Gonorrhea

What is Gonorrhea?

Gonorrhea, commonly called the "clap", is a sexually transmitted infection caused by the bacteria Neisseria Gonorrhea.

What are the symptoms of Gonorrhea?

Fifty percent of persons with gonorrhea may show no symptoms. Men are more likely than women to show signs of infection. When present, the early symptoms of gonorrhea are often mild. Symptoms usually appear within two to 10 days after sexual contact with an infected partner. A small number of people may be infected for several months without showing symptoms - the asymptomatic infection. Because symptoms are not always present, you may be infected with gonorrhea and not know it. Despite the lack of symptoms, the infection can still be transmitted.

Women and Gonorrhea

When women have symptoms, they may experience:

• bleeding associated with vaginal intercourse;
• pain associated with vaginal intercourse;
• a painful or burning sensation when urinating; and/or
• an abnormal vaginal discharge that is a creamy yellowish, greenish or bloody in nature
• bleeding between your menstrual periods
• Even women who do not engage in anal intercourse can get gonorrhea of the rectum if the bacteria are spread from the vaginal area.
• More advanced symptoms, which indicate development of PID, include cramps and pain, bleeding between menstrual periods, vomiting, or fever. (see below)

What are the symptoms of PID?

The symptoms of PID include:

• longer and/or heavier periods
• more cramping during periods
• abnormal mucus discharges
• pain in lower abdomen (often in the region of one or both ovaries)
• tiredness, weakness
• fever
• vomiting
• pain during vaginal intercourse
• pain during pelvic exam

Men and Gonorrhea

When men have symptoms, they may experience:

• Men have symptoms more often than women. Symptoms include:
• Pus (a creamy yellowish or greenish discharge) from the penis often accompanied by pain - hence the term "the drip" or "the clap"
• A burning sensation during urination that may be severe.
• Testicular pain
• Symptoms of rectal infection may include discharge, anal itching, and occasional painful bowel movements with fresh blood on the feces. It is important to note that even men who do not practice receptive anal intercourse may be infected by contact with infected secretions (be they vaginal or penile)
• Infection of the throat may (rarely) cause localized pain, painful swallowing or pus in the throat

How is gonorrhea spread?

Gonorrhea may be spread during sexual intercourse via the exchange of bodily fluids through mucous membranes in the anus, mouth, and genital areas. This means that gonorrhea is primarily spread through unprotected penetration (vaginal or anal) and/or oral sex (fellatio). It is rarely spread by cunnilingus - (licking the external genitalia of your female partner). It can also spread from a woman to her fetus during birth.

How many people have gonorrhea?

The government of Candada keeps statistics on the trends concerning sexually transmitted diseases, including gonorrhea. Please refer to the statistics report link below.

How is Gonorrhea diagnosed? This is NOT a painful procedure!

Often, the suspicion of a gonorrheal infection is based on the constellation of your symptoms and an examination compatible with gonorrhea. Doctors or other health care workers usually use one or more laboratory techniques to diagnose and confirm gonorrhea; the staining of biological samples directly for the bacterium, and growing the bacteria in laboratory cultures are routine procedures. Many doctors prefer to use more than one test to increase the chance of an accurate diagnosis.

The staining test (gram stain) involves placing a smear of the discharge from the penis, cervix or infected site on a slide and staining the smear with a dye. Then the doctor or laboratory technician uses a microscope to look for the guilty bacteria on the slide. You usually can get the test results while in the office or clinic. This test is quite accurate for men but is not that good in women. (Only one in two women with gonorrhea have a positive stain.)

The culture test involves placing a small sample of the discharge onto a culture plate (those funny looking chocolate-colored plates) or a charcoal culture and incubating it up to two days to allow the bacteria to multiply. The sensitivity of this test depends on the site from which the sample is taken. Cultures of cervical samples detect infection approximately 90 percent of the time.

The doctor also can take a culture to detect gonorrhea in the throat. Culture allows testing for drug-resistant bacteria (those that have learned to overcome older antibiotics) - this enables us to ensure that your infection will be erradicated completely.

Because symptoms are not always present, you may be infected with gonorrhea and not know it. You can be tested for gonorrhea. To test for gonorrhea, your physician will use a cotton swab to collect cells via swabs from your genital/other regions potentially infected.

Chlamydia infection is often found in conjunction with gonorrhea. People who are diagnosed with gonorrhea should also be evaluated for chlamydia infection and vice-versa.

Is there a cure for Gonorrhea?

Fortunately, YES! Doctors will usually prescribe you a single dose of one of the following antibiotics to effectively treat your gonorrhea:

• Ceftriaxone
• Cefixime
• Ciprofloxacin
• Ofloxacin

If you have gonorrhea and are pregnant or are younger than 18 years old, you should not take ciprofloxacin or ofloxacin - there are possible complications or side-effects. Your doctor can prescribe the best and safest antibiotic for you - please seek advice!

