Gonorrhoea

TREATMENTS OF SEXUALLY TRANSMITTED DISEASES

Gonorrhoea

Gonorrhea is one of the most common sexually transmitted infections in the world. The word gonorrhea comes from ancient Greek and is literally translated as "seminal discharge" because it was believed that only men could spread it through their semen.

Gonorrhoea

Table of Contents

Definition

What is it?

Gonorrhoea is one of the most common sexually transmitted infections around the world. The word gonorrhoea comes from ancient Greek and translates literally as “seminal flow” because it was believed that only men could spread it through their semen. It’s now more than proven that men and women can transmit it equally through contact with genital and urinary mucous membranes. The microbiological agent that produces this disease is neisseria gonorrhoeae, a gram-negative bacteria found only in humans that has a special predilection for the delicate epithelials of the urinary urethra, cervix, rectum, pharynx and ocular conjunctiva.

The microbiological agent that produces this disease is neisseria gonorrhoeae, a gram-negative bacteria found only in humans that has a special predilection for the delicate epithelials of the urinary urethra, cervix, rectum, pharynx and ocular conjunctiva.

El agente microbiológico que produce esta enfermedad es la neisseria gonorrhoeae, una bacteria gramnegativa que se encuentra sólo en los seres humanos y que tiene especial predilección por los delicados epitelios de la uretra urinaria, el cuello del útero, el recto, la faringe y las conjuntivas oculares.

During unprotected intercourse without barrier methods (latex condom), the likelihood of female-to-male infection is about 20 per cent. If the man is infected with the bacteria, the risk of infecting the woman is much greater because seminal secretions provide a perfect habitat for the bacteria to survive and reach other tissues.

Symptoms
Symptoms

In men are: Urethritis (inflammation and redness of the urethra). Discomfort when urinating or during sexual intercourse. Discharge of white mucus (with pus) constant and sensation of dripping. In women: Cervicitis (painful swelling of the cervix). Abnormal, white, foul-smelling vaginal discharge. Irritation and burning during urination or vaginal intercourse.

Diagnosis
Diagnosis

Swabs with urethral secretions are taken to a laboratory for further analysis. There, these samples can be stained with Gram Stain and observed under an optical microscope Other more elaborate and complex but specific tests, such as polymerase chain reaction (PCR), are also used to diagnose this and other sexually transmitted infections.

Treatment
Treatment

Treatment of gonorrhoea consists of the administration of antibiotics. When the infection is in its initial period and there are no major complications, a single dose of ceftriaxone combined with azithromycin could eliminate neisseria gonorrhoeae quickly and effectively.

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Frequent causes

What causes it?

The bacteria neisseria gonorrhoeae is an aerobic microorganism (dependent on oxygen) in the form of small circular dots that form chains, these are diplococci.

This bacteria ferments carbohydrates and gets from them the energy it needs to survive. Laboratory culture is a bit complex because the bacteria can compete for nutrients with other bacteria and die of starvation, so culture media include specific antibiotics for those other bacteria, but not for neisseria gonorrhoeae.

How does the microorganism get sick?

This bacteria invades the epithelial tissues of the urethra (and other mucous membranes of the body) and utilizing thin structures called pili adheres to those epithelials. The immune response is activated and, employing granulocytes, these bacteria are eaten.

However, as it’s an infection little or not at all known to the body, the immune response is insufficient and does not put an end to all these “invaders”, so inflammatory events and secretions are triggered to try to stop them.

How is it transmitted?

It’s transmitted from person to person by direct contact with infected mucous membranes or secretions, especially during unprotected sex.

Transmission can also occur through common sexual practices such as oral or anal sex, in which there are mucous membranes in the same way as in vaginal sex.

The skin itself, has very little susceptibility to bacteria so are rare cases of gonorrhoea on the skin of hands or trunk.

Also, a mother infected with gonorrhoea can transmit (vertically) the bacteria to her child during labour. It is often the mucous membranes of the baby's eye that are affected.

symptomatology

What are its symptoms?

The incubation period for the bacteria is three days in men and one week in women. During this time, there are no symptoms and contagion may not occur, because the mucus-purulent secretion characteristic of the disease has not begun.

Among the most frequent symptoms in men are:

In women, symptoms are similar:

In both cases, bacteria can ascend through the genitourinary tract and cause invasion of the epididymis or prostate (epididymitis or prostatitis, respectively) in men, or inflammation of the Bartholin glands or fallopian tubes in women.

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Can a contagion be asymptomatic?

