What is it?

Gonorrhea is caused by a bacteria, Neisseria gonorrhea, which invades the body’s mucus membranes causing inflammation and pus. Any close sexual contact, oral, vaginal or rectal, can transmit gonorrhea. Away from the warmth and moisture of the body, the bacteria quickly die.

A woman’s risk of infection during sexual intercourse with an infected man is about 60 to 90 per cent. A man’s risk of infection during sexual intercourse with an infected woman is 40 to 50 per cent. In women, infection of the rectum occurs not only during anal sex, but also when infected vaginal secretions are carried toward the anus. It is possible to infect other areas of your own body, ie. touching vaginal discharge and then wiping your eye.

What are the symptoms?

The incubation period for gonorrhea is short (two to 10 days). Symptoms may include the following:

Vaginal/Cervical infection:

• Increased vaginal discharge.
• Vaginal irritation.
• Burning on urination.

Oral infection:

• Often no symptoms—a sore throat is possible.

Rectal infection:

• Often no symptoms—rectal discomfort may be felt, or
• Rectal discharge of pus and/or blood.

Generalized infection:

If untreated, gonorrhea can spread to the bloodstream and, thus, throughout the body. The most common symptoms are then rash and joint pains, but other generalized symptoms may result as well.

How is it diagnosed?

Note: Routine testing for urethral gonorrhea in the men’s clinic is now done using a urine sample instead of a swab. In order to get an accurate result with this new test it is important that you do not urinate for one hour prior to your test.

When women are examined, their cervix may look irritated and contain pus, or it may look perfectly healthy. It is, therefore, important to culture the secretions of the throat, urethra, cervix and anus. If a woman’s partner is diagnosed as having gonorrhea, she should assume that she has it too, with or without positive tests.

If, during internal examination, a woman has pain when her uterus or tubes are touched, and/or any abnormal mass is found, the diagnosis of PID is considered.

PID (Pelvic Inflammatory Disease) is the spreading of gonorrhea from the cervix to the lining of the uterus and fallopian tubes. Symptoms may be mild or severe and might include the following:

• Lower abdominal pain
• Pain with intercourse
• More pain during periods
• Irregular spotting between periods
• General unwellness, fever and chills
• Weight loss

PID can result in scarring of the fallopian tubes which can lead to tubal (ectopic) pregnancy at a later date, or infertility.

Gonorrhea often co-exists with other infections. For example, 40 per cent of women with gonorrhea also have chlamydia. Therefore, tests should also be done for this condition.

How is it treated?

Gonorrhea is treated with antibiotics, usually a single large dose in one pill. Oral and rectal gonorrhea are sometimes more difficult to treat and may require additional medication. It is essential to follow treatment as instructed. As well, do not have sexual intercourse until follow up tests have been completed and have shown negative results.

The treatment of PID may require hospitalization and intravenous antibiotics. If treated at home, a woman should be reevaluated regularly to insure that she is improving. PID can sometimes involve more than one type of bacteria and treatment may require several types of antibiotics at once. If a woman has an IUD it should be removed 48 hours after antibiotics are begun.

Follow-up

All women suspected of having gonorrhea should have one follow-up test one week after treatment is completed. If the original test was positive, two follow up tests should be done—the first one week after treatment and the second two weeks after treatment. Ideally, one of the tests should be done following a menstrual period.

Women who have had PID may have recurring discomfort, particularly during sexual intercourse. This is due to scar tissue (adhesions) which develop during the infection. Also, women who have had PID should not use the IUD for birth control and should be aware of the possibility of tubal pregnancy.

Prevention

Women should inform all partners of the past two to three months. Although men usually have obvious symptoms of gonorrhea, there are a significant number who have no symptoms at all. Barrier methods of birth control, such as condom with foam or sponge, or a diaphragm protect against gonorrhea. Spermicides (creams, jellies and foam) kill bacteria as well as sperm, thus lessening the risk of infection.

What about my sexual partners?

If you have more than one partner, or if your partner has more than one partner, it is a good idea to have routine testing for gonorrhea because of the severe consequences for women if this infection goes untreated. Some doctors do not always test for gonorrhea when doing a routine Pap smear. A Pap smear itself will not pick up gonorrhea. Be sure to ask for specific STD testing.

Gonorrhea is easily treated if found early. However, having it once does not give you immunity—you can catch it again.