Sexually Transmitted Infections (STIs)- Gonorrhoea

According to WHO (World Health Organization)'s report on Sexually Transmitted Infections (STIs), 3 August 2016, about 357 million peoples are affected by 1 of 4 STIs, namely Gonorrhoea, Syphilis, Trichomoniasis & Chlamydia each year.
Gonorrhea is quite common among them. It is a preventable as well as curable disease. Today I will tell about the causative organism, common sites of involvement, route of transmission, clinical presentation and above all, how can we prevent it.

Causative Organism:

Gonorrhea is caused by Neisseria gonorrhoeae, a Gram Negative Diplococci.

Common Sites of Infection:

Lower genital tract (namely urethra, vulva, vagina, cervix), Rectum, Pharynx & Eye.

Route of Transmission:

The main route of transmission is vaginal, anal or oral sex. Men have 20% risk of having the infection from a single exposure to infected women but women have 60-80% chance of being affected by a single act of coitus with an infected man. However, Gonococcal conjunctivitis accidentally caused by infection from contaminated fingers.
Babies can be infected during delivery from untreated mother and result in Ophthalmia neonatorum.
Uncommon transmission may occur by handling contaminated object.

Clinical Presentations:

It takes about 2-14 days to develop symptoms after exposure.
In men, the urethra is commonly infected and resulting in purulent urethral discharge and dysuria  (painful urination) or burning sensation during micturition, although in 10% cases patient may remain asymptomatic.
Rectal infection usually occurs in MSM (men who have sex with men) and may present with anal discomfort, discharge or rectal bleeding.
In the case of women, about 80% of cases remain asymptomatic, unless associated with other infections such as Chlamydia, Trichomoniasis or Candidiasis, and presents with purulent vaginal discharge & dysuria.
The urethra, paraurethral glands, Bartholin's gland and endocervical canal may be infected. The rectum may be also involved either due to a contaminated urogenital site or due to anal sex.
Pharyngeal gonorrhea is usually asymptomatic and occurs as a result of oral sex.
Gonococcal conjunctivitis presents with purulent discharge from the eyes with inflammation of the conjunctiva and edema of the eyelid.

Complications:

Usually develops, if it remains untreated for prolonged periods.

In Male:

  1. Acute prostatitis
  2. Epididymo-orchitis
  3. Narrowing of the urethra due to periurethral fibrosis.
  4. Periurethral abscess.

In Female:

  1. Bartholin's gland abscess
  2. PID (Pelvic Inflammatory Disease), which may result in, infertility and ectopic pregnancy.
  3. Abortion (due to sepsis).
  4. Chorioamnionitis.
  5. Tubo-ovarian mass.
  6. Dyspareunia i.e. painful sexual intercourse.
  7. Chronic pelvic pain.
  8. Disseminated gonococcal infection (rare).

Both Sexes:

  1. Gonococcal septicemia.
  2. Septic arthritis.
  3. Pustule & petechiae on the skin.

Investigations for Diagnosis of Disease:

  • Microscopic examination of smear from the infected site.
  • In male: urethral discharge for culture and sensitivity.
  • In female: high vaginal swab for culture and sensitivity.
  • NAAT (Nucleic Acid Amplification Tests) for Gonorrhoea.

Prevention of Gonorrhoea:

Primary Prevention:

  • Avoid multiple sexual partners.
  • Use a barrier method of contraception.
  • Maintain genital hygiene.
  • Avoid sexual intercourse till cure. 

Secondary Prevention:

Early diagnosis and treatment of the infected patient and adequate treatment of the sexual partner simultaneously.

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