Saturday, December 20, 2014

Definition

Gonorrhea is caused by Neisseria gonorrhea, a bacterium that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urinary tract, mouth, or rectum.

Description

About 2.5 million cases of gonorrhea occur annually in the U.S..

In women, the cervix is the most common site of infection. However, the disease can spread to the ovaries and fallopian tubes, resulting in pelvic inflammatory disease (PID); this can cause infertility and other serious problems.

In a man, gonorrhea can cause urethritis and penile discharge. Gonorrhea can also be spread from a man's penis to the throat of his sex partner during oral sex (pharyngeal gonorrhea). People can transfer the bacteria from the genital area to the mouth with their fingers.

Gonorrhea of the rectum may develop in women due to spread of the infection from the vaginal area, and it can also occur in receptive anal intercourse. Infection of the eye (conjunctivitis) can also occur.

Gonorrhea can be passed from an infected woman to her newborn infant during delivery. The infection also occurs in children, most commonly in young victims of sexual abuse.

If the bacteria spread to the bloodstream, they can infect the joints, heart valves, or the brain. The most common consequence of gonorrhea, however, is pelvic inflammatory disease (PID), a potentially serious infection of the female pelvic organs.

PID can cause scarring of the fallopian tubes, resulting in infertility in as many as 10 percent of women affected. In others, the scarring blocks the proper passage of the fertilized egg into the uterus. If this happens, the egg may implant itself in the tube; this is called an ectopic pregnancy and is life-threatening to the mother if not detected early.

An infected woman who is pregnant may pass the infection to her infant as the baby passes through the birth canal during delivery. Most states require that the eyes of newborns be treated with silver nitrate or other medication immediately after birth to prevent gonococcal infection to the eyes, which can lead to blindness. Because of the risk of gonococcal infection to both mother and child, doctors recommend that a pregnant woman have at least one test for gonorrhea during her pregnancy.

Causes

Having unprotected sex with a partner for whom a past sexual history is not known is the primary risk factor for Gonorrhea.

Symptoms

The early symptoms of gonorrhea often are mild, and some people who are infected have no symptoms of the disease; this is one reason why it is so readily transmitted. If symptoms of gonorrhea develop, they usually appear within 2 to 10 days of sexual contact with an infected partner, although a small percentage of patients may be infected for several months without showing symptoms.

The initial symptoms in women include a painful or burning sensation when urinating or a yellowish vaginal discharge. More advanced symptoms include abdominal pain, bleeding between menstrual periods, vomiting, or fever.

Men usually have a whitish-yellowish discharge from the penis and a burning sensation during urination that may be severe. Symptoms of rectal infection include anal itching, and sometimes painful bowel movements.

Diagnosis

Gonorrhea is diagnosed through gram stain, culture, or rapid test (DNA probe).

The gram stain involves placing a smear of the discharge on a slide that has been stained with a dye and then examining it under a microscope for the presence of the gonococcus.

The culture test involves placing a sample of the discharge (usually from a man's urethra or a women's cervix) onto a culture plate and incubating it for up to 2 days in order to allow the bacteria time to multiply. The accuracy of this test depends on the site from which the sample is taken. Throat cultures and rectal cultures may be done if infection of these areas is suspected.

Treatment

Because a high proportion of men and women who have gonorrhea also have chlamydia, the goal of treatment is to cure both infections. Your partner(s) should be treated at the same time you are.

Treatment for uncomplicated gonorrhea consists of antibiotics, including ceftriaxone, cefixime, ciprofloxacin, or ofloxacin for gonorrhea along with azithromycin, doxycycline, or erythromycin for chlamydia.

Questions

Should the sexual partner be alerted so that they can be tested?

Has the gonorrhea progressed into Pelvic Inflammatory Disease (PID)?

Can the gonorrhea come back without additional exposure?

Do any of the internal contraceptive gels, ointments, devices, etc. help prevent gonorrhea?

What type of medication will you be prescribing? Are there any side effects?

Can I tell if a sexual partner has gonorrhea before having sexual intercourse?

Prevention

All sexually active persons should consider using latex condoms to prevent STDs and HIV infection, even if they are using another form of contraception. Latex condoms used consistently and correctly are an effective means for preventing disease (and pregnancy). Talk openly with your partner about STDs, HIV, and hepatitis B infection, and the use of contraception.