GONORRHEA: Symptoms, Treatment, Prevention and Control

Overview
Gonorrhea is a sexually transmitted disease that affects the reproductive health of sexually active persons. Gonorrhea occurs mostly among male and female; babies are also infected during childbirth if the mother is infected. 

Gonorrhea causes damage to vital organs such as: the throat, the rectum, the urethra and cervix.

Causative Agent:

Gonorrhea is a sexually transmitted infection that is caused by a bacterium called Neisseria gonorrhoeae

Prevalence Statistics:

Gonorrhea is the most commonly known sexually transmitted disease with a high rate of occurrence. According to WHO reports, an estimated value of about 78 million new cases of gonorrhea is recorded yearly.

In Nigeria, there are about 28.1 percent (approx. 1.5 million) new cases recorded yearly, with its greatest occurrence in Lagos and Ibadan.



Modes of Transmission
Gonorrhea can be transmitted from person to person through any of the following means:

• Sexual Transmission: this occurs when there's unprotected sexual contact (vaginal or anal sex) with an infected person. It is important to note that infection can still take place even when there is no ejaculation. 

• Oral Transmission: this occurs when there is contact with infected saliva or blood (in cases of gum disease) during kissing. 

• Vertical Transmission: this can also be referred to as Peri-natal Transmission. It occurs during childbirth from an infected mother to her baby.

Symptoms
In most cases, gonorrhea does not show any obvious symptoms in the body, this is termed Asymptomatic Gonorrhea. This condition occurs mostly when the infected person is a male.

Symptoms of gonorrhea can appear within 14 days of first contact with the infected agent, it presents different symptoms in both men and women and can affect both the genitals and other organs. 

Modes of transmission, symptoms, diagnosis and prevention of gonorrhea. Photo credit: std-gov.org

Symptoms in Men:

• Plus-like discharge from the tip of the penis, usually white, or yellow, or greenish in color.

• Painful urination

• Pains or swelling around in the testicle or scrotum

• Anal discharge. Pain, itch, or bleeding while passing stool

• Inflamed, swollen and painful joints

• Swollen neck lymph node which causes difficulty in swallowing

Symptoms in Women:

• Yellow or Green vaginal discharge

• Painful Intercourse and Bleeding after sexual intercourse

• Painful urination

• Swollen vulva

• Increased bleeding during menstrual periods

• Anal discharge. Pain, itch or bleeding while pass stool 

• Abdominal pains

• Inflamed, swollen and painful joints 

• Swollen neck lymph node which causes difficulty in swallowing

Ultrastructure of Neisseria gonorrhoeae as seen under a high power electron microscope

Diagnosis 
If symptoms appear, there are various laboratory methods that can be used in diagnosing gonorrhea infections; they include:

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• Gonorrhea of the urogenitals can be diagnosed using a molecular method by testing urine (for male) or endocervical (for female) specimen using Nucleic acid amplification testing (NAAT).

• Endocervical or urogenital tract specimens can be tested through microbiology culture methods.

• Extra-genital specimens such as pharyngeal and/or rectal specimens can be tested either with the culture or molecular methods.

• Do It Yourself (DIY) home kits for women are also available that include vaginal swabs. These kits are sent to the results are recorded. 

Treatment 
If an individual tests positive for gonorrhea, it is advised that he/she enrolls in a right treatment option recommended by the clinician. The following are some ways to treat gonorrhea: 

Photo credit: health.cleaveland.com

1. Antibiotics Treatment:

This treatment involves the use antibiotics to treat gonorrhea. These antibiotics are normally prescribed in dual forms: 

a. a shot of Ceftriaxone and 

b. an oral medication of Azithromycin. 

Patients on antibiotics treatment are advised to take their medication religiously for complete potency and recovery, and also to prevent the chances of developing antimicrobial resistance. If symptoms persists after a few days of taking medications, patients are to report back to the clinic for reevaluation.

2. Abstinence:

If a person tests positive for gonorrhea, it is necessary to avoid sex during this period until you must have been treated. The person should tell all his/her sexual partners in the past 60 days before his diagnosis, to as well test for gonorrhea because they may be at risk too.

For pregnant women who are gonorrhea positive, the infant should be given a drop of eye ointment. However, if eye infection develops antibiotics should be given.

Complications 
Gonorrhea when left untreated can lead to significant complications, such as:

• Increased risk of HIV/AIDS: having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners.

• Infertility: Untreated gonorrhea can spread into the internal genital organs. In Women, it can affect the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), which may result in scarring of the tubes, and may lead to complications in pregnancy and infertility. On the other hand, men who have untreated gonorrhea can experience epididymitis — inflammation of a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis). Epididymitis is treatable, but if left untreated, it may lead to infertility.

• Infection that spreads to the joints and other areas of your body. The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body, including your joints. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results.

• Complications in babies. Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections.

Prevention and Control

Gonorrhea can be prevented in many ways; they include:

• Abstinence from sex: the surest way of avoiding gonorrhea or STI transmission is to abstain from oral, vaginal, or anal sex. 
• Using condoms for vaginal or anal intercourse
• Using condoms or dental dams for oral intercourse
• Having sexual activity with a mutually monogamous, unaffected partner
• Consider regular gonorrhea screening

Individuals should speak with their doctor if they or their sexual partner have been exposed to gonorrhea or if they are experiencing any symptoms of infection.