Gonorrhea is one of the most common sexually transmitted infections in North America. Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The infection can affect mucous linings in the vagina, cervix, penis, rectum, throat, and eyes. In rare cases, it can affect other parts of the body.
Over the past decade, the rate of gonorrhea cases in Canada has nearly tripled, with approximately 36,000 cases reported in 2019 alone. These rates are continuing to escalate, especially for men, and well over half of all cases reported were from people under the age of 30.
People having sex without the use of condoms are more likely to acquire this infection, as are people who have multiple sexual partners. Many people with gonorrhea have other sexually transmitted diseases, such as chlamydia, HIV, or syphilis.
Gonorrhea is almost always sexually transmitted and is most easily passed on during unprotected sex. Genital sex with an infected person will cause gonorrhea of the genitals. Likewise, anal sex with an infected person can transmit gonorrhea to the rectum and oral sex can cause gonorrhea of the throat. Gonorrheal eye infections are usually found in infants who have picked it up in the birth canal, but adults may get eye infections if they touch the infected area and then rub their eyes.
Symptoms and Complications
Gonorrhea is far more likely to cause symptoms in men than in women. The first symptoms typically appear after 2 to 14 days, but occasionally appear months after infection. In men, there is a discharge of yellow or greenish pus from the penis and a frequent need to urinate. Urinating often causes burning pain that can be severe. The opening of the penis may be red and swollen.
Most women don't have symptoms unless there are complications. A few may experience pain on urination. A few have a noticeable vaginal discharge, which may actually be coming from the cervix. The discharge is usually yellow or green, but it may also contain blood. It often has an unpleasant odour. Symptoms often don't appear in women. Most women are diagnosed only when their partner seeks treatment.
While women feel fewer symptoms, they are far more vulnerable to serious complications of gonorrhea. Left untreated, gonorrhea can work its way up the urethra and cervix to other pelvic organs. The result is pelvic inflammatory disease (PID), which occurs in up to 20% of women with gonorrhea and can cause infertility. Symptoms of PID include pelvic pain, fever, abdominal tenderness, and vaginal discharge. The main complication in men is epididymitis (inflammation of the part of the testicles where sperm is stored), which can cause infertility if not treated.
Other complications of gonorrhea occur when the bacteria get into the bloodstream. They can cause inflammation and pain in the joints (arthritis) and liver (perihepatitis) and a potentially serious infection of the heart valves (endocarditis).
Gonorrhea of the throat usually has no symptoms but sometimes causes a sore throat and difficulty swallowing. Gonorrhea in the eyes is serious – it can cause blindness if left untreated.
Some people with gonorrhea have symptoms involving the rectum such as itching and discharge or possibly painful bowel movements.
Making the Diagnosis
Your doctor will ask you questions about your symptoms and may perform a physical exam. Your doctor will send either a urine sample, or a sample of the discharge from the infected site to a laboratory that will check it for gonorrhea. Your doctor may also perform a blood test to identify other diseases, since people who have a sexually transmitted infection often have more than one.
Highly sensitive tests, such as nucleic acid amplification tests (also known as NAATs) can be used to detect the bacteria's genetic material. These tests are convenient for people who are possibly infected with gonorrhea, but have no symptoms.
Treatment and Prevention
Gonorrhea is treated with antibiotics. A variety of treatments are available for gonorrhea. In uncomplicated cases, the usual treatment is a single dose of a medication such as ceftriaxone* injected into the muscle, or cefixime, a pill, plus a dose of oral azithromycin. People with gonorrhea often have chlamydia, and this treatment treats chlamydia as well. Ask your doctor how long you should wait before beginning sexual contact again after the treatment.
Any sexual partners who have had contact with an infected individual in the past 60 days should be referred to a doctor for evaluation. Regardless of whether or not the partners also test positive, or whether they are still waiting for results, they should receive antibiotic treatment. For any individuals that test positive, follow-up testing within either 3 to 7 days or 2 to 3 weeks (depending on the testing method used) should be performed to ensure the bacteria has been fully eliminated.
Fluoroquinolones, penicillins, or tetracyclines used to be effective therapies, but many of the strains today have developed resistance to these antibiotics. It is very important to take medications exactly as prescribed. It is strongly recommended that people follow-up with their doctor 6 months after completing treatment for gonorrhea, to screen for any recurrent infections.
Symptoms sometimes remain for a while after treatment. Men can suffer from post-gonococcal urethritis (inflammation of the urethra, the tube running down the centre of the penis). This condition is usually caused by chlamydia that didn't respond to an earlier treatment. Treatment with different antibiotics will usually solve this problem.
You can prevent gonorrhea in the same way you prevent any sexually transmitted infection. Use protection and choose your partners carefully. If you think you might already have a sexually transmitted infection, you should avoid sex until you've talked to your doctor.
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