Gonorrhea
Introduction
Gonorrhea is a common sexually transmitted infection (STI) caused by the bacterium *Neisseria
gonorrhoeae*. It can infect the genital tract, rectum, and throat. Gonorrhea is particularly prevalent
among young people aged 15-24 years. Early detection and treatment are crucial to prevent serious
health complications.
Causes
Gonorrhea is primarily spread through sexual contact with an infected person, including vaginal, anal,
and oral sex. It can also be transmitted from an infected mother to her baby during childbirth, leading to
neonatal conjunctivitis.
Clinical Manifestations
Symptoms of gonorrhea vary depending on the site of infection and can be asymptomatic, especially in
women:
1. Genital Infection:
Men: Urethritis, with symptoms including dysuria (painful urination), purulent
(pus-like) discharge from the penis, and testicular pain or swelling in cases of
epididymitis.
Women: Increased vaginal discharge, dysuria, intermenstrual bleeding, and
pelvic pain in cases of pelvic inflammatory disease (PID).
2. Rectal Infection:
Anal itching, discharge, soreness, bleeding, or painful bowel movements.
3. Pharyngeal Infection:
Often asymptomatic, but can cause sore throat or pharyngitis.
Investigation
Diagnosis involves several tests:
Nucleic Acid Amplification Tests (NAATs): Preferred method for detecting *N. gonorrhoeae*
from urine, urethral, cervical, rectal, or pharyngeal swabs.
Gram Stain: Microscopic examination of discharge (more useful in symptomatic men).
Culture: Used for detecting antibiotic resistance and confirming the diagnosis.
Pharmacological Management
Treatment guidelines recommend a dual antibiotic therapy due to rising antibiotic resistance:
Uncomplicated Gonorrhea:
Ceftriaxone: A single intramuscular dose of 500 mg.
Doxycycline: 100 mg orally twice a day for 7 days if chlamydial infection is not excluded.
Alternative Regimen: For patients with severe penicillin allergies, an alternative regimen such as
gentamicin combined with azithromycin may be used.
Non-Pharmacological Management
Education and Counseling: Safe sexual practices, the importance of condom use, and STI
screening.
Partner Notification and Treatment: Ensuring all recent sexual partners are informed and
treated to prevent reinfection and further spread.
Abstinence: Avoiding sexual contact until treatment is completed and symptoms resolve.
Regular Screening: Particularly for high-risk groups.
Complications
Pelvic Inflammatory Disease (PID): In women, leading to infertility, ectopic pregnancy, and
chronic pelvic pain.
Epididymitis: In men, which can lead to infertility if untreated.
Disseminated Gonococcal Infection (DGI): Bacteremia leading to arthritis, tenosynovitis, and
dermatitis.
Neonatal Conjunctivitis: In newborns, which can lead to blindness if not treated.
Referral
Referral to a specialist is recommended in cases of:
Complicated Infections: PID, epididymitis, or disseminated gonococcal infection.
Antibiotic Resistanc: Treatment failure or resistance to standard therapy.
Pregnancy: Management of pregnant women with gonorrhea to prevent neonatal
complications.
Co-Infections: Co-infection with other STIs like HIV requires specialized management.
Early diagnosis, effective antibiotic treatment, and preventive measures are essential for managing
gonorrhea and preventing its complications. Regular screening and public health measures are crucial in
controlling the spread of this infection.
