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Gonorrhea: Definition, Symptoms, Cause

by Josephine Andrews
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Gonorrhea  is a sexually transmitted disease caused by an infection with bacteria (gonococci). Typical for gonorrhea is an inflammation of the genital and urinary organs with purulent discharge from the urethra. But gonorrhea sometimes affects other parts of the body. Using condoms drastically reduces the risk of contracting gonorrhea. Read everything you need to know about gonorrhea here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

A54

quick overview

  • Symptoms: Burning pain when urinating, discharge from the urethra (in men), purulent or bloody discharge from the vagina, conjunctivitis if the eyes are infected, more rarely general symptoms such as fever, joint pain, skin rash. Symptoms do not always appear.
  • Causes and risk factors: Neisseria gonorrhoeae bacterium, direct contact of the mucous membrane (e.g. of the penis , vagina, rectum, mouth and throat, eyes) with an infected person, for example through unprotected sexual intercourse, rare infection of newborns during birth by an infected mother
  • Diagnosis: Detection of the gonorrhea pathogen through a swab, creation of a bacterial culture, test for antibiotic resistance
  • Treatment: Administration of two different antibiotics at the same time (so-called dual therapy), therapy of the infected person and their sexual partners
  • Prognosis: Prognosis good if treated early; If left untreated, there is a risk of long-term effects such as adhesions and adhesions of the internal genital organs, infertility , abdominal pain, narrowing of the urethra, blindness (very rare today)
  • Prevention: Consistent use of condoms reduces risk

What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is therefore one of the sexually transmitted diseases. Gonorrhea is caused by bacteria called gonococci (Neisseria gonorrhoeae). The dermatologist Albert Neisser discovered the pathogens in 1879.

Gonorrhea causes inflammation of the genitals and urinary tract. Typical for gonorrhea in men is a purulent discharge from the urethra. In women, the symptoms are usually much weaker, which is why gonorrhea often goes undetected in women. If left untreated, there is a risk that gonococci will spread throughout the body. Gonococcal infection occurs through unprotected sexual intercourse (genital, oral, anal) with an infected person.

It is also possible for the child to be infected by the mother at birth. The pathogens then cause purulent conjunctivitis (gonococcal conjunctivitis) in newborns, which usually spreads to the cornea of ​​the eye if left untreated. In the past, this form of gonorrhea was probably the most common cause of blindness in children in the western world (“newborn blennorrhea”). To prevent this, a one percent silver nitrate solution was dropped into the eyes of the newborns (Credé prophylaxis).

Today, doctors treat newborns with gonococcal infection with antibiotics, which the children are given as an injection. Such treatment of infants is only rarely necessary, since pregnant women are also examined for gonorrhea as part of the check-ups.

Occurrence and frequency of gonorrhea

Gonorrhea is common all over the world. Only humans contract this sexually transmitted disease (STD). According to estimates by the World Health Organization (WHO), gonorrhea is the third most common sexually transmitted disease, with around 87 million new cases per year.

The number of gonorrhea cases has been declining for several years. Since the mid-1990s, however, an increase in cases of gonorrhea has been observed. Gonorrhea particularly affects young adults between the ages of 15 and 25, affecting both women and men.

In Germany there is no general obligation to report gonorrhea. For this reason, there is hardly any up-to-date, reliable data on the frequency of gonorrhea in Germany. However, if the doctor detects pathogen strains that are resistant to certain antibiotics, he is obliged to report the infection to the health department.

What are the symptoms?

Typical gonorrhea symptoms in the early stages are inflammation of the urinary and genital organs and a purulent discharge from the urethra. In many cases, however, there are no symptoms with a gonorrhea infection (silent infection).

About every third infected man does not feel any symptoms from the disease. In women, gonorrhea is even more common with no or only minor symptoms: About half of the infected women do not notice any typical symptoms.

The problem: Those who do not feel any gonorrhea symptoms usually do not know that they have an infectious disease. Thus, gonorrhea is often passed on unknowingly. This means a high risk for the undetected spread of gonorrhea.

The time from infection to the appearance of the first symptoms (incubation period) is between one and a maximum of 14 days for gonorrhea, but the symptoms usually appear after two to seven days. A distinction is made between acute gonorrhea symptoms and chronic symptoms.

