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Gonorrhea

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Gonorrhea is an infection of the lower genital tract and if left untreated can spread to the upper genital tract, leading to complications such as prostatitis or epididymitis in men and scarring and pelvic inflammatory disease in women. There is no screening program for gonorrhea in the UK (unlike chlamydia) because it’s not as prevalent. The latest Health Protection Agency (HPA) figures for gonorrhea outbreaks in 2010 show a total of 16,531 for men and women combined compared to 189,612 for chlamydia.

Causes

Gonorrhea is caused by a complex organism: Neisseria gonorrhoeae. It lives in the mucous membranes of the eyes, throat, vagina, rectum and urinary tract, and is spread via vaginal, oral and anal sex with an infected partner (whether the man ejaculates or not). A research paper presented at a British Association For Sexual Health & HIV (BASHH) conference in May 2011 showed high levels of gonorrhea of the throat among British prostitutes because they give oral sex frequently without using protection. It can also be passed from mother to baby via the vaginal canal during delivery, which can cause complications such as blindness, blood or joint infections if left untreated.

Signs and Symptoms

According to PubMed, part of the US National Institute of Health, symptoms typically appear within a week of infection. Men may experience:

  • Painful, increased urination
  • A white/green discharge from the tip of the penis
  • Swollen tip of the penis
  • Swollen and sore testicles
  • Sore throat
  • Itching around the anal area

In women, symptoms can be milder, if they show at all:

  • White/green vaginal discharge
  • Painful, frequent urination
  • Sore throat
  • Painful sex
  • Stomach and pelvic pain (if the infection has travelled to the reproductive area)
  • A fever and/or rash (if the infection has travelled to the bloodstream)

Not everyone will have symptoms. According to the HPA, gonorrhea is symptomatic in 90-95% of men and asymptomatic in approximately 50% of women, which is why it’s important to have regular sexual health screening. Having unprotected sex and multiple sexual partners is a risk factor.

Tests and Diagnosis

Get medical advice if you experience any of the above symptoms or are worried that you have slept with someone who may have an STI. A GP or nurse will check any symptoms, ask you some questions about your sexual history and perform standard tests to diagnose the STI. These include a urine test, a swab sample from the cervix, urethra and/or throat according to your symptoms, and a blood test. You will be tested for the common STIs to rule out any other infections, as it’s possible to have more than one STI. Having a swab taken can be momentarily uncomfortable – a bit like having a smear test.

You can opt to receive your results via text message within a couple of weeks. If you do test positive the clinic will call you in to start antibiotic treatment as soon as possible.

Treatment

Gonorrhea used to be routinely treated with penicillin, which was effective but newer strains of the germ have shown resistance. The Gonococcal Resistance to Antimicrobials Surveillance Programme in England and Wales (GRASP) recently identified high levels of resistance to the routine treatment, with a class of antibiotics called luoroquinolones (ciprofloxacin/ofloxacin/levofloxacin) so in 2011 the guidelines changed and the recommended treatment is now a single class of antibiotics called cephalosporins. This is given as a single dose injection or pill.

Antibiotics should clear up any symptoms within a few days but a repeat test may be required to make sure it has gone. Treatment needs to be prompt to prevent further complications such as scarring of the fallopian tubes or urethra or the development of pelvic inflammatory disease, which can cause infertility in women. The infection can spread via bloodstream and affect mucous membranes in body, manifesting in the form of rashes and joint pain.

The Canadian Medical Association Journal recently reported that gonorrhea has evolved into a ‘multiresistant bacteria because most [antibiotic] treatments are now ineffective’. The authors of the report explain that the organism is complex and so far, attempts to create a vaccine have failed. They suggest switching the focus to safe sex and education for at risk groups.

Prevention

Abstaining from sex is the only way to avoid STIs so for most people it’s a case of practicing safe sex. Get tested regularly and know your partner’s sexual history – have the chat before you sleep together. Always use condoms and dental dams with a new partner. They don’t have to be a passion killer – a friend of mine says it drives men wild when she puts a condom on with her mouth.

  • References
    • 1. Canadian Medical Association Journal. “Antibiotic-Resistant Gonorrhea Increasing – Urgent Action Needed.” Medical News Today. MediLexicon, Intl., 20 Sep. 2011. Web.
      28 Sep. 2011. <http://www.medicalnewstoday.com/releases/234658.php>
    • 2. “Gonorrhea: MedlinePlus Medical Encyclopedia.” National Library of Medicine – National Institutes of Health. Web. 16 Sept. 2011. <http://www.nlm.nih.gov/medlineplus/ency/article/007267.htm>.
    • 3. ”Gonorrhoea: Causes, Symptoms, Treatment – Sexually Transmitted Infections (STIs) – FPA.” FPA – the Sexual Health Charity. Web. 20 Sept. 2011. <http://www.fpa.org.uk/helpandadvice/sexuallytransmittedinfectionsstis/gonorrhoea>.
    • 4. HPA – Health Protection Agency Homepage – Protecting People, Preventing Harm, Preparing for Threats. Web. 20 Sept. 2011. <http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1203348026613>.

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