Gonorrhea is distributed worldwide and is the world’s most common sexually transmitted disease. The disease is triggered by certain bacteria. They are called gonococci – or medically more accurate: Neisseriae gonorrhoeae. The pathogens affect the mucous membranes of the urethra and cervix and – depending on the sexual practice – also the mucous membrane in the rectum, mouth and throat. There they trigger a purulent inflammation. Also, the conjunctiva can be affected when the bacteria get there, for example, by eye rubbing.

The infection happens especially in unprotected traffic with a patient. During sex, the bacteria are transmitted through direct contact with the mucous membranes. Gonorrhea, like syphilis and genital herpes, is a sexually transmitted disease (STD). Outside the body, the gonococci die quickly. Therefore, it is unlikely to be infected by contaminated objects. However, such an infection risk can not be completely ruled out.

Good protection against infection is provided by condoms. Those at risk are therefore people who do not use condoms, as well as people with frequently changing sexual partners.
The signs of gonorrhea infection are easy to spot. In fact, men’s symptoms are more pronounced and similar to the typical signs of some sexually transmitted diseases, such as the burning sensation of urination.
In women, it is a bit more problematic because although rarely have symptoms, but the disease can cause greater damage to gonorrhea. If left untreated, this may result in infertility or miscarriage and stillbirths. If you suspect that you have gotten infected with gonorrhea, you can order our test kit online here.

How to diagnose gonorrhea?

Gonorrhea is a sexually transmitted disease that can spread to many parts of your body – from the genitals, to the rectum, as well as the eye area. Usually, areas of the abdomen of the patient are usually affected. Normal transmission, as with chlamydial infection, is via vaginal, oral or anal sex – , but can also be transmitted from mother to child at birth. Sexually transmitted diseases are most prevalent in young people between the ages of 15 and 30 with frequently-changing sexual partners. Therefore, it is incredibly important to use condoms with changing sexual partners, so that a further spread of the infectious disease can be prevented. If you have a new relationship, it is a good idea to have yourself and your partner tested so that you can have carefree unprotected sex.

If there is a gonorrhea infection, it can easily be treated with an antibiotic. So do not hesitate and test yourself too early, too late to avoid serious complications (such as infertility or spreading the disease to other parts of your body).

Symptoms of gonorrhea in women

A gonococcal infection manifests itself in women mostly by increased vaginal discharge. The infection itself is usually located in the area of ​​the cervix and cervix. It may also affect the Bartholin glands, which open in the area of ​​the vagina and are important for moistening the vagina. The inflammation of the excretory ducts of these glands can lead to an abscess due to pus formation and cause a swelling and redness in the area of ​​the vagina.

Due to the rising of bacteria, gonococcal infection often causes cystitis. This causes discomfort when urinating. Involvement of the uterine lining may also cause bleeding and particularly strong and long-lasting menstrual bleeding. In ascending infection infestation of the entire pelvis including the peritoneum is possible. The peritonitis (peritonitis) manifests itself by involuntary defense tension of the abdominal muscles in the affected area, which can be caused by palpation of the abdomen when touching the abdomen and which manifests itself by reflexive tensing of the abdomen. In addition, peritonitis is associated with severe pain and often fever.

Symptoms of gonorrhea in men

Unlike women, men find it easier to get infected with gonorrhea, because 90% of them experience symptoms after about a week and you can quickly get treatment. Due to the urethral infection, men often suffer from a burning sensation, as well as pain when urinating. Other symptoms include white discharge or an egg droplet at the exit of the urethra. Since it “greets” the man as the first one at an early stage, it is also called Bonjour Droplet. The infection can rise above the urethra and cause inflammation of the spermatic cord, prostate, bladder and epididymis. Depending on which part of the body the inflammation overlaps, redness, swelling and pain appear in these areas. If the epididymis is affected, it can lead to acute scrotum, in which the scrotum is painfully swollen.

Blood in the urine and pain in the groin area and pressure or tension in the perineal area may be evidence of inflammation of the prostate (prostatitis).
While the symptoms are likely to decrease after a few weeks, the infection (untreated) still remains in the body and can spread to other organs.

Can gonorrhea symptoms spread to the whole body?

