Gonorrhea - Causes, Symptoms And Treatment

A common but curable sexually transmitted disease. gonorrhea is an infection of the genitourinary tract (especially the urethra and cervix) and, occasionally, the rectum, pharynx, and eyes. Untreated gonorrhea can spread through the blood to the joints, tendons, meninges, and endocardium; in females, it can also lead to chronic pelvic inflammatory disease (PID) and can cause ectopic pregnancy and infertility in as many as 10% of infected women. After adequate treatment, the prognosis for both males and females is excellent, although reinfection is common. Gonorrhea can also grow in the mouth, throat, eyes, and anus.

Gonorrhea is especially prevalent among young people and in people with multiple sexual partners. particularly those between ages 19 and 25. The highest rates of infection are found in women ages 15 to 19 and men ages 20 to 24.

What causes Gonorrhea?

Transmission of Neisseria gonorrhea, the organism that causes gonorrhea, almost always follows sexual contact with an infected person. Pregnant women infected with gonorrhea can pass the disease to their neonate during delivery through the birth canal. Neonates born of infected mothers can contract gonococcal ophthalmia neonatorum. Also, children and adults with gonorrhea can contract gonococcal conjunctivitis by touching their eyes with contaminated hands.

Signs and symptoms of Gonorrhea

Although most males infected with gonorrhea remain asymptomatic, some may develop mild symptoms after a 2- to 10-day incubation period. Most infected females remain asymptomatic. Those with symptoms may complain of bleeding during intercourse, yellow or bloody vaginal discharge (probably the most common symptom in females), or pain or burning during urination. Their symptoms may progress to cramping, bleeding between menstrual periods, vomiting, and pain, indicating the development of PID. (See What happens in gonorrhea, page 300.) Other possible symptoms include pharyngitis, tonsillitis, and rectal burning, itching, and bloody mucopurulent discharge.

Other clinical features vary according to the site involved:

• urethra - dysuria, urinary frequency and incontinence, purulent discharge, itching, and red, edematous meatus
• vulva - occasional itching, burning, and pain due to exudate from an adjacent infected area (with symptoms that tend to be more severe before puberty or after menopause)
• vagina (most common site in children over age 1) - engorgement, redness, swelling, and profuse, purulent discharge
• liver - right upper quadrant pain in patients with perihepatitis
• pelvis - severe pelvic and lower abdominal pain, muscle rigidity, tenderness, and abdominal distention as well as nausea. vomiting, fever, and tachycardia in patients with salpingitis or PID as the infection spreads

Possible complications of gonorrhea include gonococcal septicemia and, if the women is pregnant, gonococcal ophthalmia neonatorum of the neonate after birth.

Gonococcal septicemia is more common in females than in males. Its characteristic signs include tender papillary skin lesions on the hands and feet; these lesions may be pustular, hemorrhagic, or necrotic. Gonococcal septicemia may also produce migratory polyarthralgia and polyarthritis and tenosynovitis of the wrists, fingers, knees, or ankles. Untreated septic arthritis leads to progressive joint destruction.

Signs of gonococcal ophthalmia neonatorum include lid edema, bilateral conjunctival infection, and abundant purulent discharge 2 to 3 days after birth. Adult conjunctivitis, most common in men, causes unilateral conjunctival redness and swelling. Untreated gonococcal conjunctivitis can progress to corneal ulceration and blindness.

Other possible complications of gonorrhea include infections, arthritis, PID, endocarditis, and infertility in women.

Diagnosis information

A culture from the site of infection (urethra, cervix, rectum. or pharynx), grown on a Thayer-Martin or Transgrow medium, is the gold standard for diagnosing women by isolating N. gonorrhoeae. A Gram stain showing gramnegative diplococd supports the diagnosis and may be sufficient to confirm gonorrhea in males.

Confirmation of gonococcal arthritis requires identification of gramnegative diplococd on smears made from joint fluid and skin lesions. Complement fixation and immunofluorescent assays of serum reveal antibody titers four times the normal rate. Culture of conjunctival scrapings confirms gonococcal conjunctivitis.

Treatment of Gonorrhea

For adults and adolescents, the recommended treatment for uncomplicated gonorrhea caused by susceptible penicillinase-producing N. gonorrhoeae is a single dose of ceftriaxone (Rocephin), 125 mg I.M. Other treatments include a single dose of dprofloxacin (Cipro), ofloxadn (Floxin), or levofloxacin (Levaquin). Gonorrhea and chlamydial infections commonly infect people at the same time. Thus, for presumptive treatment of concurrent Chlamydia trachomatis infection, the clinician may prescribe doxycycline (Vibramycin) or azithromycin (Zithromax) with the ceftriaxone. A single dose of ceftriaxone and erythromycin (Erythrocin) for 7 days is recommended for pregnant women and patients allergic to penicillin. Ciprofloxacin and ofloxacin are contraindicated for children and pregnant or breast -feeding women.

If left untreated, gonorrhea can spread to the reproductive tract and even into the blood stream, infecting the heart, brain, and joints.

Treatment of gonococcal conjunctivitis requires a single dose of ceftriaxone, 1 g I.M., and lavage of the infected eye with saline solution once. Routine instillation of 1 % silver nitrate drops or erythromycin ointment (llotycin) into neonates' eyes soon after delivery has greatly reduced the incidence of gonococcal ophthalmia neonatorum.

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Alternative treatment

Although there is no known alternative to antibiotics in the treatment of gonorrhea, there are herbs and minerals that may be used to supplement antibiotic treatment:

• Several herbs may reduce some symptoms or help speed healing: kelp has balanced vitamins and minerals. Calendula ( Calendula officinalis ), myrrh ( Commiphora molmol ), and thuja ( Thuja occidentalis ) may help reduce discharge and inflammation when used as a tea or douche.
• There may be acupressure and acupuncture points that will help with system cleansing. These exact pressure points can be provided and treated by an acupressurist or acupuncturist.

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Special considerations or prevention

Before treatment. establish whether the patient has any drug sensitivities, and watch closely for adverse drug reactions during therapy.

• Warn the patient that, until cultures prove negative, she's still infectious and can transmit gonococcal infection.
• Practice standard precautions.
• If the patient has gonococcal arthritis, apply moist heat to ease pain in affected joints.
• Urge the patient to inform sexual contacts of her infection so that they can seek treatment, even if cultures are negative. Advise her to avoid sexual intercourse until treatment is complete.
• Report all cases of gonorrhea to local public health authorities for follow-up on sexual contacts. Examine and test all people exposed to gonorrhea as well as children of infected mothers.
• Routinely instill two drops of 1 % silver nitrate solution or erythromycin ointment in the eyes of all neonates immediately after birth. Check neonates of infected mothers for signs of infection. Take specimens for culture from the newborn infant's eyes, pharynx, and rectum.
• Use latex condoms when having sexual intercourse.
• Report all cases of gonorrhea in children to child abuse authorities.
• Avoid sexual contact with high-risk partners.