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.