Acute gonorrhea symptoms in men:

  • Burning pain when urinating (dysuria). In extreme cases, there is a feeling of “shards of glass in the urethra”. The cause of the symptoms is inflammation of the urethra (urethritis).
  • Redness and painful swelling of the penis and foreskin
  • Purulent discharge from the urethra. Initially, only small amounts that are slimy are formed. But the amount increases very quickly, the discharge looks yellowish-creamy.
  • If treatment is not given, the bacteria rise into the male sex organs and cause, for example, an inflammation of the prostate or an inflammation of the epididymis.
  • During anal intercourse, there is a possibility that gonorrhea may develop in the rectum (rectal gonorrhea). It becomes noticeable, for example, through mucopurulent admixtures in the stool and pain during bowel movements.
  • In the case of an infection through oral sex, there are sometimes gonorrhea symptoms in the mouth. To be more precise, a sore throat develops with a sore throat (pharyngeal gonorrhea). However, an infection of the throat with gonorrhea causes no symptoms in 90 percent of cases.

Acute gonorrhea symptoms in women:

  • In the early stages, gonorrhea symptoms are usually very mild. Vaginal discharge and a slight burning sensation when urinating are possible. The discharge from the vagina sometimes smells bad.
  • Inflammation of the cervix (cervicitis) is evident, for example, from a purulent or bloody discharge.
  • Sometimes gonorrhea spreads further to the internal genital organs, causing inflammation of the uterus , fallopian tubes, and ovaries in some cases. Fever, abdominal pain, discharge and spotting occur.
  • Rectal gonorrhea often occurs in women when the pathogen spreads from the genital tract to the rectum (secondary infection).

Without treatment, there is a risk of chronic gonorrhea symptoms. The local symptoms on the mucous membranes mostly disappear, but the pathogens penetrate into deeper tissue layers, where they usually cause chronic inflammation.

Men are more likely to develop chronic prostate inflammation (prostatitis) and/or epididymitis (epididymitis). The production of pus is low. A drop of pus forms only overnight, which typically flows out of the urethra before the first urination in the morning (“Bonjour droplet”). The chronic inflammation is difficult to access with antibiotics and may lead to narrowing of the urethra (urethral stricture).

In women, chronic gonorrhea often leads to far-reaching complications: If the bacteria rise in the female genital organs, there is a risk of inflammation of the fallopian tubes and ovaries (adnexitis). As a result, in some cases the fallopian tubes become blocked and lead to infertility. Also, blocked fallopian tubes increase the risk of an ectopic pregnancy . In some women, the symptoms worsen during menstrual bleeding.

In both sexes, in rare cases, the pathogens can spread throughout the body and also cause gonorrhea symptoms in other parts of the body. About two to three weeks after infection, gonorrhea symptoms appear, including fever, skin changes (such as a rash or punctate bleeding), painful joint inflammation and tendonitis. Doctors also speak of a disseminated gonococcal infection (DGI).

Only in rare cases are the meninges (meningitis) and the heart ( endocarditis ) involved. If gonorrhea is present during birth, the newborn may develop an infection of the conjunctivae in the eyes (“neonatal blenorrhea”).

Eye infections with gonococci occasionally also occur in adults. Most of the time it is a question of “carried over” bacteria in people with an existing genital gonorrhea infection. Eye inflammation (gonococcal ophthalmia) in adults is highly acute and usually has a worse course than in newborns.

If you suspect gonorrhea symptoms in you or your partner, don’t be afraid to see a doctor!

How do you get infected?

Gonorrhea is caused by infection with the bacterium Neisseria gonorrhoeae (gonococci). Gonorrhea is primarily transmitted through unprotected sex (vaginal, oral, anal) with an infected person, less commonly during childbirth. This means that gonorrhea is one of the sexually transmitted diseases (STDs).

Transmission occurs when body fluids containing bacteria come into direct contact with the mucous membrane (such as the urethra, vagina, cervix , rectum, pharynx, conjunctiva). The bacteria then multiply at the site of infection and trigger inflammation there. Without treatment, the pathogens spread further in the body. Outside the human body, gonococci die very quickly.

If a pregnant woman has gonorrhea, there is a high risk that the baby will become infected during the birth process. Typically, the child then develops conjunctivitis (gonococcal conjunctivitis). If left untreated, the infection spreads to other areas of the eye, such as the cornea, and in some cases leads to blindness (“neonatal blenorrhea”).

In pregnant women with a known gonococcal infection, the newborn is given antibiotics. General treatment of newborns is not required. Usually, check-ups during pregnancy rule out infections such as gonorrhea (and other sexually transmitted diseases).

Especially in women, the symptoms of clap (gonorrhea) are often very mild and difficult to recognize. This poses a risk of spreading the infection unnoticed. People who offer or use sexual services and people who frequently change sex partners are at higher risk of contracting gonorrhea.

