WHAT IS IT?
Gonorrhea is a venereal disease, transmitted by sexual contact. It is caused by the bacterium Neisseria gonorrhoeae. The disease is difficult to control because many women and some men have no symptoms of disease but are highly infectious.
Gonorrhea is generally found in the genitourinary tract, and occasionally, in the rectum, pharynx, and eyes. It can uncommonly be transmitted from mother to baby during childbirth.
HOW IS IT DIAGNOSED?
History is typically of sexual contact with a new partner, who may or may not know they have the infection. In males, symptoms include a thick discharge from the penis, and pain when urinating; these symptoms follow a ten to fourteen day incubation period.
Most females have no symptoms. Some may urinate more frequently with a burning sensation, or have abnormal uterine bleeding, pelvic pain or cramping, a vaginal discharge, or swelling and tenderness of the vulva. Other symptoms in males and females can include pain in the rectum, or sore throat with fever and difficulty swallowing.
Physical exam in males will usually show a thick discharge from the penis. In females, a similar discharge from the cervix, and possibly tenderness of the fallopian tubes may be found. Abscesses of the tubes can sometimes be detected by a pelvic examination. If the throat is infected,
tonsillitis and lymph node swelling in the neck are noted.
Tests: The diagnosis can be confirmed by microscopic examination of the urethral discharge, as well as culturing the discharge or a smear taken from the throat, urethra or rectum. There are no blood tests to diagnose gonorrhea reliably.
HOW IS IT TREATED?
Antibiotics will be quickly effective in most individuals. Many different antibiotics have been used to treat gonorrhea.
This has led to the emergence of antibiotic-resistant strains of the bacterium.
Effectiveness of treatment also varies with the site of infection.
An antibiotic that works for genital gonorrhea may not be effective for gonorrhea in the throat.
Anyone treated for gonorrhea should also be treated for chlamydia infection and be tested for other
sexually transmitted diseases, as they may accompany each other.
WHAT MIGHT COMPLICATE IT?
In men, urethral gonorrhea infections can result in acute or chronic prostate gland inflammation or testicular infection. Women may have
pelvic inflammatory disease, ectopic pregnancy, or sterility. In pregnant women, infection can lead to spontaneous abortion, premature rupture of the membranes, premature delivery, and stillbirths.
Gonorrhea can occasionally spread through the blood stream to infect other areas of the body including the skin, joints (producing an acute arthritis with pus formation inside the joint), or rarely, the heart or meninges.
PREDICTED OUTCOME
The prognosis for gonorrhea infections is good, with effective antibiotic treatment and follow-up. The infections usually clear in two to four weeks. With an impaired immune system, infections may last for months and become more severe.
ALTERNATIVES
Genital infections of bacterial, viral, fungal and chlamydial origins can result in similar symptoms. If the bacterium cannot be isolated, the diagnosis can be difficult. Meningococcemia can resemble a systemic gonorrhea infection.
APPROPRIATE SPECIALISTS
Infectious disease specialist, urologist and gynecologist.
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