Gonorrhea is a highly contagious sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae bacterium. The genitourinary tract is the main system that is usually affected, but gonorrhea can also spread to the rectum, the throat, and the eyes. Left untreated, gonorrhea can spread through the bloodstream and infect the brain, heart valves, joints, and the reproductive system. Exposure to an infected mother during birth may cause permanent blindness in the newborn.
Description
Gonorrhea, commonly referred to as “the clap,” is the most prevalent reportable disease in the United States. Adolescents and young adults are in the highest risk category, with more than 80% of gonorrhea cases affecting the 15–29 year-old age group. Individuals living in urban areas who have multiple sex partners have the highest risk of contracting the disease.
Still, the incidence of gonorrhea has been steadily declining since 1987. This appears to be largely due to increased public awareness about the risks and prevention of contracting STDs such as herpes and HIV. However, in 2002, the Centers for Disease Control (CDC) expressed concern about rising rates of gonorrhea in certain urban areas during 1999 and 2000. About 650,000 new cases of gonorrhea occur every year in the United States. In particular, rates of gonorrhea were increasing substantially among men who have sex with men.
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Causes & symptoms
Gonorrhea is transmitted very efficiently. It can be spread by merely contacting the fluids of an infected person as well as by sexual contact. A person runs a 60–90% chance of contracting the disease after just one sexual encounter with an infected person. The symptoms usually begin between one day and two weeks after the initial encounter with the infection.
People who are infected with gonorrhea commonly experience increasingly frequent and painful urination, and the urethra may be painful and swollen. There may be a thick white, yellowish, or bloody discharge from the penis or vagina. Other symptoms may include nausea, vomiting, fever, chills, and pain during intercourse.
In the case of oral infection, there may be a sore throat or pain during swallowing. An anal infection may cause rectal itching, rectal discharge, and a constant urge to move the bowels. Women who show symptoms of gonorrhea often have abdominal pain and breakthrough bleeding (spotting) between menstrual periods. However, many women who have gonorrhea do not experience any symptoms.
In infants and children, irritation, redness, swelling with a pus-like discharge, and possibly pain and a change in urination may point to a gonorrhea infection. The infection may be due to child abuse or exposure to infected materials. An in-depth history should be taken if gonorrhea is suspected.
Diagnosis
The initial diagnosis of gonorrhea will be based on symptoms, sexual history, and at-risk behavior. One laboratory test for diagnosis involves the observation of a gram-stained sample of the discharge under a microscope. In the gram stain test, the sample is dyed, washed with various solutions, and dyed with a different color. The final color identifies the class of bacteria present in the sample. The advantage of this test is that results can be obtained very quickly so that treatment can commence at the initial visit. In the vast majority of men, it is quite accurate; however, the test is not very accurate for women.
For all women and for men with a questionable gram-stain reading, samples of the discharge from the infected area can be collected and cultured. The sample is incubated for up to two days, which provides enough time for the bacteria to multiply and be accurately identified.
This test is very accurate and specific for gonorrhea, but improper handling can lead to a false-negative reading. Other tests coming into favor include the ELISA (enzyme-linked immunosorbent assay) antibody test and DNA probe testing of genetic material from the discharge, both of which are quite accurate in identifying Neisseria gonorrhoeae.
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Treatment
Although there is nothing that can totally replace antibiotics in the treatment of gonorrhea, certain herbs and minerals may be used to supplement the treatment. These may be used to improve the body’s immune function: zinc, multivitamins and mineral complexes, vitamin C, and garlic (Allium sativum). Lactobacillus acidophilus in supplements and live-culture yogurts help replenish gastrointestinal flora that may be destroyed by the intake of antibiotics.
Several herbs may reduce symptoms and help speed healing. These include kelp (Macrocystis pyrifera and related species), Calendula officinalis, myrrh (Commiphora molmol), and Thuja occidentalis. These herbs can be taken by the mouth or used as a douche. The Chinese herb Coptis chinensis, used for damp-heat infections, is helpful in treating the genitourinary tract, especially if pelvic inflammatory disease (PID) develops.
An herbalist should be consulted to make recommendations for further complications. Some recommend a three-day cleansing fast to quicken and support healing. Fasting should be done only with the approval and supervision of a physician. Referral to an acupuncturist is also recommended, as there may be acupressure and acupuncture points that will help with system cleansing.
Allopathic treatment
The typical treatment for gonorrhea is penicillin or a penicillin derivative, given orally or by injection. If the patient is pregnant or allergic to penicillin, erythromycin may be substituted. Gonorrhea has become more difficult and expensive to treat since the 1970s because it has become increasingly resistant to certain antibiotics.
In fact, according to projections from the Centers for Disease Control and Prevention, 30% of the strains of gonorrhea were resistant to routine antibiotics in 1994, and resistance has been increasing steadily. Because of this, the doctor may also prescribe probenecid, which will increase the antibiotic activity.
In 2002, the Centers for Disease Control (CDC) updated guidelines concerning antibiotics for treating gonorrhea. Resistance of the infection has increased to certain classes of drugs, particularly when gonorrhea was contracted in certain states, particularly California. Guidelines had already warned against use of these drugs, called fluoroquinolones, in Hawaii, other Pacific islands, and Asia.
Since other STDs, such as chlamydia and syphilis, often occur with gonorrhea, patients may also be tested and treated for these related infections. Patients should refrain from sexual intercourse until treatment is complete and should return for follow-up testing. Anyone the patient has had sexual contact with during the time of infection should be notified and treated, even if those persons do not show symptoms. Doctors are required to report this disease to public health officials.
More than one health care provider may have to be consulted. Physicians trained in obstetrics or gynecology may be involved if gynecological complications occur. Men who experience complications may be referred to a urologist. There are also infectious disease doctors who specialize in the treatment of infectious diseases, including STDs.
Expected results
The prognosis for patients with gonorrhea varies based on how early the disease is detected and treated. Patients who are treated early and properly can be entirely cured of the disease. The most common complication is PID. PID can occur in up to 40% of women with gonorrhea and may result in damage to the fallopian tubes, an ectopic pregnancy, or sterility. If an infected woman is pregnant, gonorrhea can be passed on to the eyes of the newborn during delivery. This can lead to infection and blindness.
Although the risk of infertility due to gonorrhea is higher in women than in men, men may also become sterile if urethritis (inflammation of the urethra) develops. Complications of gonorrhea can affect the prostate, testicles, and surrounding glands as well. In either gender, inflammation, abscesses, and scarring can occur. In approximately 2% of patients with untreated gonorrhea, the infection may spread throughout the body and can cause fever, arthritis-like joint pain, and skin lesions.
Prevention
Currently, there is no vaccine for gonorrhea. The best prevention is to abstain from having sex, or to engage in sex only when in a mutually monogamous relationship in which both partners have been tested for STDs. The next line of defense against gonorrhea is the use of condoms, which have been shown to be highly effective in preventing disease.
The use of a diaphragm can also reduce the risk of infection. Since the risk of contracting gonorrhea increases with the number of sexual partners, those who have sexual contact with more than one partner are advised to be tested regularly for gonorrhea and other STDs.