Although systemic gonococcal infection is rare, the bacteria can enter the blood and spread to the whole body. This happens in 0.5-3 percent of patients with local gonorrhea. While men with a local gonococcal infection become more symptomatic than women, affected women develop more systemic gonococcal infestations. The systemic infection with Neisseria gonorrhea is characterized by general signs of infection such as malaise, fever and body aches, often accompanied by punctate to pustular rash. These symptoms can be so toned down that an infection is not immediately noticeable. In the course of a systemic spread of the gonococci, there may additionally be acutely reactive joint changes due to the formation of immune complexes. This phenomenon is referred to as sexually acquired reactive athritis. In rare cases it can also come to infestation and inflammation of the heart (endocarditis).

What long-term symptoms does a gonococcal infection have?

Dangerous is the germ ascension, especially by a possible infection and inflammation of fallopian tubes and ovaries. In the acute phase, there are sudden severe abdominal pain, high fever, constipation and defensive tension. This phase usually lasts only briefly and then goes into a chronic stage without therapy. Long-term consequences include infertility, implantation of a fertilized egg outside the uterus (extrauterine pregnancy) and chronic abdominal pain due to adhesions.

Which gonorrhea symptoms occur in the newborn if the mother suffers from gonorrhea during pregnancy and childbirth?

Transmission of the infection to the child may occur before or more often during birth. This can lead to conjunctivitis (gonococcal conjunctivitis) in the newborn. Most of the symptoms occur about five days after birth. Since the inflammation can also affect the cornea, there is a risk of blindness. Conjunctivitis of the newborn was still one of the main causes of blindness in Europe in the 19th century. If gonococcal infection is suspected, Credé prophylaxis is performed after birth. For this purpose, silver nitrate-containing eye drops were used until 1992, which is no longer common today due to the mucous membrane irritating effect. Instead, Credé’s prophylaxis will be replaced by treatment of the newborn with an ophthalmic antibiotic-containing ointment.

Treatment of gonorrhea

For the treatment of gonorrhea, the doctor prescribes antibiotics for oral use, which can kill gonococci. Against many older, but also newer agents, the pathogen has already become insensitive (resistant). In recent years, resistance has developed faster and faster. Therefore, the doctor prescribes a combined treatment of two modern drugs. Unless otherwise stated, an adult patient with gonorrhea of ​​the genital area or rectum receives the cephalosporin antibiotic ceftriaxone once as a syringe into the muscle or as an infusion. Only if an injection or infusion is not possible will the physician replace it with the administration of a tablet containing the active substance cefixime. The latter is chemically related to ceftriaxone but no longer effective against many strains of the gonorrhea pathogen. In addition to ceftriaxone or cefixime, the doctor once administers the antibiotic azithromycin in the form of a tablet.

Patients who are allergic to one of the antibiotics mentioned, or to patients who are pregnant or breastfeeding, should deviate from the generally recommended combination therapy. In this therapeutic decision, the physician helps to determine the bacterial culture, including testing for susceptibility to various antibiotics.

If the infection has already led to complications – for example, for prostate or uterine infection – the patient receives the antibiotics for several days by infusion into the vein. This also applies to an infection of the eyes with the gonorrhea pathogen. Then an antibiotic-containing eye ointment is also used.

About two weeks after the end of the antibiotic therapy, a medical follow-up is necessary to check whether the treatment has struck. Until this is assured, the person suffering from the disease should refrain from sexual intercourse. If a correct combination therapy is carried out early in gonorrhea, the disease usually heals without consequences. Inadequate treatment, on the other hand, is not only ineffective, but may also contribute to the development of gonorrhea pathogens, which are no longer responsive to the currently recommended antibiotics.

Important: The sexual partner should also be examined and, if necessary, given treatment. He could be infected without feeling any symptoms. Then it would possibly lead to a renewed mutual infection (ping-pong effect). Sometimes gonorrhea is detected only by chance, and the time of infection can not be determined accurately. Potentially affected are all partners who have had intercourse with the patient in recent months.

About the author – Dr. H.S. Hermanides
Dr. H.S. Hermanides obtained a PhD for her research on HIV in the Caribbean. She is currently working as a specialist in infectious diseases at the Red Cross Hospital in Beverwijk, The Netherlands.