Gonorrhea

Overview

The ancient disease with modern treatments

Gonorrhea has plagued millions of people from the earliest times. But what was once known as a fatal disease is now fully curable with antibiotics and proper medical treatment.

A bacterial infection that is usually spread through sexual contact, gonorrhea affects the reproductive tissue in both men and women. Untreated, it can spread to the circulatory system and infect the heart, liver, joints, tendons, and other vital organs. Symptoms include burning and itching during urination, and a thick, yellowish fluid from the penis or vagina. But since women are less likely to show immediate symptoms than men, a doctor should check sexual partners if either has any of the signs of gonorrhea. Sometimes there are no symptoms — so if you have been exposed to gonorrhea but see no signs of it, it is still critical to get tested.

While the number of people with gonorrhea has been dropping since 1975, more than 800,000 new cases of gonorrhea still occur every year in the United States. You can prevent gonorrhea by adopting safer-sex practices, such as regularly using latex condoms and refraining from oral and anal sex unless you're confident that your partner is not infected. Also, you should not share personal items such as douche equipment.

Detailed Description

This sexually transmitted bacteria is passed between partners during oral, anal, or genital sexual contact. The bacteria thrive in the delicate, moist tissue found in the reproductive tract and genitals. They can also live in the throat, rectum, joints, or eyes.

Symptoms are generally easier to notice in men than in women. In men, the first symptoms usually appear two to seven days after infection. Mild discomfort in the urethra (which carries urine and semen through the penis) is followed in a few hours by mild to severe pain during urination and a flow of pus from the penis. Frequent, urgent needs to urinate gradually get stronger. The opening of the penis may become red and swollen.

In women, symptoms may first appear within seven to 21 days after infection. But weeks or months can pass with no sign of infection. Often doctors discover the disease in women only after diagnosing her male partner. The symptoms for women are usually mild, but they can become severe: pain during urination, frequent need to urinate, vaginal discharge, and fever. Women may notice pelvic pain and tenderness during intercourse because of infections in the cervix, uterus, fallopian tubes, ovaries, urethra, and rectum. The cervix, urethra, or glands near the vaginal opening may be the source of pus discharged from the vagina. A skin rash is another symptom.

While oral antibiotics such as penicillin and tetracycline used to be standard treatments for gonorrhea, some types of gonorrhea are now growing resistant to these drugs. To overcome this, doctors now prescribe for most people both an oral antibiotic and a potent injectable antibiotic, such as Rocephin (ceftriaxone). This combination will usually cure gonorrhea.

If you have symptoms of gonorrhea, it is critical that you abstain from sexual activity until you are tested and cured. If you are exposed to gonorrhea but don't have any symptoms, it is still vital that you get checked for the disease. Gonorrhea symptoms may take a while to become noticeable, but during that time the disease can progress and you can spread it to others. Because women often have no symptoms of a gonorrhea infection, it is especially important to know your sexual partner's history and to get checked if you see any signs of gonorrhea infection.

If you do not get treatment, the disease may cause pelvic inflammatory disease, which can infect internal reproductive organs and cause infertility; gonococcal arthritis; and infections of the heart, liver, tendons, joints and other vital organs.

If you have gonorrhea, you may also be infected with chlamydia, which is often difficult to detect. When you are tested for gonorrhea, your doctor should also check for chlamydia and potentially treat you on the assumption you have it, too.

How Common Is Gonorrhea?

Gonorrhea has reached epidemic proportions in the United States. Most new infections occur in people ages 18 to 30, but the disease may affect anyone who engages in sexual activity with an infected person. Infants are at high risk of being born with a severe eye infection (gonococcal conjunctivitis) if the mother is infected. Males and females are both affected, but symptoms are usually more noticeable in males.

Conventional Treatment

Goals of Treatment

Since there are effective treatments currently available, the goals of treating gonorrhea are both to get rid of symptoms and to cure the infection.

Treatment Overview

Treatment usually includes oral antibiotics and an injection of an antibiotic called ceftriaxone. You may also have other sexually transmitted diseases (STDs), which may mean your treatment will be more complex. Also, if the gonorrhea has spread to other organs, treatment may include a regimen of intravenous antibiotics for three to 10 days. No matter how severe the infection, anyone exposed to gonorrhea should have a follow-up culture study four to seven days after finishing treatment to make sure the medication got rid of the infection.

Your treatment probably won't require a hospital stay — you'll be treated in your doctor's office (usually by a gynecologist or family practitioner) and go home the same day. However, if complications arise you may need to stay in the hospital.

Drug Therapy

The following antibiotics are most commonly prescribed to treat gonorrhea and should always be taken with another antibiotic effective against chlamydia such as doxycycline or azithromycin:
Zithromax http://www.nmihi.com/a/azithromycin.html
Cipro http://www.nmihi.com/c/ciprofloxacin.html
Floxin (Ofloxacin)
Rocephin (Ceftriaxone
Suprax (Cefixime)
Noroxin
Sumycin
buy Minocycline
Amoxicillin http://www.nmihi.com/a/amoxicillin.html
While not an alternative to antibiotics, analgesics (acetaminophen or aspirin) can also be used to reduce fever or pain.

Considerations When Selecting Treatment

In the past, doctors used oral antibiotics as the solitary treatment for gonorrhea, an approach that cured infections quickly. But a growing problem exists with this form of treatment: certain strains of gonorrhea are developing a resistance to these drugs, lowering their effectiveness. Most doctors now also prescribe ceftriaxone, an injectable antibiotic.

Activity Recommendations

Until your infection is cured, be sure to stop having sex. If you have been exposed to gonorrhea but don't have any symptoms, you should still refrain from all sexual activity until you and your partner have been thoroughly checked for the disease. A follow-up culture after completion of treatment will show if the infection is cured.

Monitoring Gonorrhea

In most cases, gonococcus bacteria disappear after antibiotic treatment, but symptoms may come back. However, recurrent cases of gonorrhea are usually the result of re-infection, not treatment failure. Your doctor may need to take a culture to check whether the treatment worked.

Possible Complications

If caught in time, gonorrhea can be cured without any permanent damage. The following complications can arise if the infection is left untreated:

• Pelvic inflammatory disease in females
• Infertility
• Infectious arthritis
• Infection of the interior of the heart (endocarditis)
• Infection of the covering of the liver (perihepatitis)
• Epididymitis
• Increased risk of HIV infection

Quality of Life

If you are diagnosed with gonorrhea, inform all sexual partners who may have been exposed to the disease so they can also be tested, both now and after you are both treated. Be sure to abstain from sex until the infection is fully cured. Your doctor is required to report your infection to the local health department.

Pregnancy

If you're infected with gonorrhea during your pregnancy, your baby may become infected with the bacteria as he or she passes through the birth canal. This may cause swelling of both your baby's eyelids and discharge of pus from the eyes. All babies are treated at birth to prevent eye infections, and possible blindness. Doctors recommend that a pregnant woman have at least one test for gonorrhea before labor.

Nursing mothers

If you are nursing, check with your doctor before taking antibiotics. They could pass through your breast milk to your baby.

Considerations for Children and Adolescents

Genital infections in infants and young children may be a result of sexual abuse by adults. Any genital infection should be thoroughly examined by a doctor.

Teens will be treated for gonorhea, and also be taught about safer sex and STDs.

Considerations for Older People

Aging hampers the immune system, opening the way for infections such as gonorrhea. The characteristic signs and symptoms of gonorrhea may change or be absent in older people.