Gonorrhea: A Detailed Study – Causes, Treatment, Prevention & More

by Nick Swanson

Gonorrhea
Gonorrhea is a sexually transmitted infection (STI). Although it is treatable and can be resolved within days, if left untreated it can result in fertility and other health complications. It can affect both men and women. Gonorrhea is a common disease amongst young people of age 15-24 years. It is also popularly known as “the clap”.

Gonorrhea is caused by a bacterium called Neisseria gonorrhea. They can live in the cervix (entrance to uterus), uterus (womb), the urethra (tube through which urine comes out), the rectum (back passage), the throat and rarely the eyes. It is a rather weak bacteria and takes longer period of time to incubate. Also it needs certain specific condition to grow and reproduce.

It is one of the reasons why people affected with gonorrhea shows no immediate or significant symptoms. Although the bacteria is weak, keeping the infection undiagnosed or untreated can cause serious health repercussions and can be proven to be life-threatening.

Globally, on a year, around 78 million cases of gonorrhea has been diagnosed. The number kept increasing each year due to lack of awareness among teenagers and increasing number of polyamorous relationships.

Gonorrhea doesn’t affect according to age or gender. Anyone who is sexually active is at the risk of having gonorrhea. Not having multiple partners also will not guarantee protection from the infection.

In 2016 only, more than 468,514 cases of gonorrhea[1] were reported in the United States alone. It is one of the major reasons of pelvic inflammatory disease (PID) in the United States.

This can lead into serious other health complication in women such as infertility, ectopic pregnancy, stillbirth in infants, increased risk of HIV and chronic pain in pelvic.

It is also found out[2] that gonococcal infections facilitate transmission of HIV infection. Sexual behavior and community prevalence contribute to more STI and STDs, especially in youngsters who are less aware and bothered about having protected sex.

Anyone who is sexually active can contract gonorrhea. But studies say[3] that teenagers, young adults and African – Americans happen to be the people who are affected most by the infection.

Among people who are infected by gonorrhea, a majority would also be infected with chlamydia, another sexually transmitted infection caused by another bacteria. It is because these two bacteria complement each other and co-exist without really causing any symptoms.

Gonorrhea Infos


What are the Causes of Gonorrhea?

Gonorrhea, like any other STI, is transmitted through sexual contact with an infected person. It could be anything from anal sex, oral sex or vaginal intercourse.

It can potentially affect not only the reproductive tract, but also the mucous membranes of mouth, throat, rectum and eyes. It can also be transmitted from a mother to baby during pregnancy. Men are at the risk of contracting or transmitting gonorrhea even without ejaculation.

Similar to other STIs and STDs, gonorrhea can be infected in the following ways.

  • Unprotected and unsafe sex; either vaginal, oral or anal with one or more partners
  • From an infected mother to infant during pregnancy
  • Using sex toys of another person, without cleaning it properly
  • Male to male sex (MSM), without protection

The general belief is that gonorrhea can be infected through toilet seats, sharing bath products, using the same towel or door handles. But the chances, according to experts is zero! This is due to the fact that the bacteria that causes the infection will only survival, grow and reproduce under strict conditions. It can only survive in a living body. Once it is out of the body, it dies within few minutes.

It can’t survive on the skin as well such as knees, hands or legs. The bacteria needs moist surfaces to thrive and hence is mostly found in vagina or cervix. Kissing, hugging, deep-kissing, touching another person etc. will also not transfer the bacteria from one person to another.


What are the Symptoms of Gonorrhea?

Gonorrhea generally comes with no symptoms. Most people may not even get diagnosed or have it delayed due to lack of significant symptoms. However, for men, mild symptoms appear within 2 -10 days after exposure to the virus and for women it might even take up to 3 weeks.

According to various studies, 20 -30 % of the infected women and 50% of the infected men doesn’t show any symptoms.
This makes diagnosis even more difficult. So it is possible to contract gonorrhea and actually be unaware of it. Sexually active people can take frequent tests and monitor to diagnose in case of infection to avoid such situations.

