Gonorrhoea: Epidemiology, Risk factors, and Prevention.

Introduction

Gonorrhoea is a sexually transmissible infection caused by bacteria known as Neisseria gonorrhoeae. It usually affects the genital area, although the throat or anus (back passage) may also be affected. Gonorrhoea affects both men and women and is easily transmitted during vaginal intercourse. It can also be transmitted during anal or oral sex.

Neisseria gonorrhoeae

Infection in tongue due to oral sex

History

The exact time when gonorrhea started cannot be ascertained. Earliest records of the disease are found from 1611 when the English parliament enacted a law to ensure that the spread of the infection is decreased and curbed.

This was followed by a similar law in 1256 in France during the reign of Louis IX. The symptoms of the infection were observed when the crusaders lay siege of Acre. After the Pope Boniface secularized the practice of medicine, the doctors began to treat common men as well as prostitutes for this infection.

In 1879 Neisser discovered the gonococcus or Neisseria gonorrhoeae and it was soon proven to be the causative agent of gonorrhoea. He demonstrated its presence consistently in patients with symptoms. In addition, when discharge and cultures of gonococci was introduced into the urethra of healthy men, it caused the disease

Gonorrhoea was referred to as the clap. According to some historians the name came about because the infected person would experience a clapping sensation that appeared suddenly when urinating.

History of gonorrhea treatment

The earliest treatment of gonorrhea was with the use of mercury. Earliest findings from an English warship “Mary Rose” show that several special surgical tools were used to inject mercury via the urinary opening.

In the 19th century gonorrhea was treated with the help of silver nitrate. Silver nitrate was soon discontinued and instead protargol was used which a type of colloidal silver was sold by Bayer from the year 1887.

Around 1859 another treatment was popular. These were cubebs, an Indonesian variety of pepper of which the dried powdered unripe fruit was used, and balsam of copaiba (or copaiva), which was extracted from a South American tree. The indication of their effectiveness was cessation of the discharge.

In the 1890s the first vaccine prepared from killed gonococci taken from Neisser’s laboratory. This vaccine was introduced in 1909.

Before antibiotics came into being metals were tried against the infection this included arsenic, antimony, bismuth, gold etc.

The use of other drugs for treatment continued right until the 1940s till antibiotics – notably Penicillin – came into use. Other antibiotics that arose during this time were the sulphur compounds or Sulphanilamide, Sulfapyridine and sulfathiazol.

Penicillins continued to be mainstay of therapy until 1970’s. In 1980 the first gonococcus isolates were identified that were resistant to penicillin. In 1983 a local epidemic caused by a penicillin resistant strain occurred in North Carolina. Patients were successfully treated with spectinomycin.

Epidemiology

The World Health Organization (WHO) has estimated the global incidence of several sexually transmitted infections (STIs) among individuals aged 15 to 49 years based on data from regions that have good case-based surveillance systems as well as data from population-based studies. In 2008, the WHO estimated global incidence of N. gonorrhoeae was 106 million cases, which represented a 21 percent increase over the estimate for 2005.

The highest incidence areas included Africa and the Western Pacific (including China and Australia) regions. In one review of infections during pregnancy in sub-Saharan Africa, the prevalence of sexually transmitted and reproductive tract infections was comparable with that of malaria. The prevalence of N. gonorrhoeae during pregnancy ranged from 1.5 percent in West and Central Africa to 4.9 percent in East and Southern Africa.

Causes of gonorrhea

  • Gonorrhea is an infection caused by the bacterium Neisseria gonorrhoeae. It not only affects the reproductive tract, but can also affect the mucous membranes of the mouth, throat, eyes, and rectum.
  • The infection is transmitted through sexual contact with an infected person involving the penis, vagina, anus, or mouth. Men do not need to ejaculate to transmit or acquire gonorrhea.
  • Gonorrhea can also be passed from an infected mother to her baby during delivery.
  • Although all sexually active individuals are at risk for acquiring gonorrhea, the highest rates of infection occur in teenagers, young adults, and African-Americans.
  • Babies who display signs of a gonorrhoea infection at birth (such as inflammation of the eyes), or who are at increased risk of infection because the mother has gonorrhoea, will usually be given antibiotics immediately after birth. This is to prevent blindness and other complications developing and does not harm the baby.

