Gonorrhea is a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae. It is one of the most common STIs in the United States with about 800,000 infections per year.

Gonorrhea is more often detected in men than in women, possibly because in men it causes obvious signs while in more than half of women this infection causes no visible signs. Men aged 21 to 30 and young women aged 16 to 25 are most affected by the diagnosis of this sexually transmitted infection (STI).

It can infect the penis and vagina, urethra, rectum, throat and sometimes eyes. In women, the cervix can also be damaged.

Causes of Gonorrhea

Gonorrhea is spread through unprotected oral, anal or vaginal sex with an infected partner, the exchange of body fluids and contact with mucous membranes. It is rarely transmitted through cunnilingus.

Gonorrhea can also be passed to a newborn baby from an infected mother during childbirth, causing an eye infection.

Symptoms of gonorrhea

The signs of gonorrhea or gonorrhea usually appear 2 to 5 days after the time of infection in men, but they can probably take around 10 days in women, possibly longer. The infection can appear in the rectum, penis, cervix, or throat. In women, the infection goes unnoticed in more than half of the cases, causing no specific signs.

The most common course of untreated gonococcal urethritis in men is symptom resolution: symptoms may resolve in more than 95% of men within 6 months. The infection persists, however, as long as it is not treated. In the absence of treatment or in the event of failure, the risk of transmission remains, and is the bedrock of complications and sequelae.

Symptoms of gonorrhea in men

• Purulent, greenish-yellow discharge from the urethra
• Difficulty urinating
• Intense burning sensation when urinating
• Tingling in the urethra
• Pain or swelling in the testicles
• Pain or discharge from the rectum

A man showing these signs should talk to his partner, as she may not show any signs, even if she is a carrier of the bacteria. And in 1% of cases, men show little or none of these signs.

Symptoms of gonorrhea in women

Most women have no signs of gonorrhea, and that’s between 70% and 90% of cases! When they exist, these symptoms are often confused with those of a urinary or vaginal infection:

• Purulent, yellowish or sometimes bloody vaginal discharge
• Vulvar irritation
• Abnormal vaginal bleeding
• Pelvic pain or heaviness
• Pain during sex
• Burning sensations when passing urine and difficulty passing urine

In case of unprotected sex, screening should be done, along with screening for chlamydia.

Symptoms of anorectal gonorrhea

It is especially common in men who have sex with men (MSM) and can present with the following signs:

• Itching in the anus
• Inflammation of the anus
• Purulent discharge from the anus
• Diarrhea
• Bleeding through the anus
• Discomfort in defecating

Gonorrhea of ​​the mouth and throat is often not associated with any noticeable signs. Sometimes there may be pharyngitis or sore throat that resolves on its own. This oropharyngeal gonorrhea is present in 10 to 40% of MSM (men who have sex with men), 5 to 20% of women who already have vaginal or anorectal gonorrhea, and 3 to 10% of heterosexual people.

Eye infection is rare in adults. It occurs mostly by self-infection; meaning the affected person with gonorrhea in a sexual area brings the germs to their eyes with their hands. The signs are:

• Swelling of the eyelids
• Thick and profuse secretions
• Sensation of a grain of sand in the eye
• Ulcerations or perforation of the cornea

Possible complications from gonorrhea

In women, gonorrhea can lead to pelvic inflammatory disease, which is an infection of the reproductive organs of the fallopian tubes, ovaries and uterus. It can cause infertility, increase the risk of ectopic pregnancy, and cause chronic pelvic pain.

In men, gonorrhea can cause inflammation of the prostate (prostatitis) or testes (epididymitis), which can lead to infertility.

Gonorrhea also increases the chances of transmitting HIV.

In addition, a newborn baby infected by its mother can suffer from serious eye problems or blood infections (sepsis).

Inflammation of the Bartholin’s glands

In women, the most common complications observed are inflammation of the para-urethral glands and Bartholin’s glands, infection of the uterus (endometritis) and infection of the tubes (salpingitis), often progressing without causing any particular signs. Later, as the infection progresses, pelvic pain, infertility or risk of ectopic pregnancy may occur. This is because the tubes can become blocked by gonococcal infection.

Some studies show that between 10 and 40% of untreated gonococcal cervical infections (gonococcal cervicitis) progress to pelvic inflammatory disease. However, no longitudinal study has been able to assess the percentage of gonorrhea giving rise to the main complications, and in particular the risk of infertility.

Tubal infection

In comparison with infection with Chlamydia trachomatis, complications related to gonorrhea are less frequent. Both can, however, lead to tubal infection (salpingitis) with the risk of infertility and ectopic pregnancy.

Generalized forms of gonorrhea are rare. They can present as subacute septicemia (circulation of gonococcal-like bacteria in the blood), and can be accompanied by damage to the skin. Disseminated gonorrhea can also manifest itself in the form of osteoarticular damage: subfebrile polyarthritis, purulent arthritis, tenosynovitis.

Risk factors

• Men who have sex with men (MSM) are a high risk population
• People with more than one sexual partner
• People with a partner who has other sexual partners
• People who use condoms inconsistently
• People under 25, sexually active men, women or adolescents
• People who have contracted a Sexually Transmitted Infection (STI) in the past
• People who are HIV positive (AIDS virus)
• Sex workers
• Drug users
• People in prison
• People who go to the toilet without washing their hands systematically (ocular gonorrhea)

Basic preventive measures

Using condoms helps prevent the transmission of gonorrhea during anal or vaginal sex. Condoms or dental dams can also be used as a means of protection during oral sex.

Washing hands after using the toilet also helps prevent the bacteria from reaching the eye.

If a pregnant woman gets infected with the bacteria, the newborn child needs to take antibiotic treatment against gonorrhea at birth. A drop of rifamycin can be added in each eye. In fact, 30 to 50% of children born to women with untreated gonorrhea contract a serious eye infection that could make them blind.

Screening measures

Regular screening helps prevent the infection from being passed on to new partners. In the event of a positive result, it is important to notify anyone with whom you have had sex and who may have been exposed. That person will need to be tested and treated immediately if infected.

Gonorrhea can be detected in both men and women by urinalysis or culture of specimens taken from infected areas (in the throat, urethra, vagina or rectum using a cotton swab).

Treatment of gonorrhea

Gonorrhea is treated with single dose antibiotics taken by mouth or by intramuscular injection. Resistance has appeared for certain antibiotics which have become ineffective, such as penicillin or tetracyclines.

Currently, ceftriaxone 500 mg is used as a single intramuscular or intravenous injection. Usually the treatment of gonorrhea is combined with that of that chlamydia using for example azithromycin at a dose of 1g in a single dose, because one infection often leads to the other.

The treatment is given immediately after the test, before even awaiting results in humans. The partner(s) must also be treated. The person treated must return for consultation after 7 days.

Everyone who takes treatment for gonorrhea should also be screened for chlamydia infection. In pregnant women at risk for sexually transmitted infections (STIs) or who have had an STI, just after childbirth, the newborn baby is given rifamycin drops in the eyes to treat for possible gonorrhea.