The symptoms may vary for women and men. Some of them are discussed below. These symptoms may vary from person to person and gender to gender. In most cases, symptoms would be mild or even unrecognizable that that infected person would totally be unaware of it or misjudge the symptoms for a less-dangerous condition.

Being mindful about the changes happening in your body will help you to understand and observe the symptoms better to get an early diagnosis and treatment.


Symptoms for Women

Unusual vaginal discharge

  • Unusual vaginal discharge, usually green or yellow in color, either thin or watery
  • Urination accompanied by burning sensation or pain
  • Pain or an uneasy tingling sensation around the lower abdominal area
  • Bleeding between periods, although this is less common
  • Heavy periods and bleeding
  • Unusual bleeding after sex
  • Itching or irritation in the vagina
  • Frequent urge to urinate
  • Uncomfortable sexual intercourse, often painful
  • Intense vulvar swelling
  • Unusual vomiting accompanied by abdominal pain
  • Eye pain, light sensitivity, and abnormal pus discharge

Symptoms for Men

  • Urination accompanied by burning sensation or pain
  • Thick and yellowish penile discharge most of the times
  • Inflammation of the foreskin
  • Pain in the testicles, although this is uncommon
  • Inflammation in the prostate gland
  • Eye pain, light sensitivity, and abnormal pus discharge
  • anal discharge, itching, pain, bleeding, or pain when passing stools
  • itching, difficulty swallowing, or swollen neck lymph nodes

Oral or Rectal Gonorrhea Symptoms

Oral or rectal gonorrhea comes with a completely different set of symptoms than normal gonorrhea. Some of them are discussed below

  • Unusual sore throat without any symptoms of flu or clod. People who complain of sore throat without any symptoms of flu or cold should get tested for rectal gonorrhea
  • Throat infections are transmitted through oral sex
  • Kissing or deep-kissing will not cause oral gonorrhea

How to Diagnose Gonorrhea?

Diagnose Gonorrhea
Gonorrhea symptoms are often confusing and less visible. Medical test is the most reliable way to diagnose the infection. If someone experiences the mentioned symptoms for a considerably longer time, a test is always recommended as is the wise option.

The infection is easier to treat and cure if it is diagnosed in the initial stages itself. Individuals who fall under the below classifications can take a test even if no symptoms show up.

  • People having more than one sexual partner
  • People who are actively involved in unprotected sex with one or more partners
  • Unprotected sex with gay/bisexual men
  • Someone with a partner who is not monogamous
  • Someone with a partner with any sexually transmitted infections
  • Someone with any other sexually transmitted infections other than gonorrhea
  • If a person has a new sex partner
  • In case of potential pregnancy plans

Women and men are diagnosed differently, obviously due to genetic and biological differences. The mode of testing and diagnosing for both genders are given below. Although the method of diagnosing in the lab is pretty much the same, the method of collecting sample for testing significantly varies among men and women.

For Women

Gonorrhea is tested by swabbing the affected area (vagina, rectum, pelvis etc.) and taking a sample to the laboratory to perform diagnosis. The sample is usually collected from the vagina or cervix. In some cases, the sample may be collected from the urethra as well.

In some cases, a nurse will do the swabbing while in few cases, you will be provided with a swab or tampon to collect a sample yourself. The sample is then taken to the lab to identify bacteria. It is done either by growing the bacteria in the lab or identifying the material of the bacteria.

Women are generally not tested using their urine because it has proven to be ineffective and less-accurate.

For Men

For men, it is usually done by taking urine samples. Sometimes, a swab may be provided to take a sample from the end of the penis. If you have had oral sex or anal sex, you might want to take a swab test from the throat or rectum.

If you have conjunctivitis[4] with red, puffy eyes with abnormal puss discharge, a sample may be collected from your eyes too. Same would applicable for women as well.

Some of the challenges faced during diagnosis is inability to find bacteria in the sample or technical difficulties. In the latest arena, tests using DNA probing is done to diagnose gonorrhea.

