Gonorrhea (aka "clap" or "drip") is a sexually transmitted disease which can affect the mucous membranes of the genitourinary tract, eye, rectum and throat. Thus, it can be spread via vaginal, anal, or oral intercourse. A pregnant woman can infect her baby during birth, causing a severe eye infection. Fortunately, most newborns are routinely given medication (a silver nitrate solution) to prevent this infection. If a young child is found with the infection in other areas of his or her body, it is almost invariably due to sexual abuse.

According to the World Health Organization, 62 million people across the planet were infected with this disease in 1996. The disease is found most often in younger (aged 15-30) people who have many sex partners. It's more common in cities than in rural areas. In 1996, the U.S. Centers for Disease Control and Prevention says that 358,995 cases of the disease were reported; luckily, the number of cases have been declining since 1987. The CDC further estimates that the disease most often infects women ages 15-19 and men ages 20-24 and that the economic cost of the disease is over $1 billion annually.

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. People who catch gonorrhea are also very likely to get infected with chlamydia at the same time. Previous infections do not confer immunity and may in fact make future infections worse. A person can spread the disease the moment they become infected, even before symptoms occur. Condoms and dental dams can protect against transmitting the disease during sex, but the only safe course is to avoid sex entirely until one has sought and completed treatment.

Symptoms typically show up 2-7 days after intercourse with an infected person, but sometimes it may take a month before a person starts feeling ill effects. Some people (10-15% of men and 80% of women) may never get acute symptoms and may continue to spread the disease unknowingly.

Symptoms include, depending on the area infected:

If left untreated, gonorrhea may spread into the uterus and fallopian tubes and cause pelvic inflammatory disease in women; up to 10% of all infected women may suffer from infertility or sterility. Women with the disease also suffer from an increased risk of ectopic pregnancy. It may cause swelling of the penis (balanitis) and testes in men. In both sexes, it may spread to the skin and internal organs, causing swelling, pain and tissue scarring. If it gets in the bloostream, it can infect the joints and cause arthritis.

As with most other STDs, the inflammation and tissue damage that gonorrhea causes makes an infected person more susceptible to catching and passing on HIV, the virus that causes AIDS.

If a physician or patient suspects a gonorrheal infection, the physician may make a diagnosis in any of several ways:

  • The physician will swab a sample from the penis or cervix (which is typically the first site of infection in women) and smear it on a slide. He or she will apply a stain to the smear and look for the stained bacteria under a microscope. This method works very well for detecting infections in men but produces a high rate of false negatives in women.

  • The physician may take a urine sample or cervix swab and test it for the bacteria's DNA.

  • The physician may take samples of genital discharge or a swab from the throat and send it to the lab to be cultured to see what kind of bacteria grow. The culturing test gives an accurate result 90 percent of the time and takes two days to complete.

Gonorrhea can be cured with antibiotics, usually cephalosporin or quinalone analogs. In the U.S., treatment is most often a single dose of cefixime, ceftriaxone, ciprofloxacin, ofloxacin, or levofloxacin. Because of the frequency of additional chlamydial infections, physicians will often prescribe antibiotics that will knock out both diseases: ceftriaxone, doxycycline or azithromycin. People who are under the age of 18 and women who are pregnant should not take ciprofloxacin or ofloxacin.

Some strains are becoming resistant to standard antibiotics, unfortunately. These strains first appeared in Southeast Asia and have spread to the West Coast of the U.S. via Hawaii; they may be present in other cities with frequent travel to and from Southeast Asian countries.


References:

  • http://www.health.state.ny.us/nysdoh/consumer/gonor.htm
  • http://www.encyclopedia.com/html/g1/gonorrhe.asp
  • http://www.cdc.gov/ncidod/dastlr/gcdir/gono.html
  • http://www.niaid.nih.gov/factsheets/stdgon.htm

Gon`or*rhe"a, Gon`or*rhe"a (?), n. [L. gonorrhoea, Gr. ; that which begets, semen, the genitals + to flow: cf. F. gonorrh'ee.] Med.

A contagious inflammatory disease of the genitourinary tract, affecting especially the urethra and vagina, and characterized by a mucopurulent discharge, pain in urination, and chordee; clap.

 

© Webster 1913.


Gon`or*rhe"a, Gon`or*rhe"a (?), n. [L. gonorrhoea, Gr. ; that which begets, semen, the genitals + to flow: cf. F. gonorrh'ee.] Med.

A contagious inflammatory disease of the genitourinary tract, affecting especially the urethra and vagina, and characterized by a mucopurulent discharge, pain in urination, and chordee; clap.

 

© Webster 1913.

Gonorrhoea, among the most common and one of the most recognized sexually transmitted diseases (STDs) in the world, is caused by the Gram-negative intracellular diplococcus Neisseria gonorrhoeae, otherwise known as a gonococcus. Humans are the only host for this bacterium and it is spread only via intimate physical contact -- it is intolerant to drying and thus spread via fomites is very rare.

Gonorrhoea is the British spelling for this disease. The American spelling is gonorrhea.

This bug loves infecting the columnar epithelium of the urethra and endocervix. Non-genital sites which it also loves are the rectum, the oropharynx and the conjunctivae (eyes). The vulva and vagina in women are usually spared because they are lined by stratified epitehelial cells.

The incubation period varies from 2 to 14 days with most symptoms occurring between days 2 and 5.

Clinical features

Men
In male patients dysuria accompanied by thick, copious, purulent (condensed milk-like) urethral discharge is the usual presentation. Examination show a reddened external urethral meatus. Without effective treatment, ascending infection could extend to the epididymis, testes or prostate. In homosexual men (rectal gonorrhoea tends to come from anal sex), proctitis may be asymptomatic or present with anal discharge, pruritus, tenesmus and rectal bleeding. Protoscopy shows inflamed mucous membrane with little mucous.

Women
About 50% of women with gonorrhoea are asymptomatic. The patient may complain of a vaginal discharge, dysuria and intermenstrual bleeding. The cervix may appear anywhere from normal to the extreme of marked cervicitis with a mucopurulent exudate. Involvement of the urethra causes little dysuria, purulent secretion and frequency. The combination of urethritis and cervicitis on examination is very suggestive of the diagnosis as both sites are infected in most patients.

Gonococcal Conjunctivitis
This can result from rubbing of the eyes with contaminated fingers in both sexes, and presents with pain and a purulent yellow discharge. Conjunctivae are inflamed with chemosis, keratopathy and corneal ulceration leading to blindness in severe cases.

Gonococcal ophthalmia develop within 7 days of birth of a baby to an affected mother and is usually bilateral with intense conjunctivitis, copious purulent secretion and lid edema. Without proper urgent treatment, ulceration of the cornea leading to scarring will seriously affect vision.

Complications
In men, epididymitis, prostatitis and urethral stricture. In women, Bartholinitis and abscess formation (causing trouble walking), Pelvic Inflammatory Disease, Fitz-Hugh-Curtis Syndrome and disseminated gonococcal infection.

Diagnosis:
the organism is identified via Gram stain and culture from the affected area. Neisseria gonorrhoeae looks like kidney beans under the microscope. screening for other STDs is usually done at the same time.

Treatment
Antibiotics. An increase in antibiotic resistance has led to the decline in use of penicillin for treating gonorrhoea. Nowadays, a third generation cephalosporin such as ceftriaxone is recommended for treating gonorrhoea.

Follow up treatment is needed to ensure the organism has been eradicated. Sexual contacts should also be screened and treated if necessary.

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