Gonorrhea

Gonorrhea is the second most common sexually transmitted infection (STI) in the world (Chlamydia is number one). For years, it was in decline in Canada and elsewhere. Then between 1997 and 2001, we experienced a 45 percent increase (among men aged 30 to 39, there was a 68 percent increase!). With more than 6,000 cases being reported a year, it became the most common disease in Canada of people under 30 years old.

Gonorrhea is curable. But, if left untreated, it can lead to serious complications, especially in women. In addition, gonorrhea makes HIV transmission easier.

Cause

Gonorrhea is caused by bacteria called Neisseria gonnorhoeae that can infect the genital tract (most common), mouth, and rectum of both men and women. The bacteria, which are carried in semen and vaginal fluids, spread by genital, oral, and anal sex. A baby born vaginally of a mother with gonorrhea can also get infected.

Symptoms

Gonorrhea, like Chlamydia, is often referred to as a silent disease since those infected, especially women, sometimes don't know they have it - until complications develop. If symptoms do appear they tend to occur in men within 2 to 10 days after sexual contact with an infected partner, and in women 7 to 21 days after. Some people can be infected for several months without showing symptoms.

What to look for:

• unusual (typically yellow or bloody) discharge from the vagina
• discharge (typically white, yellow, or green pus) from the penis
• pain or burning when peeing
• swollen testicles
• bleeding or pain associated with sexual intercourse (women)
• discharge, anal itching, soreness, bleeding from the rectum.

Later symptoms among women may include cramps and pain, bleeding between menstrual periods, vomiting, or fever.

Transmission

Gonorrhea is spread through person-to-person contact with the penis, vagina, mouth, or anus; ejaculation does not have to occur to get infected. Gonorrhea can also be spread from mother to infant during a vaginal birth.

There is no acquired immunity from gonorrhea; you can keep getting it over and over again.

Diagnosis

To confirm a diagnosis of gonorrhea, your doctor needs to take a sample of the discharge and examine it for the presence of N. gonnorhoeae under a microscope. Because this test only finds the disease 60 percent of the time among women (90 percent among men), its absence is not definitive and so the doctor has to have the sample cultured to produce more bacteria to be tested. Another type of test that is being used more frequently involves looking for DNA (the bacteria's genes) in the discharge sample. The doctor may also take a blood test; although it won't pick up a gonorrhea infection, it may pick up another STI. People who have one STI, often have more than one.

Risk

People who are the most vulnerable to getting infected with gonorrhea are men and women between the ages of 15 and 29 year of age, who have multiple sex partners and engage in unprotected sexual intercourse. The highest rates of infection are usually found in 15- to 19-year old women and 20- to 24-year-old men.

Treatment

If you think you may have gonorrhea:

• stop having sex.
• get tested and treated at a clinic or doctor's office;
• avoid over-the-counter pain relievers which may reduce signs or symptoms, but won't get rid of the infection;
• make sure your sexual partner(s) get treated to reduce reinfection;
• have follow-up tests to be sure you are clear of the infection.

All sexual partners within 2 months before symptoms onset or diagnosis should be treated.

The only effective therapy for gonorrhea is antibiotics. Your doctor will decide whether a single injection or a single pill is best for you.

To protect a newborn from getting infected, pregnant women are generally advised to have at least one test for gonorrhea during prenatal care. In addition, anti-gonoccal medication is routinely applied to an infant's eyes immediately after birth.

Complications

In women, the opening to the uterus, the cervix, is the first place of infection. Thus, untreated gonorrhea or infections that repeat frequently in women often spread to the uterus and fallopian tubes. Pelvic inflammatory disease (PID) may result, which can lead to infertility and tubal (ectopic) pregnancy.

In men, gonorrhea can scar the urethra, making urination difficult. Repeated epididymitis (inflammation of testicles) can leave men infertile.

Gonorrhea can spread through the bloodstream into the joints of both men and women causing inflammation and swelling - a type of arthritis known as Reiter's syndrome.

Prevention

Despite gonorrhea's increasing prevalence, there are certain things you can do to protect yourself from being infected:

• use latex or polyurethane condoms correctly and consistently during vaginal or rectal sexual activity, and dental dams for oral sex.
• get tested regularly for gonorrhea and other STIs if you are sexually active.
• if infected with gonorrhea, stop having sex until both you and your sexual partner(s) have completed antibiotic treatment. You can easily be reinfected if your partner is not treated as well.
• if treated for gonorrhea, get tested again three months later to be sure the antibiotics have cleared up the infection.

For more information :

The Society of Obstetricians and Gynaecologists of Canada

www.sogc.org

Sexuality and U

www.sexualityandu.ca