This will help to identify the root cause of this bacteria which further help in the research and development of effective medicines and cure. Because of high-complex activities with DNA samples, these kind of tests are costlier than others but fetch immediate and accurate results in no time.

Some clinics take the test rapidly giving you results right away. While some other tests require at least 2 -4 weeks of time to diagnose the infection.

In this case, the patients are given treatment well in advance, before the results arrive if there are sufficient evidence of infection. This will fast-track treatment and recovery.


What could be the Treatment for Gonorrhea?

Treatment for Gonorrhea
In the past, treatment of gonorrhea or any sexually transmitted infection for that matter were pretty simple. During the earlier period, one shot of penicillin was the cure to any and all of the STIs or any bacterial infections for that matter.

But as time progressed, the new genetically modified bacteria structure became resistant to penicillin and various other antibiotics. Hence, the treatment became complicated and new methods had to be found.

Fortunately, gonorrhea is still a treatable and fully curable infection by using oral medications or IM injections. The treatment is 95% effective if taken it the right way.

Gonncoccal infections of the cervix, urethra, and rectum that are uncomplicated are usually treated with one shot of ceftriaxone intramuscularly or a single oral dose of cefixime[5]. For gonococcal infections of pharynx, it is recommended to take a single intramuscular shot of ceftriaxone.

Some other treatments are as follows:

  • Spectinomycin: For cervix, urethra, and rectum gonococcal infections that are considered harmless.
  • Cephalosporins with Probenecid (Benemid): Single IM dose for non-pregnant women.

One of things that should always be taken into consideration while treatment is another STI called chlamydia. Any treatment should include treatment and medications for chlamydia as well because both these infections usually co-exist in someone who is diagnosed with either of the infections.

The sexual partners of the diagnosed person should also receive treatment since the chances of them being infected as well are pretty high. Partners undergoing treatment will prevent relapse of infection once the person is treated.

If a woman is suffering from pelvic inflammatory disease as well, she needs a much more elaborated and inclusive treatment regimen against the gonococcal bacteria and bacteria affecting any other organs. One-time shot or oral medication would not work on those people and should be hospitalized for intravenous antibiotic treatment.

For pregnant women, however it should be taken into consideration that all the medications are not suitable. For example, a drug called doxycycline, which is otherwise recommended, is not suitable for pregnant women.

So self-diagnosing the infections using home-delivered kits and consuming generic tablets is not the ideal option for pregnant women. It is always advisable to seek professional medical help for diagnosis and treatment.

One of the primary measures is to avoid all sexual activities while undergoing treatment. This is applicable not just for the infected person but also their partner/partners. It should be ensured that the bacteria is completely eradicated from the host’s body. The risk of infection is same even if someone is under treatment.

Only after getting a clean chit from the medical practitioner that a person and the partner/partners should commence their sexual life again.

If a woman is pregnant, the child might be born with conjunctivitis. In this case, the child is also been affected by gonorrhea and is at risk. So an eye ointment is given to the infant to prevent gonorrhea transmission. In some cases, antibiotics is administered to the infant if the infection has progressed.

A retest for infection is not mandatory once treatment is over. Still, doctors will suggest to take up a retest after 7 days of treatment on special cases.

This will be given only after considering aspects such as the medical history of the patient, any other illness or infections, the severity of the infection etc. Irrespective of the doctor’s suggestion, it is always wise to have a retest to ensure complete recovery and cure.


Complications

Although, gonorrhea is a pretty common and treatable infection, the health complications related to it are pretty severe. Some of it can be chronic and even life threatening. This makes it extremely important to diagnose it quickly and seek medical attention as soon as possible.