Indeed, during the incubation period (which varies between men and women) not only is the disease not transmissible but there is also an absence of symptoms.

Differences between men and women

In women, the incubation period is longer and the symptoms of secretion are greater than in men.

Risk Factors

Risk factors

Factors such as the following may increase the risk of getting the bacteria and developing gonorrhoea:

¿Cómo prevenir la enfermedad?

To prevent the disease it’s necessary to maintain an optimal sexual health, in which there is only one partner or always use a latex condom whenever there is a new partner.

Also, avoiding oral sex if there are doubts of contagion, especially with new sexual partners, is of great help in preventing possible infections from occurring.

According to WHO, it is recommended that every person (men and women) with an active sex life be tested for sexually transmitted diseases at least once a year.

Diagnosis

How is it diagnosed?

Swabs with urethral secretions are taken to a laboratory for further analysis. There, these samples can be stained with Gram Stain (a chemical that colours the cell wall of bacteria) and observed under an optical microscope. If the diagnosis is positive, neisseria gonorrhoeae may be evidenced as a set of small circles grouped in chains.

Swabs can also be used to perform microbiological cultures in special nutritional media for the bacteria to grow, after a few days, you can see the growth of bacterial colonies. If the characteristics of these colonies coincide with those of neisseria gonorrhoeae, it will be possible to confirm the disease in the patient and apply the correct treatment.

Other more elaborate and complex but specific tests, such as polymerase chain reaction (PCR), are also used to diagnose this and other sexually transmitted infections.

medicación posoperatorio
Techniques and treatments

How to treat the disease

medicación posoperatorio

Treatment of gonorrhoea consists of the administration of antibiotics.

When the infection is in its initial period and there are no major complications, a single dose of ceftriaxone combined with azithromycin could eliminate neisseria gonorrhoeae quickly and effectively.

On the other hand, if the bacteria has spread through the bloodstream and caused arthritis infection (an infection and painful joint inflammation due to the presence of bacteria inside the synovial capsule of joints), the treatment includes a period of hospitalization and administration of antibiotics intravenously.

In allergic to cephalosporins (such as ceftriazone) patients, gentamicin has also been successfully tested.

During treatment, patients should abstain from sexual intercourse, to avoid ping-pong infections, a form of reciprocal coinfection between two partners. In addition, they must receive pharmacological treatment at the same time.

Are there any re-infections after treatment? Until when is it still transmissible?

Having previously had gonorrhoea does not protect against new infections because the body cannot efficiently develop specific antibodies for this bacteria.

The disease will be transmissible until a couple of weeks after treatment. This is because there may be small accumulations of bacteria still alive within the urinary tract.

For this reason, it’s necessary to have sex with a condom after treatment, for a few weeks. Although the best option is temporary abstinence.

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Frequent questions

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Can there be complications?

Complications from this bacteria are rare but can occur as a result of bacteremia (the passage of bacteria into the bloodstream), where there may be invasion of other tissues.

As a result, there may be skin infections (in the form of painful pustules that bleed) or joint inflammation (infectious arthritis), which is common in the knee or ankle and causes a lot of pain when trying to bend or extend the limbs.

Inflammation of the meninges surrounding the brain and spinal cord (meningitis) or heart infection (endocarditis) may also occur.

Gonococcal sepsis can be life-threatening, although it’s rare in civilized countries.

What is ocular gonorrhoea and how is it treated?

Ocular gonorrhoea occurs in adults by self-inoculation (touching the eyelids with contaminated hands and fingers, with purulent secretions from the genitals) or, in children during birth.

This condition usually occurs as inflammation and redness of the eyelids and the presence of pus, but can be complicated when the bacteria reaches the cornea.

Treatment includes eye washing and antibiotics.

What is neonatal gonorrhoea and how is it treated?

During birth, a mother with gonorrhoea can transmit the disease to the child, causing neonatal conjunctivitis and other associated eye discomforts, just like adults.

The treatment of neonatal conjunctivitis for neisseria gonorrhoeae is the application of antibiotics (such as gentamicin) in drops.

Dr. Natalio Cruz

Author

Dr. Natalio Cruz


El Dr. Cruz, con 25 años de experiencia médica, ha sido hasta 2016 Jefe de la Unidad de Andrología en el Servicio de Urología del Hospital Virgen del Rocío de Sevilla, Coordinador Nacional de Andrología de la Asociación Española de Urología (AEU) y Secretario General de la ESSM, cargos que ha delgado para centrarse de lleno en el ilusionante proyecto de ofrecer una consulta médica privada de alto nivel en Sevilla.

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