Gonorrhea

According to world health organization, 106 million cases with gonorrhea in 2008, which represented a 21 % increase over the estimate for 2005. 

Overview

 

Gonorrhea is a sexually transmitted disease (STD) that can affect the urethra, rectum, cervix, or throat. It is caused by a bacterium called Neisseria gonorrhoeae.

Gonorrhea is more common in younger age, people with a history of drug use, having other sexually transmitted infections, and among other risk factors may increase the risk of developing gonorrhea.

Gonorrhea is caused by a gram-negative diplococcus, also known as Neisseria gonorrhoeae. The pathogenicity of Neisseria gonorrhoeae derives from properties of the surface pili . Pili is prevented phagocytosis by neutrophils, and contain on IgA protease, which digests the IgA on the surface of the urethra, fallopian tubes and endocervix.

Usually, Initial infection is seen in the cervical region, the infection may ascend by the adherence to spermatozoa through the uterus into the fallopian tubes and finally out into the peritoneal cavity.

Several signs and symptoms of gonorrhea that appear on men, women and babies , including painful urination ,pus-like discharge from the tip of the penis , pain or swelling in one testicle,  increased vaginal discharge, vaginal bleeding between periods , thick, pus-like discharge eyes , and among other symptoms .

Laboratory diagnosis of gonorrhea is based on urine test, and swabbing of infected area. It is treated with a short course of antibiotic.

If untreated of gonorrhea, it can cause serious problems, include pelvic inflammatory disease (PID), pregnancy problems, infection in the testicles and prostate gland, septicemia, and increased risk of HIV/AIDS.

There are many ways may prevent of gonorrhea, include practicing safe sex, regular testing for sexually transmitted diseases, and refusing sex from someone who has unusual symptoms.

According to world health organization, 106 million cases with gonorrhea in 2008.

 

 

Definition

Gonorrhea, also known as gonococcal Infection, the clap, the drip, it is a sexually transmitted disease (STD) that can infect both men and women. It can cause infections in the genitals, rectum, throat, and  in rare cases can infect eyes. 

Causes

Gonorrhea is caused by a bacterium called Neisseria gonorrhea. The gonorrhea bacteria are most often passed from one person to another during sexual contact, it may infect many sites of body including oral, anal or vaginal intercourse, in rare cases can infect eyes. 

Risk Factors

Several factors that increase risk of developing of gonorrhea, include:

  • Age

Gonorrhea is more common in younger age. 

  • Sex

A new sex partner, a sex partner who has concurrent partners, multiple sex partners, not practicing safe sex, and previous gonorrhea diagnosis that increase the risk of developing gonorrhea. 

  • Sexual disease

Having other sexually transmitted infections may increase the risk of developing gonorrhea. 

  • Drug use

People with a history of drug use are at an increased risk of developing gonorrhea. 

Pathophysiology

Gonorrhea is caused by a gram-negative diplococcus, also known as Neisseria gonorrhoeae, often referred to as gonococcus. The pathogenicity of Neisseria gonorrhoeae derives from properties of the surface pili; it is a small hairlike extensions of the surface membrane. pili is prevented phagocytosis by neutrophils. In addition, the pili contain on Immunoglobulin A )IgA) protease which digests the IgA on the surface of the urethra, fallopian tubes and endocervix. Adherence to the surface of spermatozoa allows transmission of the organism to the fallopian tube, the presumed mechanism of ascending infection. Initial infection may be asymptomatic, but the organism incites a typical acute inflammatory reaction resulting frequently in a purulent exudate.  

 

The clinical consequences of gonorrhea are due to classic pyogenic infection with resolution by fibrosis. Initial infection is usually seen in the cervical region, but due to the adherence to spermatozoa, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. A purulent vaginal discharge is often seen, but frequently the purulent material exudes from the fimbriated end of the fallopian tubes into the peritoneal cavity. Untreated infections may progress to fibrosis. urethral stricture, fallopian tube stricture, tubo-ovarian abscess, pelvic inflammatory disease (PID) and infertility are the complications of the fibrotic reaction ,and depending on its location . Peritonitis may present in PID and cause life threatening acute bowel obstruction. 

However, it is important to treat the symptoms of gonorrhea as early as possible. Gonorrhea is much more responsive to antibiotic therapy, when the infection is confined to the lower genital tract. Once the infection ascends and becomes well established, it is difficult to deliver the needed concentrations of antibiotics and the infection is much more difficult to cure with drugs alone. This is due to the lack of blood flow in the walled off areas and is the reason that surgery often becomes necessary in this case. 