Complication

In women, gonorrhea can lead to,

  • Infertility, one of the most common and dangerous effects of gonorrhea
  • Chronic pelvic pain that can last for a very long time and cause serious trouble
  • Ectopic Pregnancies – It is a type of pregnancy where the embryos are attached outside of the uterus, increasing complications, it can be treated effectively but can also result in miscarriage if left untreated
  • Pelvic inflammatory disease that can cause abscesses
  • Miscarriage in the early stages of pregnancy or premature labor of infant
  • The baby might be born with conjunctivitis (Inflammation of the eye) and might need serious antibiotic treatment as soon as it is born

In men, however, the complications are:

  • Infertility, one of the most common and dangerous effects of gonorrhea
  • Inflammation of the epididymis, which controls the production of sperm, resulting in less or no sperm production
  • Lack of sexual arousal, although not very common

Both men and women are at a high risk of developing life-threatening gonococcal infection when it is left untreated. Some of it is accompanied by

  • Fever and flu-like symptoms
  • Arthritis or chronic inflammation
  • Tenosynovitis[6] – Inflammation and swelling around tendons
  • Dermatitis[7] – A type of skin inflammation and can be chronic sometimes.

Those infected with gonorrhea are also at a high risk to be contracted with HIV. It is therefore important to get this treated at the earliest.

After the treatment, within couple of days, you will notice that the symptoms are fading away. You can observe the following changes from couple of days after starting the treatment

  • Discharge or pain while urinating will reduce within the first couple of days of treatment
  • Discharge or pain in the rectum should reduce within the first couple of days
  • Bleeding between periods or heavy bleeding during periods should stop by the next period
  • Pelvic pain and testicle pain should improve by 2 days but it will take up 2 weeks for them to go away completely
  • It may take up to 4 -5 weeks to get the bacteria completely out of the system. Until then, the patient and his/her partners are recommended to refrain from any sexual activities

How to Prevent Gonorrhea?

Prevent Gonorrhea
Gonorrhea can be avoided by taking the necessary preventions. By following the below safety measures, one can easily prevent any sexually transmitted infections.

Safe sex is the best option as STDs and STIs usually infect a person through unprotected sex. Some of the preventions that should be considered to eliminate the risk of gonorrhea are given below

  • Irrespective of vaginal, oral, or anal sex, always use a condom during sexual intercourse
  • Sharing sex toys with your partner, under any circumstances is not advisable. However, if you choose to do so, ensure that it is thoroughly cleaned and sterilized before being used again
  • In case of polygamy, ensure to communicate to all the partners and get them tested for infections
  • Try to be in a monogamous relationship with another monogamous person
  • Both you and your partner/partners should have a thorough sexual wellness check-up once a year
  • Get tested for sexually transmitted diseases like gonorrhea and chlamydia if you are pregnant or planning to get pregnant

Read Next: What Is Syphilis & What Can You Do About It?


Outlook

There are certain misconceptions associated with gonorrhea. One of them is that it causes cervical cancer. Cervical cancer[8] is a tumor in the lowest part of the uterus on the other hand STIs are bacteria-inflicted infections that can survive and grow only under strict conditions. Therefore having gonorrhea or any other sexually transmitted diseases cannot cause cervical cancer.

Also, contrary to popular belief, gonorrhea can be cured without treatment but it might take a long time. If you did not opt for treatment or delay treatment you might be putting yourself at risk of causing long-term damages and other serious sexually transmitted diseases such as HIV.

Also, you might pass on the infection to someone else. Having it untreated can adversely affect your sexual life and general wellness.

Another important aspect to keep in mind is that a one-time treatment and cure of gonorrhea doesn’t guarantee protection for lifetime. Each time, you get sexually involved with a new person, whose medical history is unknown, you are getting into the risk of being infected.

If that person is affected, you will get infected again, in case of unprotected sex. So the ultimate solution to prevent the infection is to always engage in protected sex.

Infections like gonorrhea will cause major issues in an individual’s life. Not only will it affect one’s health but also the confidence and mental sanity.

Many people keep these kind of issues under the rug due to shame, fear of being judged and losing their lover. But that will, in no way solve the problem or give any solution.

It is crucial that you and your partner should have an open mind and discuss on sexual wellness openly to avoid sexual complications. Before involving with someone new, be sure to have a checkup; both for you and your partner.

This will help you to prevent gonorrhea or any other sexual infections. Prevention efforts are much easier than any treatment when it comes to STDs as it keeps you on the safer side in terms of health and confidence.

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