Given the fact that the infections gonorrhea and chlamydia are frequently found traveling together, your doctor will usually prescribe you a combination of antibiotics, such as ceftriaxone and doxycycline or azithromycin, which will treat both diseases (see Chlamydia)

If you have gonorrhea, all of your sexual partners should get tested and then treated if infected, whether or not they have symptoms of infection.

Your doctor can help you decide which is the best treatment for you. Seek advice.

What if I don't treat my Gonorrhea? Is Gonorrhea dangerous?

When treated early, there are no long term consequences of gonorrhea. Serious complications can result, however, when left untreated.

Long term complications in men may include:

• Epididymitis - an inflammation of the testicles that can cause sterility
• Scarring and difficult urination of the urethra (penile canal)
• Prostatitis (infection of the prostate gland).

Long term complications in women include:

• Pelvic Inflammatory Disease - an ascending infection that spreads from the vagina and cervix to the uterus and fallopian tubes. PID can lead to sterility. (see section on PID)
• Ovarian or tubal abscesses
• Ectopic pregnancy - a pregnancy outside of the uterus
• Perihepatitis - an infection around the liver
• Sterility (see PID)

Gonorrhea can also be transmitted to newborns during their passage through the vaginal canal at the time of delivery.

Approximately 2% of persons with untreated gonorrhea may develop an uncommon complication known as Disseminated Gonococcal Infection (DGI). This may be characterized by fever, skin lesions and arthritis type pain.

How does Gonorrhea affect pregnancy?

Women infected with gonorrhea at the time of childbirth can transmit the infection to their newborn (conjunctivitis). This complication is rare because newborn babies routinely receive eye antibiotics to prevent infection. In some cases, gonorrhea is transmitted earlier in the pregnancy and can be responsible for pre-term delivery and fetal death – fortunately this is infrequent. Because of the potential risks to both mother and child associated with gonoccocal infection, doctors recommend that a pregnant woman have at least one test for gonorrhea during her pregnancy. The treatment of gonorrhea during pregnancy requires a consultation with your doctor – several antibiotics used to treat gonorrhea are not considered safe for use during pregnancy.

Who is most likely to get Gonorrhea?

• people who have several different sex partners
• people whose sex partners have a number of different sex partners (and so on, and so on…)
• people who don't use condoms
• people with a history of other sexually transmitted infections
• Women who contract gonorrhea while using the IUD (the intra-uterine device) are at higher risk of developing PID because the bacterium has a direct and rapid access to the upper genital tract. That is why only women in stable, monogamous relationships are advised to use the IUD.
• sexually abused children

Young adults have the highest rates of gonorrhea. Persons who have more than one sex partner, especially women under 25, should be tested for gonorrheal infection regularly, even in the absence of symptoms.

How can people with gonorrhea avoid spreading it?

• Inform your sex partners of the infection (or ask your physician to help you in contact tracing and treatment)
• Have no sex until treatment is complete (oral sex included)
• Be sure that your sex partner(s) are screened and treated at the same time.
• Use female or male condoms every time.
• All sexual contacts should be screened for gonorrhea. Sexual partners must be treated to prevent passing the infection back and forth between them, even though both may not have symptoms. There is no immunity following the infection and a person may become repeatedly infected.
• Ensure proper handwashing during treatment so as to prevent the transfer of the infection to your eyes.

How can I avoid getting gonorrhea?

Abstinence from both genital and oral sex is the only way to be 100% sure that you are protected from gonorrhea and other sexually transmitted infections.

If you are sexually active, you can lower your risk of gonorrhea and other STDs by following these guidelines:

• Use a female or male condom every time.
• Have routine checkups for sexually transmitted infections - discuss the frequency with your doc
• Aside from total abstinence, a monogamous sexual relationship with a known healthy partner is the best way of avoiding this and all other sexually-transmitted diseases.
• Condoms remain the best and most reliable protection against this and other sexually-transmitted diseases for sexually active people. Condoms should be used consistently and correctly when any sexual behavior falls outside abstinence or monogamy with a healthy partner. Consider using a condom or dental dam for oral sex, particularly if the risks are unknown.
• Limit your number of partners. Your risk of acquiring gonorrhea and other STD's increases as your number of partners increases.
• Regular check-ups. STD testing should be part of your regular exam. Do not wait for symptoms to appear. You should see your health care provider regularly if you or your partner have other sexual contacts.

DO NOT BECOME SEXUALLY INTIMATE WHEN DRINKING ALCOHOL OR USING OTHER DRUGS. Drugs reduce your ability to make sensible decisions.