Gonorrhea

The incubation period of gonorrhea (the time between exposure to the infection and the appearance of symptoms) is 10 days in women and 1-3 days in men. The various symptoms are listed below:

A. Symptoms of uncomplicated gonorrhea in men

• Urethral discharge
• Dysuria (painful urination)
• Urgency
• Frequent urination
• Urinary itch
• Painful erection

B. Symptoms of uncomplicated gonorrhea in women

• Dysuria
• Hematuria (blood in urine)
• Inflammation of the anus
• Increase in vaginal discharge

Here’s more on the common causes & treatment of vaginal discharge.

C. Symptoms of complicated gonorrhea in men

1. Epididymitis: Inflammation of the epididymis (a coiled tube attached to each of the two male reproductive organs, the testes). The typical symptoms include:

   • Swelling of the epididymis
   • Severe pain in the epididymis, groin, and lower abdomen
   • Discharge from the urethra

2. Seminal vesiculitis: Inflammation of the tube that produces fluid for the semen known as the seminal vesicles. The typical symptoms include:

   • Dysuria (painful urination)
   • Frequent urination
   • Hematuria (passage of clear urine with blood)
   • Hemospermia (blood in semen)
   • Lower abdominal pain

3. Prostatitis: Inflammation of the prostate gland. The typical symptoms in gonorrhea include:

   • Chills
   • Fever
   • Frequent urination
   • Pain or discomfort in the pubic region

D. Symptoms of complicated gonorrhea in women

1. Pelvic inflammatory disease: Inflammation of the female genital tract. It is characterized by the following symptoms:

   • Chills
   • Fever
   • Anorexia (loss of appetite)
   • Nausea
   • Vomiting
   • Lower abdominal pain
   • Irregular vaginal bleeding
   • Abnormal vaginal discharge

2. Perihepatitis: Inflammation of the liver capsule. It is characterized by:

   • Sudden pain in the upper abdomen
   • Fever
   • Nausea
   • Vomiting

E. Symptoms of gonorrhea at other sites

1. Oral gonorrhea: Also known as pharyngeal gonorrhea. Oral contact with either penis or vagina can cause oral gonorrhea. Usually, oral gonorrhea remains asymptomatic but can cause the following symptoms:

   • Sore throat
   • Difficulty in swallowing food
   • Redness of the throat
   • White spots on the throat
   • Swollen lymph nodes in the neck
   • Fever

   These symptoms are common for men and women and usually take 7-21 days to appear after oral contact with the infected genitals. Kissing does not spread oral gonorrhea as bacteria do not infect the mouth and tongue.

2. Gonococcal conjunctivitis (GC): GC infects the eyes and spreads through direct contact of the eye with the infected secretions of the genitals. An infected pregnant woman can also transmit the infection to neonates during delivery. It occurs due to exposure of the neonate to vaginal secretions containing bacteria. When it occurs in neonates, GC is known as gonococcal ophthalmia neonatorum. Symptoms take 24 to 28 hours following exposure to the bacteria and include:

   • Red eyes
   • Thick pus in the eyes
   • Swelling of the eyelid and conjunctiva
   • Turbid and foggy cornea

3. Proctitis: Inflammation of the lining of the rectum developed due to anal-genital intercourse. In most cases, it is asymptomatic. Some patients may experience symptoms such as:

   • Itching and burning sensation in the anus
   • Discharge from the anus
   • Rectal bleeding
   • Blood in the stool
   • Rectal pain
   • Tenesmus (frequent and urgent feeling of passing stool)

Gonorrhea is caused by an obligate pathogen, Neisseria gonorrhoeae. Obligate pathogens are bacteria that transmit disease from one host to another and cannot survive outside the host body. The bacteria are mainly present in the discharge of the penis and vagina. The disease can be transmitted through:

• Unprotected vaginal, anal, and oral sex
• Sharing of contaminated vibrators and sex toys
• Infected mother to baby during childbirth

Neisseria gonorrhoeae cannot survive on surfaces outside the body. Therefore, the infection of gonorrhea does not spread through kissing, hugging, or sharing swimming pools, toilet seats, towels, or utensils.

• Have unprotected oral, anal, or vaginal sex with an infected partner
• Have low immunity
• Have been diagnosed with gonorrhea in the past
• Are having multiple sexual partners
• Have a sexual partner who has multiple partners
• Are sexually active
• Are a sex worker
• Have sex with someone from an endemic area, have a history of gonorrhea, have any sexually transmitted infections, or have human immunodeficiency virus (HIV)
• Lack of education and low socioeconomic status also increase the risk of developing gonorrhea
• If the condom breaks during sex with an infected partner, it increases the risk of gonorrhea
• Men who have sex with men (MSM) are at a higher risk for gonorrhea

The laboratory confirmation is done through the detection of bacteria in samples from the urinary tract, rectum, throat, or eyes. In various cases, urine samples are also used. In case of any symptoms of gonorrhea, abstain from any kind of sexual activity until it is confirmed negative by the tests. The following tests help in the diagnosis of gonorrhea:

• Physical examination: This includes looking for any signs of gonorrhea. Manifestations such as discharge from the throat, rash, eye symptoms, and pain in the abdomen are evaluated by the healthcare provider.
• Nucleic acid amplification test (NAAT): This method detects the genetic material of Neisseria gonorrhoeae in either urine or swab samples of the patients. The swab sample is taken from the urethra for males, while in females, the sample is taken from the vagina or cervix. In cases of rectal or pharyngeal infection, samples may be taken from the rectum or throat, respectively.
• Culture: This test is one of the most widely used for gonorrhea as it has a specificity of 100%. The test can be performed using samples collected from the throat, urethra, vagina, or rectum, but not urine in both men and women.
• Smear test: This test is usually used to diagnose uncomplicated gonorrhea in men. It involves the examination of urethral smears under the microscope.