Risk factors

Factors that may increase your risk of gonorrhea infection include:

  • Younger age
  • A new sex partner
  • A sex partner who has concurrent partners
  • Multiple sex partners
  • Previous gonorrhea diagnosis
  • Having other sexually transmitted infections

What do gonorrhoea symptoms look like?

Gonorrhoea symptoms normally appear within 10 days of infection but they can occur many months later. Roughly 10% of men and 50% of women will not experience any symptoms at all.

In women, symptoms include:

  • Unusual discharge from the vagina that is thick and green or yellow in colour
  • Pain when urinating
  • Pain in the lower abdomen
  • Bleeding between periods and/or heavy periods
  • Bleeding after sex – this is rare.

Men may experience:

  • Unusual discharge from the tip of the penis that may be white, yellow or green in colour
  • Pain when urinating
  • Inflammation or swelling of the foreskin
  • Pain in the testicles – this is rare.

Infected semen or vaginal fluid in the eyes can cause inflammation of the eye (conjunctivitis). Unprotected anal or oral sex can lead to infection and symptoms in the rectum (discomfort, pain, bleeding or discharge) or throat (normally no symptoms).

Complications of gonorrhoea

If you get treatment for gonorrhoea early, it’s less likely to cause you any further problems. If you don’t get treatment, there’s a risk the infection might spread to other parts of your body and cause complications. Not everyone who gets gonorrhoea will have complications, but the more times you have the infection, the greater your chance of becoming infertile, for example.

  • In women, gonorrhoea can lead to pelvic inflammatory disease if the infection spreads to your womb (uterus), fallopian tubes and ovaries. Pelvic inflammatory disease can make you infertile and cause ectopic pregnancy.
  • In men, a gonorrhoea infection can spread to your testicles. This may lead to pain and inflammation (swelling) in the tubes that carry sperm. It’s possible this can make you infertile, but this is rare.

The infection can potentially spread to other parts of your body too. You can get symptoms such as:

  • A fever
  • Pain
  • Tiredness
  • Pain and swelling in your joints
  • A rash
  • Your heart and spine can also be affected.

Diagnosis and Testing

Testing for gonorrhoea can be done by:

  • Taking a urine sample which is sent to the laboratory for testing (urine testing is preferable in men only)
  • Taking a swab from the cervix or vagina in women, or from the urethral opening in men or women (for women who have had a hysterectomy) or from the anus in anyone who has had unprotected anal sex. This is done with a cotton swab or similar device and does not usually hurt
  • Taking a swab from the throat of people who have had unprotected oral sex.

Treatment

It is important to receive treatment for gonorrhoea as quickly as possible. It is unlikely the infection will go away without treatment and, if you delay treatment, you risk the infection causing complications and more serious health problems. You may also pass the infection onto someone else.

Gonorrhoea is treated with a single dose of antibiotics, usually one of the following:

  • Ceftriaxone
  • Cefixime
  • Spectinomycin

The antibiotics are either given orally (as a pill) or as an injection.

Abstaining from sexual intercourse – until treatment is complete, there is still a risk of complications and spread of infection.

Repeat testing in some cases – it is not always necessary to be tested to make sure the treatment has worked. However, the CDC recommends retesting for some patients, and a doctor will decide if it is necessary. Retesting should be performed 7 days after treatment.

If a woman is pregnant and infected with gonorrhea, the infant will be given an eye ointment to prevent gonorrhea transmission. However, antibiotics may be required if an eye infection develops.

Prevention

Gonorrhoea can be successfully prevented by:

  • Using condoms (male or female) every time you have vaginal or anal sex.
  • Using a condom to cover the penis, or latex or Plastic Square (dam) to cover the female genitals if you have oral sex.
  • Not sharing sex toys. If you do share them, wash them and cover them with a new condom before anyone else uses them.
  • Taking these precautions can also help to protect you from getting other sexually transmitted infections (STIs), such as genital herpes and chlamydia.
  • Having sexual activity with a mutually monogamous, unaffected partner.
  • Abstinence from sex.
  • Before you have sex with a new partner, you could both consider having a test for gonorrhoea and other STIs.
  • You can reduce your chances of getting gonorrhea by practicing safe sex, and by getting regular screenings.
  • No sex until antibiotic treatment is completed and your usual sexual partner has completed treatment.
  • A follow-up test must be done to make sure that treatment has cleared the infection.
  • All sexual partners need to be contacted, tested and treated, if indicated. Even if partners have no symptoms they may be able to transmit infection to other sexual partners.
  • Testing to exclude other sexually transmitted infections is advisable.

