it, and storing it isn’t very easy. Also, it requires waiting up to 72 hours for a positive culture.
Current guidelines recommend a quicker test. A nucleic acid amplification test provides a diagnosis within a few hours after collecting the sample. It is not as accurate as a bacterial culture, but it comes pretty close.
The CDC recommends performing nucleic acid amplification tests before taking a culture sample because it is quicker and more cost-effective. Serologic blood tests are not really useful in this disease because they provide many false negatives and false positives.
Other tests that might be useful include:
- Complete blood count: It can reveal an elevation win white blood cell levels, usually between 10.000 and 15.000, particularly in patients in which the bacterium has already reached the bloodstream.
- Erythrocyte sedimentation rate: This one is an inflammation marker; patients with gonorrhea usually have a mild elevation of this marker.
- Blood cultures: They are the indication when doctors suspect bloodstream invasion of the bacteria.
- Ruling out other STDs: Patients with suspected gonorrhea infection should also get tested for other STDs like syphilis and chlamydia—also hepatitis b virus, hepatitis c virus, and human immunodeficiency virus (HIV). Rapid HIV tests make testing in the emergency department readily available and inexpensive.
How do doctors treat gonorrhea?
As with any other bacterial infection, gonorrhea requires antibiotic therapy. After antibiotic therapy begins, you should start feeling some relief after just a few days.
The treatment of choice for gonorrhea consists of a single dose of intramuscular ceftriaxone (one injection in the buttocks’ upper exterior corner). Alternative treatment includes a single dose of azithromycin by mouth.
However, the frequency of antibiotic resistance of Neisseria gonorrhea is an ongoing challenge. Every day more and more patients declare a failure of initial antibiotic therapy with azithromycin or ceftriaxone.
They require other, more potent antibiotics for a more extended period. The case of antibiotic-resistant infection usually requires treatment for seven days or longer.
Some guidelines currently recommend combined therapy with both azithromycin and ceftriaxone; it should be administered on the same day and under medical supervision.
Doxycycline 3 times a day for seven days in the second choice for gonorrhea treatment might be very useful for treating antibiotic-resistant strains. Importantly, before 2007 fluoroquinolones like ciprofloxacin were the treatment of choice for gonorrhea, and it changed due to increasing bacterial resistance towards them.
In the United States, the law requires doctors to report all gonorrhea cases to the county public health department. The sexual partners of the patient should be contacted, informed of the situation, and receive treatment as well.
Gonorrhea usually receives treatment in an outpatient setting. When complications such as septic arthritis and purulent conjunctivitis are present, patients receive treatment in a hospital setting to receive intravenous antibiotic treatment and constant monitoring to prevent permanent sequels. Septic arthritis requires joint drainage and might require surgery in some cases.
What can be done to prevent the spread of gonorrhea?
The best way to promote gonorrhea is through abstinence or having a single sexual partner in a monogamous relationship. However, this is a free world, and that is not always possible.
The second-best alternative is still using a condom when engaging in sexual intercourse with every person who is not your monogamous sexual partner. Be open with your sexual partners and get tested for STDs regularly if you have multiple sexual partners.
Suppose your partner shows any sign of having an STD avoid any sexual contact with him or her until that persona has received adequate testing and treatment if necessary.
Does past infection with this infection make a person immune?
No, there is no such thing as immunity to gonorrhea. Every time you engage in sexual activity with an infected person, you will get the disease. It doesn’t matter how many times you have had it before.
Do you have symptoms of this disease? Do not worry anymore.
This tool is a Gonorrhea Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this condition. Therefore, the tool would help anyone who uses it to determine the likelihood that their symptoms are because of gonorrhea. This tool’s most important feature is that it is free and would only take a few minutes.