Gonorrhea or gonococcal urethritis is an infection caused by the gram negative gonococcal bacteria Neisserria gonorrhoea and is transmitted through sexual intercourse. Gonorrhea is one of the most common sexual transmitted diseases and affects both men and women.
In recent years, resurgence of the disease has been observed in Western Europe and North America, especially in certain risk groups or in socially and economically deprived areas. The epidemics in Eastern Europe remain stable. Pandemics are very common in parts of Africa and East West Asia where strains resistant to antibiotics, particularly penicillin and quinolones, thrive.
The bacillus enters the urethra through sexual intercourse and causes intense inflammation at the urethral epithelium resulting in purulent urethritis in more than 90% of the people who are infected. Nevertheless, the disease can be asymptomatic and the patient may not understand that he/she has acquired the infection. This usually occurs in women patients or when someone masks the clinical presentation by receiving the wrong antibiotic treatment. The asymptomatic patient can transmit the disease to others and thus this individual is considered a danger to others, since, due to lack of symptoms, the asymptomatic patient does not seek medical assistance.
The incubation period of gonorrhea is short, ranging from 2 to 14 days, with most symptoms appearing between 3 to 4 days following the suspicious sexual contact.
In men, symptoms include purulent yellowish or greenish discharge from the penis, pain and burning sensation during urination (symptoms of dysouria) and frequent urge to urinate. It can cause inflammation of the glands around the urethra, redness at the urethral meatus (external urethral orifice), as well as prostatitis, epididymitis and orchitis. In this case, there is pain and swelling (edema) of the testes. Moreover, inflammation of the intestine, the rectum, the mouth and the throat (gonococcal pharyngitis) can also occur. If appropriate treatment is not administered, gonorrhea can spread to the vas deferens and cause infertility. It can even spread to the joints leading to gonococcal arthritis.
A high percentage of women are asymptomatic. The most common symptoms in women are increased vaginal discharge (vaginitis), symptoms of dysouria with burning sensation and pain during urination, and urinary frequency. More rarely, women may experience dyspareunia (pain during sexual intercourse), sore throat (gonococcal pharyngitis), acute salpingitis with intense lower abdominal pain and fever. Infertility may occur in cases of chronic infections and infections that were left untreated.
Once there is suspicion of infection, the diagnosis is made by clinical examination which reveals the presence of yellowish discharge in the urethra, which is more pronounced before first morning urination.
The diagnosis is confirmed by microscopic examination of the discharge following Gram staining, by which the Gram negative diplococcus is detected. Final diagnosis is confirmed by culturing the discharge in specific culture media.
Patients should also undergo routine screening for the exclusion of other co-infections such as syphilis, hepatitis B and HIV.
The treatment of choice for gonorrhea is a single dose of ceftriaxone 150 mg (3rd
generation cephalosporin) by intramuscular injection. Amoxicillin is also effective and is administered as a single dose of 3 g. In cases where the gonococcus strain is resistant to penicillin, treatment with ciprofloxacin, doxycycline or erythromycin can be administered.
It is important to identify recent sexual partners who also have to undergo treatment. The patient should be re-examined 3 months following treatment administration and be re-subjected to complete serology testing in order to exclude co-transmission of other sexually transmitted diseases such as syphilis, hepatitis B and HIV.
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