Gonorrhea is a sexually transmitted disease (STD) that spreads by sharing sexual fluids. This can be prevented by following safer sex practices:

• Using condoms, dental dams, or latex/nitrile gloves during oral, anal, or vaginal sex
• Getting tested for STDs regularly if you are sexually active
• Avoiding sex with your partner until he or she has completed treatment for any STD
• Washing hands after touching your partner’s genitals
• Washing sex toys with soap and water regularly
• Using condoms on sex toys
• Avoiding multiple partners

Note: Washing the genitals, urinating, or douching after sex will not prevent gonorrhea.

Are you using condoms correctly? Here are 9 condom mistakes that you should avoid.

Gonorrhea can be treated with antibiotics. The various treatment options for different symptoms or types of gonorrhea are discussed as follows:

Urogenital infections

• Ceftriaxone
• Doxycycline

If a person is allergic to ceftriaxone, other antibiotics can be used such as:

• Azithromycin
• Gemifloxacin
• Gentamicin

Gonococcal conjunctivitis

Newborns who develop gonococcal conjunctivitis are treated with ceftriaxone based on their body weight. The eyes should be washed every hour with normal saline. Mothers of infected newborns should be examined, and those with gonorrhea should be treated.

Gonorrhea during pregnancy

Erythromycin or amoxicillin are the drugs of choice for treating gonorrhea during pregnancy.

Follow-up

• Usually, follow-up testing is not recommended for rectal and genital infections. However, if symptoms persist after a few days of treatment, the patient should consult a doctor.
• Re-evaluation after 7-14 days of treatment is recommended for throat infections.
• Re-testing is advised after 3 months of treatment to check for re-infection.

Sexual partner management

If diagnosed with gonorrhea, it is important to test the sexual partner if sexual activity occurred before the onset of symptoms or within two months of the diagnosis.

Any kind of sexual activity should be avoided until the completion of treatment.

The mother of a neonate diagnosed with gonococcal conjunctivitis should be tested for gonorrhea along with her sexual partner.

Home Remedies

Gonorrhea can be effectively treated with antibiotics. However, the following home remedies can be used as an adjunct to the antibiotics:

• Garlic (lehsun): Possesses antibacterial properties and can help combat bacterial infections like gonorrhea.
• Apple cider vinegar: Known for its antibacterial properties. It is recommended to consume it every morning using a metal straw to prevent abrasion of the teeth.
• Aloe vera gel: Moisturizes the skin and accelerates the healing of wounds due to its antibacterial and anti-inflammatory properties.
• Goldenseal: This plant is recognized for its antimicrobial properties. It is available in capsule and cream form. It is advisable to consult a doctor for the appropriate dosage before taking or applying it.
• Echinacea: Used to reduce inflammation in the genitals due to its anti-inflammatory properties. It is available in the form of creams and gels.

Untreated gonorrhea usually spreads to other parts of the body, leading to several complications:

1. Pelvic inflammatory disease (PID)
   Gonorrhea can spread from the vagina to other reproductive parts of the female, such as the fallopian tubes and uterus. The symptoms of PID include fever and abdominal pain, and it can lead to reproductive complications such as:
   • Long-term pelvic pain
   • Infertility
   • Internal abscesses
   • Endometritis
   • Ectopic pregnancy
2. Pregnancy-related complications
   Gonorrhea in pregnant women increases the chances of miscarriages, premature labor, and first trimester abortion. A pregnant woman can also pass the infection to the fetus, which can develop several abnormalities, such as conjunctivitis, joint pain, blindness, and blood infections. However, early treatment of the pregnant woman can reduce the chances of these complications.
3. Infertility in men
   Gonorrhea can cause a painful infection in the testicles and prostate gland. It can also cause inflammation of the epididymis. All these changes can affect fertility in men.
4. Disseminated gonococcal infection (DGI)
   DGI occurs as a result of untreated gonorrhea over a long period of time. In DGI, the infection spreads through the bloodstream and can cause sepsis. It can also lead to conditions such as:
   • Septic arthritis (inflammation of the joints)
   • Tenosynovitis (inflammation of a tendon and its sheath)
   • Endocarditis (inflammation of the inner lining of the heart's chambers and valves)
   • Dermatitis (inflammation of the skin)
5. Fitz-Hugh-Curtis Syndrome
   Also known as perihepatitis, this condition develops due to PID and is characterized by inflammation of the liver capsule. It causes the formation of adhesions in the liver that results in persistent pain.

Though gonorrhea can be managed with antibiotics, a few important points should be kept in mind:

• Avoid sexual activity: Patients diagnosed with gonorrhea should refrain from any kind of sexual activity for at least one week following antibiotic treatment. It is advised to resume sexual activity only after the symptoms have subsided.
• Retesting for gonorrhea: It is recommended to test for the infection after completing therapy or if symptoms persist for an extended period. Retesting helps identify any antibiotic resistance and avoid further treatment failure.
• Testing for other sexually transmitted infections (STIs): Infected patients with gonorrhea are also at an increased risk of contracting other STIs, including HIV. Therefore, it is necessary for patients to get tested for other STIs, such as HIV infection.