In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery, and may lead to infection of the conjuctiva of the eye. This appear as severe discharge with marked swelling and redness of the eyelids and conjunctiva from one to four days after birth. This can lead to corneal perforation and blindness. Diagnosis is made by gram stain of the exudate and culture. 

Signs And Symptoms

Symptoms of gonorrhea usually develop within two weeks of infection, but it may take several months. Gonorrhea usually affects the genital tract and causes different symptoms in men and women. The infection may also be transmitted from a mother to her baby during childbirth or affect other sites causing additional symptoms. These symptoms include: 

 

  • Signs and symptoms in men:
  • Painful urination.
  • Pus-like discharge from the tip of the penis, which may be white, yellow or green.
  • Pain or swelling in one testicle. 
  • Inflammation (swelling) of the foreskin. 
  • Need to urinate urgently or more often. 
  • Red or swollen opening of penis (urethra). 
  • Tender or swollen testicles. 
  • Sore throat also known as gonococcal pharyngitis. 

 

  • Signs and symptoms in women:
  • Increased vaginal discharge.
  • Painful urination.
  • Vaginal bleeding between periods, such as after vaginal intercourse.
  • Painful intercourse.
  • Abdominal or pelvic pain.
  • Sore throat.
  • Fever, if the infection spreads to the fallopian tubes and stomach area. 

 

Signs and symptoms in babies:

Gonorrhea can also be passed from a mother to her baby during childbirth. The symptoms of gonorrhea in babies include red and swollen eyes during the first two weeks, and thick, pus-like discharge eyes. 

 

Signs and symptoms in other sites in the body:

  • Rectum.

 

  • Eyes.
  • Eye pain.
  • Sensitivity to light.
  • Pus-like discharge from one or both eyes. 

 

  • Throat.
  • Sore throat.
  • Swollen lymph nodes in the neck. 

 

  • Warm, red, swollen joints and extremely painful. 
Diagnosis

There are ways to diagnostic gonorrhea, include:

  • Urine test: to identify bacteria in urethra.
  • Swabbing of infected area: A swab of throat, urethra, vagina or rectum may collect bacteria and identify the bacteria in the laboratory. 
Treatment

Gonorrhoea is usually treated with a short course of antibiotic ceftriaxone in combination with either azithromycin or doxycycline. Some research indicates that oral Gemifloxacin or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics.

Complications

If untreated, it can spread to other parts of body and cause serious problems. Complications in both men and women may include:

  • Pelvic inflammatory disease (PID).

Gonorrhea in women can spread to the reproductive organs and cause pelvic inflammatory disease.it can lead to long-term pelvic pain, ectopic pregnancy and infertility. 

 

  • Pregnancy problems

Gonorrhea can cause some complications during pregnancy, include:

  • Miscarriage.
  • Premature labor.

 

Gonorrhea in men can cause painful infection in the testicles and prostate gland and lead to reduced fertility in a small number of cases, and it may cause inflammation of a small, coiled tube in the rear portion of the testicles that called as epididymitis. If left untreated of epididymitis, it may lead to infertility. 

 

  • Septicaemia

Gonorrhoea can spread through the bloodstream to cause life-threatening infections in other parts of the body including joints in rare cases. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results. 

  • Increased risk of HIV/AIDS.

Gonorrhea makes more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. 

  • Complications in babies.

Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. The baby being born with conjunctivitis (inflammation of the eye) and Progressive and permanent vision damage. 

  • Abscess

Untreated gonorrhoea in men can cause collection of pus around the urethra that known as Abscess. 

  • Scarring or narrowing of the urethra

Gonorrhea in men can lead to narrowing of the urethra ; tube that carries urine out of the body. 

  • Heart valve infection

Gonorrhea may lead to Heart valve infection. 

  • Meningitis

If untreated gonorrhea may lead to meningitis, it is Infection around the brain. 

Prevention

There are steps may prevent of gonorrhea, include:

  • Practicing safe sex

Use a condom to prevent gonorrhea during any type of sexual contact. 

  • Regular testing for sexually transmitted diseases 

Testing for those sexually active and at risk of acquiring gonorrhoea. 

  • Refusing sex from someone who Has unusual symptoms

Avoiding sex with a partner that displaying signs or symptoms of a sexually transmitted infection, such as burning during urination or a genital rash or sore. 

Prognosis

A gonorrhea infection can be treated with antibiotics. Most of the time, it gets better with treatment. If untreated disease, it is a more serious complications. 

Epidemiology

According to world health organization, 106 million cases with gonorrhea in 2008, which represented a 21 % increase over the estimate for 2005.