Gonorrhoea

Gonorrhoea is a sexually transmitted disease caused by the bacteria Neisseria gonorrhoeae (gonococci).

Gonorrhoea is manifested by inflammation of the genital organs, including a discharge typical of the disease. However, the bacteria can also spread to other organs. Neisseria are transmitted through unprotected sexual intercourse with an infected person, or during birth from mother to child.

For a long time, the number of cases of gonorrhoea declined, but since the mid-1990s there has been an increase in the number of cases in Germany. Young adults are the main risk group. Women and men are affected to the same extent. The average age of onset is about 30 years. Until the year 2000, gonorrhea was considered a notifiable disease, but since the majority of cases were not reported, the reporting requirement was relinquished.

Congenital gonorrhea used to be considered the most common cause of blindness in children in the Western world. To counteract this blindness, silver nitrate was dripped into the eyes of newborns.

The disease is triggered by infection with neisseria (gonococci). The main source of transmission is sexual intercourse. Infection is possible when body fluid containing bacteria comes into direct contact with the mucous membrane (for example, urethra, cervix, rectum, pharynx, conjunctiva). If a pregnant woman is affected by gonorrhoea, there is a risk that she will infect her baby during the birth process.

The following people are at high risk of contracting the disease:

• People who change sexual partners frequently
• People who have unprotected sexual intercourse, as gonorrhea can be transmitted during vaginal, oral and anal intercourse.

The disease manifests itself through typical symptoms such as discharge. In some cases, there are no symptoms at all after a gonorrhoea infection (silent infection). Around 50% of women who suffer from gonorrhoea do not show any symptoms. In contrast, only about one tenth of men with gonorrhea have no symptoms. Thus, there is a risk that the disease will be passed on unknowingly, increasing the risk of spreading gonorrhea unnoticed.

Symptoms in men:

• Burning pain when urinating, which in the worst cases resembles the feeling of having broken glass in the urethra.
• Discharge from the urethra. At first, only small amounts are formed, which have a mucus-like consistency. However, the amount increases as the stage progresses.
• During anal intercourse, gonorrhea can cause inflammation in the rectum. This can be recognized by mucopurulent admixtures in the stool, as well as pain during defecation.

Symptoms in women:

• In the early stages, symptoms can often be very mild. There is discharge and a slight burning sensation when urinating.
• A possible inflammation of the cervix (cervicitis) can be manifested by a purulent discharge, as well as by contact bleeding.
• In some cases, gonorrhea can cause ascending inflammation of the uterus, fallopian tubes, and ovaries, which brings fever, lower abdominal discomfort, discharge, and spotting.

In both men and women, gonorrhea infection can affect the entire body. If this is the case, sufferers will show fever, skin lesions, painful joint inflammation and tendonitis. An exception is the spread to the meninges (meningitis) and the heart (endocarditis).

Newborns often have purulent conjunctivitis after infection has occurred in the birth canal. Depending on the route of infection of the gonorrhoea bacteria, non-specific symptoms in the throat and pharynx (sore throat, bad taste) may also occur.

To diagnose gonorrhea, the doctor takes a swab, which should show the bacteria (gonococci).

An examination for neisseria is performed on all those who have a purulent discharge from the urethra, vagina or cervix.

Partners of infected persons and persons suffering from unexplained inflammatory lower abdominal complaints are subjected to an examination for gonorrhoea. Men under the age of 40 who have testicular or epididymitis are also advised to undergo gonococcal testing.

To ensure a reliable diagnosis, the pathogens must be detected. This is done with the help of a swab from the conjunctiva, urethra, uterus, throat or anus. In addition, the gonorrhea pathogens are cultivated in specific media (bacterial culture) in order to examine them under the microscope.

In addition, the bacterial cultures are also used to test the effectiveness of different antibiotics to see which antibiotic achieves the best cure and which are ineffective. In recent years, there has been an increasing incidence of bacteria that have shown immunity to common antibiotics. In gonorrhoea sufferers who have no symptoms (asymptomatic), methods based on laboratory propagation of the bacterial genome (PCR) show more precise accuracy than bacterial cultures.

The first choice in the treatment of gonorrhea are antibiotics. In the past, mainly penicillin was used. However, since penicillin-resistant gonococcal strains from Africa and Asia have been observed more and more frequently in recent times, other antibiotics (mainly cephalosporins and gyrase inhibitors) are now used.

In most cases, a single treatment is successful, as the gonococci die off and are no longer detectable. Nevertheless, it is advisable not to end the therapy for gonorrhoea too early under any circumstances. This favours the development of resistance, which is very difficult to treat.

All sexual partners of those infected with gonorrhea must also be examined and treated in case of disease. This is especially the case for sexual contacts within two weeks before the onset of the first symptoms. If it is a silent infection without symptoms, all sexual partners of the last 90 days should be examined. Sexual contact should not be resumed until therapy has ended.

Newborns suffering from purulent conjunctivitis caused by gonorrhoea are given a single dose of antibiotics into the muscle (intramuscular) or into the vein (intravenous). In addition, regular rinsing of the eyes and conjunctiva with a saline solution is recommended.

The prognosis of gonorrhea is positive in most cases. If the disease is detected in time, no late sequelae are to be expected. For this reason, therapy is essential.

In very rare cases, it can also happen that the gonorrhea pathogens spread throughout the body through the bloodstream. In this case, one speaks of gonococcal sepsis. Symptoms can include joint and tendon sheath inflammation, typical skin rashes with red pustules or small bleedings (petechiae), fever and chills.

In the worst case, gonococcal sepsis can lead to meningitis and endocarditis.

If gonorrhoea remains untreated, serious illnesses can result. Late consequences include chronic inflammation of the internal genital organs with persistent pain, adhesions of the oviducts or vas deferens and infertility as well as joint inflammation.

Gonorrhoea can be prevented in the same way as other sexually transmitted diseases by using condoms during sexual intercourse.

If you suspect that you have gonorrhoea, you should urgently consult a doctor. In any case, the partner should also be involved and treated, otherwise there is a risk of re-infection (ping-pong effect). Treatment should also be carried out if the partner is not suffering from any symptoms.

Pregnant women are already examined for gonorrhoea in advance.