 

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125 comments

  1. pls i want to know of staphloccoccus and how it can be treated.

    Thanks.

  2. How can gonorrhoea can be completely treated? What is the most effective drug for gonorrhoea? Hope to read back from Asap….. Thanks

  3. What is most effective drug to completely treat gonorrhoea? Hope to read back from you Asap….. Thanks

  4. will you be infertile if the deseases been with a boy for one or two years without noticing it?..

    • As gonorrhea begins to spread, you may experience complications such as epididymitis, where your epididymis (the gland where sperm travel) becomes inflamed. You may also develop prostatitis, an inflammation of your prostate gland. Both conditions may affect your ability to bear children, so it’s important to seek treatment immediately to avoid these long-term effects of gonorrhea.

  5. and what will be the way out for that situation

    • Gonorrhea is usually treated with an antibiotic injection of Ceftriaxone one time to the buttocks or a single dose of Azithromycin by mouth. Once on antibiotics, you should feel relief within days.

      You should avoid having sex until you (and your partner) have been treated and given the all-clear, to prevent re-infection or passing the infection on to anyone else.

  6. do gonorrhea can lead to hot body frequealy..tiredness.

  7. is it true that a lady can have gonorrhea for almost a year but feeling no sign or symptoms at ol??

  8. JusticeYour Name

    pls can we get one specific drug for curing Gino.

  9. Good information. keep it up.

  10. please is UTI associated with ghonorreah

  11. is Gonorrhoea the same as UTI?

  12. Can a person who is circumcised get infected?

  13. can woman be infertile if she have gonorrhea

  14. quite helpful.

  15. whose page is this because you are not well informed and you are only using jargon that’s over most folks heads so they will believe you and not ask any questions your theory and over treatment has caused death by Superbugs and now this disease is almost untreatable as the bacteria has mutated and changed. sexual contact is not the only way to get this disease and there have been so many false positives it isn’t even funny. it has no exact measurements for the ingredients to do the tests with

  16. Can u become fertile again after you have been free from gonorrhea ?

  17. olalekan oluwoleYour Name

    can someone who is infertile be productive again

  18. Ajakaye Adesunkanmi alaba Your Name

    please, is it a must to take injection & drug.

  19. can a man stay infected after the dose maybe when the dose has not worked without knowing or getting complications, thanks

  20. What medicine can you use for newborn baby who is infected with gohnoria through birth.Thanks

  21. what are the effects of prostate Cancer

  22. thanks for showing some prevention

  23. I have infected for two years, I need help.

  24. My gonorrhea has not been treated earlier so am experiencing pain when urinating

  25. please if it was a boy of 17 years old that was infected for not just less than two months how many injection will he take and how many tablet will he take among the medicine listed. thanks

  26. Did gonorrhoea come from Dog?

  27. without seeing discharge from your penis is there a possibility that you still have Gonorrhea after you have received the prescribed drugs?

  28. I notice my penis muscles hold me strong when am trying to urinate, I have use doxycycline but its relief and came back strong what can I do to cure properly

  29. i have had gonorrhea 3 times ,and i was taking medicine ,1St was treated by CDC using injection2012 an 2nd was in kba by tablets 14 and again in 2016, n i sex too much ,n now am confused if am still infected or nt,cus my sperm quality has. reduced

  30. thanks for the medication but can someone use streptomycin to treat gonorrhoea

  31. I like this website because I get help from this in my mdcl study and treating my patients in clinic

  32. 8years ago I contacted gonorrhoea and I have a feeling that it was badly treated as my swollen pens which passed out a white liquid just became normal after a while and today I’m infertile. Can the antibiotics u mentioned work now?If yes,what dose?

  33. Hi sir, what cause skin pain when ever I finished taking bath ?. and how can treat or cure this problems ?. thank you !.

    • It may be a symptoms of allodynia. So consult a doctor. your doctor might prescribe medications such as lidocaine (Xylocaine) or pregabalin (Lyrica) to help ease your pain.

  34. ZAKARIYYA SALEH SHEHU

    good contribution

  35. what is STD how to treat it. Is there any drugs to take before having sex to prevent one from contacting STIS and STDS

    • Sexually transmitted infections (STIs) are infections that are spread by sexual contact. STIs can cause severe damage to your body and even death. Get vaccinated against the human papillomavirus (HPV) and hepatitis B (HBV).

