Gonorrhoea (GC)

• What is Gonorrhoea (GC)?
• Statistics
• Risk Factors
• Progression
• Symptoms
• Clinical Examination
• How is it Diagnosed
• Prognosis
• Treatment
• References

What is Gonorrhoea (GC)?

Gonorrhoea is a disease of the epithelial lining of the urogenital tract, rectum, pharynx and conjunctivae. Gonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It can be passed on by vaginal, oral or anal sexual intercourse.
Gonorrhoea usually causes a urethritis (inflammation of the tube carrying urine from the bladder) in men, but occasionally it may spread to the heart, joints and brain. In women, the most common site of infection is the cervix (the lower end of the uterus or womb) but it may ascend and cause pelvic inflammatory disease (PID) which also involves the uterus and fallopian tubes. Spread through the body can cause fever, joint pain and rash.

Statistics

Men
Gonorrhoea is a worldwide disease. There are an estimated 60,000 new cases of gonorrhoea in Australian males each year (1999 statistics). It is likely that many more cases are present, but these go undiagnosed or are not notified to the appropriate agencies.
Gonorrhoea is more common in males than females in Australia. Gonnorhoea is asymptomatic in approximately 10% of males. A large proportion of women have no symptoms, so men are often infected after having vaginal intercourse with an infected asymptomatic female. The risk of infection after sexual intercourse with an infected female is around 20% for men.

Women
Gonorrhoea is the second most common sexually transmitted disease in females (second to chlamydia). The majority of females are asymptomatic and can easily pass on the infection without knowing. After a single exposure to an infected man, women have a 50% risk of acquiring the infection.
There is a higher prevalence of gonorrhoea in large metropolitan areas, inner city areas, populations with lower overall levels of education and people with a lower socioeconomic status. A large proportion of Australian cases are amongst Aboriginal people or are aquired overseas. Gonorrhoea is most prevalent in people aged 15 to 29 years.

Children
As gonorrhoea is a sexually acquired disease it rarely affects children. However, newborns to an infected mother can develop a purulent conjunctivitis (ophthalmia neonatorum), which is an infection of the thin membrane lining the surface of the eye and eyelids. If poorly treated, the child may become blind.

Risk Factors

Risk factors include having multiple sexual partners, a partner with a past history of any STI and unprotected sex (sex without the use of a condom or female condom).

Progression

Humans are the only host of Neisseria gonorrhoea. It is spread by intimate physical contact.

How is it Diagnosed

N. gonnorrhoea can be identified by culture from an infected area on selective media. The doctor takes a swab from inside the tip of the penis for culture. Microscopy of secretion shows a specific shape of bacteria, which is intracellular, Gram-negative diplococci. Throat swabs can’t be used for diagnosis. If the infection has spread, the physician may take blood samples or samples from joint fluid.
If gonorrhoea is identified, all sexual partners also need to be investigated while maintaining confidentiality.

Prognosis

When gonorrhea is treated immediately the outcome is likely to be good. This means that no permanent scarring of the urethra will take place, and the infection will not spread to other areas of the body. When treatment is delayed there is a greater likelihood of complications.

Men
There may be spread of infection to the epididymus or testicles. Men with gonorrhoea are also at greater risk of acquiring other sexually transmitted infections, such as human immunodeficiency virus (HIV). In some patients the infection can spread throughout the body causing arthritis (pain and swelling in joints), rash, fever and malaise.  

Women
There may be spread of infection from the cervix to the uterus, fallopian tubes and ovaries. If left untreated, infertility may occur.

Treatment

Gonorrhoea is treated with antibiotics. The particular treatment varies depending on where you caught the disease (locally, inter-state or overseas) because resistance to antibiotics depends on the area. Anyone you had recent sexual intercourse with will also need to be treated.
A typical regimen is a single-dose of intramuscular ceftriaxone 250mg. In addition, patients should be given azithromycin 1g orally or doxycycline 100mg orally BD for 10 days. This is to cover possible chlamydial infection.
More serious infections may require longer or intravenous treatment. After treatment is completed, you will often be retested to ensure the infection is cured. Sexual intercourse should be avoided until after this test is clear.
General measures to protect yourself from gonorrhoeal infection include:

• Always use condoms – These are the best contraceptive method to prevent transmission of STIs.
• Have long-term relationships where both partners are not infected and neither person has additional partners.
• Limit your sexual partners – The less people you have sex with, the less likelihood you will become infected.
• Talk to your partners about STIs.
• If you suspect you may have been infected, seek advice and treatment early.

More information

For more information on different types of sexually transmitted infections, prevention of STIs, treatments and effects on fertility, see Sexually transmitted infections (STIs).

 

References

1. Behrman. Gonorrhea. eMedicine. Web MD. 2005. [Available online at http://www.emedicine.com/emerg/topic220.htm]
2. Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 2002.
3. Murray PR. Rosenthal KS., Kobayashi GS, Pfaller MA. Medical Microbiology, 3rd Ed. Mosby 1999.
4. Therapeutic Guidelines: Antibiotic Version 12. Therapeutic Guidelines Limited, 2003.
5. World Health Organisation. “Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections Overview and Estimates.” WHO 2001.