More frequent infections are also assumed for men who have sex with men. However, the risk of contracting gonorrhea is high, especially with unprotected sex of any kind.

investigations and diagnosis

A specialist in skin and venereal diseases is the right person to contact if you suspect gonorrhea. These doctors are called “venereologists”. Venereology is the study of sexually transmitted diseases. The family doctor or the gynecologist are also a possible first point of contact if gonorrhea is suspected.

In the case of purulent discharge from the urethra or vagina, an examination is always advisable. It is important that all partners of infected people or people with unclear inflammatory abdominal symptoms are examined for gonorrhea or other sexually transmitted diseases. It is also recommended for sexually active men with testicular or epididymitis to be screened for gonococcal infection.

The diagnosis of gonorrhea is made by detecting the pathogen (gonococci). To do this, the doctor takes a swab from the appropriate area, such as the urethra, the cervix, the throat, the anus or the conjunctiva. He then examines the sample under the microscope.

In order to make a reliable diagnosis, the laboratory also prepares a pathogen culture: To do this, the gonococci are transferred from the swab to a suitable culture medium. The pathogens multiply there and can then be reliably detected.

For effective gonorrhea therapy, the effectiveness of various antibiotics is also tested in the bacterial culture (antibiogram). In this way you can see which antibiotics the gonococci are sensitive to and which active ingredients are ineffective. In recent years, bacteria that are resistant to the usual antibiotics (antibiotic resistance) have repeatedly been detected.

In the case of gonorrhea infected people without symptoms (asymptomatic), test methods based on laboratory amplification of the bacterial genetic material (PCR, polymerase chain reaction) are more accurate than bacterial cultures. Even if there are no symptoms, it is possible to infect other people.

What helps against gonorrhea?

Antibiotics are used to treat gonorrhea. In the past, penicillin was primarily used to treat gonorrhea . Penicillin-resistant gonococcal strains from Asia and Africa have become more common in recent years. Doctors are therefore now using other antibiotics to treat gonorrhea. In most cases, two different antibiotics ( ceftriaxone and azithromycin) are used in combination. In special cases, for example to treat gonorrhea during pregnancy, the doctor only uses an antibiotic.

In most cases of gonorrhea, the gonococci die within 24 hours after administration of the effective antibiotics and are then no longer detectable. Nevertheless, it is important not to end gonorrhea therapy too early: This promotes the development of resistance – and resistant germs are difficult to treat.

All sex partners of those infected with gonorrhea should be evaluated and treated if necessary. This applies to sexual contacts within two weeks before the onset of symptoms. If a gonorrhea infection was discovered accidentally without symptoms, it is recommended that all sexual partners in the last 90 days undergo gonorrhea therapy. During and up to seven days after the therapy, it is important for all those affected to refrain from unprotected sex.

Newborns with purulent conjunctivitis caused by gonorrhea are given a single dose of antibiotics as an injection into a muscle (intramuscular) or into a vein (intravenous). In addition, the eyes and conjunctiva should be flushed regularly with saline solution.

antibiotic resistance

According to estimates by the World Health Organization (WHO), gonorrhea will probably pose major problems for mankind in the coming years. The reason for concern is the observation that some gonococcal strains have become resistant to the usual antibiotic gonorrhea therapy (antibiotic resistance).

For this reason, experts already recommend dual therapy for gonorrhea, i.e. with a combination of two antibiotics. A preparation alone no longer offers sufficient security for the success of the treatment. More and more fully resistant gonococcal strains are being found worldwide, especially in Asia.

Course of the disease and prognosis

Normally gonorrhea can be cured and the prognosis is good: If the gonorrhea is treated in time, you do not have to expect any long-term effects.

However, long-term untreated gonorrhea is likely to have health consequences. The late effects of gonorrhea include chronic inflammation of the internal genital organs with persistent pain, adhesions of the fallopian tubes or vas deferens and thus infertility. Therapy is therefore very important.

Without treatment, in very rare cases, the gonorrhea pathogens can spread through the bloodstream throughout the body. Doctors speak of a disseminated gonococcal infection (DGI). The consequences are joint and tendonitis, characteristic skin rashes with red pustules or small hemorrhages (petechiae), fever and chills.

In severe cases, the disseminated gonococcal infection is followed by meningitis and endocarditis. However, this is only very rarely the case.

Prevent

Consistent use of condoms reduces the risk of gonorrhea.

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