  36. hello, I have been battling with gonorrhoea for 3 years now. I’ve been taking antibiotics but the disease is not improving. it has reduced my pens size. What medical treatment will be effective for me.

  37. am having white thick discharge what should I use to get ride of it. the drug u mentioned below can I use it

  38. If a pregnant women is infected with it, what treatment will she take as she is pregnant

    • The traditional treatment for uncomplicated gonorrhea is a dose of ceftriaxone, which are safe for pregnant mothers and infants.

  39. Godsway Fordsberg

    I have rushes all over my penis after having sex what is the cause and the prescribe medicine to cure it pls

  40. can the antibiotics mentioned cure the gonorrhea that’s coming out milky stuff?
    and how wil it take to be cured

  41. I’m affected with gonorrhoea
    what is the most effective drug to completely treat it

  42. I have gonorrhea since 2012 up to now is in body, what is the cure?

  43. pls if pennis is itching a man is it also symptoms of gonorrhoea

  44. pls can I continue to take the drugs after treatment

  45. If you are on medication is it OK to take beer .

  46. What about if you are urinating blood and also having pains in ur penis too

  47. l would like to find out if azithromicine if it can cure gonorrhoea .

  48. is the drugs available in the various drug stores and how long should one take the drug

  49. I had white discharge from my penis for like three days ago now and my troat is gasing atimes, what can of symptoms is this and what kind of disease be this, what is the solution, thanks

  50. plz what should i do i have treated my gonorrhea after some week i feel the symptoms again what can i do

  51. for how long is one likely to notice the infection after sex or affection especially in men.

    • The average incubation period for male gonorrhoea is around two to six days. In some cases, though, it may take as much as 30 days. What makes this situation worse is that your infection may be asymptomatic.
      Similarly, gonorrhoea in women acts fast. Upon infection, it may take just a few days for symptoms to appear. However, in some women, it may take as much as 30 days before symptoms manifest.

  52. please I have treated mine, but for over a year now my urine is yellow how sure am I that is cured, please help me out,

  53. please I really need your help

  54. hii think like having an sti disease😷

  55. Doctor l feel pain on my penis and anus also have rush on my puberty can be the disease if so how can l treat it and what type of medicine can l use.

  56. hello sir/madam in 2012 I felt severe burning sensation during passing of urine in my penis and continued to the third day when I found a small threadlike blood pass through my urine. I have consult doctors several times with several treatment but still feels the pains partially which seems it has not been properly treated. I have pass through urethra swab laboratory test which confirm No organism found. sometimes I have sores at the tip of my penis and it will disappear without treated help me

  57. whenever l finish bathing after some minutes, l do have itching all over my body. What can cause this and type of medication one can use to stop this. Thanks.

  58. Please Doc, what are causes or problems for someone who does not treated gonorrhea for a long time like (10-15 years?)

    • If a person is not treated for gonorrhea, there is a good chance complications will occur. Women frequently suffer from pelvic inflammatory disease (PID), a painful condition that occurs when the infection spreads throughout the reproductive organs. PID can lead to sterilization in females. Men may suffer from swelling of the testicles and penis. Both sexes may suffer from arthritis, skin problems and other organ infections caused by the spread of gonorrhea within the body.

  59. SulaimanYour Name

    good app

  60. SulaimanYour Name

    I love this health tips

  61. good information and help me a lot

  62. FADEKEMI ADEJUMO

    I really love an appreciate this site a lot it really helpful, well done guys 👍

  63. Can gonorrhea cause itching all over the body?

  64. pls i do discharge normally comes out yellowish in colour

  65. can the white discharge confuse the Elisa kit due to production of antibodies against the antigen to show that someone has HIV but in reality it gonorrhea

  66. please when a Doctor write this ( VDRL- REACTIVE) what does it mean pls?

    • Venereal disease research laboratory (VDRL) test is a nontreponemal test, used for screening of syphilis due to its simplicity, sensitivity and low cost. Reactive means you are affected with syphilis.

  67. you’re so great. for this educative site.

  68. pls when someone is having itching in all over his body, most especially in the penis but without other symptoms. Those he mean the person has gonorrhea?

  69. I have been suffering with gonorrhea for two years, what medicine can I use now coz I tried cefixime but it failed to treat me, and now I have signs like pain in the low abdomen, frequent urinating,yellowish urine, and milky discharge but I don’t feel pain when urinating.

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