Gonorrhea: Symptoms, Causes and Treatment

Gonorrhea is a sexually transmitted disease that's transmitted through semen and vaginal fluids. Using protection is the best way to combat it.

Written and verified by el biólogo Samuel Antonio Sánchez Amador.

Last update: 17 March, 2021

Every day, more than 1 million people contract a sexually transmitted infection (STI). This means that, per year, about 376 million patients around the globe suffer the effects of one of these 4 diseases: gonorrhea, chlamydia, syphilis, and trichomoniasis.

Many people tend to think of STIs as a bad experience, an itch, or a brief annoyance, but nothing could be further from the truth. For example, the human papillomavirus (HPV) in women is the cause of at least 70% of cervical cancer cases. Other STIs result in infertility, miscarriages, and severe pelvic inflammation.

For all these reasons, today we’re going to address one of the 4 most common STIs: gonorrhea. If you want to know about the symptoms, causes, and treatment of this disease, keep reading.

The significance of STIs in the world

While we’ve presented you with some shocking numbers by way of introduction, they don’t even cover the tip of the iceberg. The World Health Organization (WHO), in addition to the data already mentioned, brings us even more:

• More than 370 million patients are infected each year with one of these diseases: syphilis (12 million), gonorrhea (62 million), chlamydia (92 million), and trichomoniasis (more than 174 million).
• It’s estimated that more than 500 million people carry the herpes simplex virus (HSV), which causes genital infections.
• More than 290 million women are infected with the human papillomavirus (HPV). Varieties 16 and 18 cause at least 70% of the world’s cervical cancer (CUC) cases. This results in 311,000 deaths annually, almost all in low- and middle-income countries.
• In 2016, more than 980,000 pregnant women contracted syphilis. This resulted in 200,000 premature fetal deaths.
• Some STIs can facilitate HIV infection.

We can brush all this information aside, but we must understand that STIs are not a game.

We’re not only referring to adults, but also to young people who are discovering sexuality: news shows that 1 in 4 students will contract one of these infections before leaving high school.

Given all these figures, the warning is clear: the use of condoms can save lives.

What is gonorrhea?

Now that we’ve described the importance of STIs globally, we’re ready to move on. According to the Centers for Disease Control and Prevention (CDC), gonorrhea is defined as an infection caused by a sexually transmitted bacteria that affects both men and women. The causative agent is Neisseria gonorrhoeae.

Knowing the bacteria

Before addressing the symptoms and treatment of the disease, it’s necessary to get to know the causative agent. As indicated by the Vircell portal, Neisseria gonorrhoeae is a gram-negative bacterium, difficult to culture under experimental conditions and differentiated from the rest of the Neisseria species due to its ability to ferment only glucose.

It’s an aerobic or facultative anaerobic, which means that oxygen doesn’t prevent it from growing, and it appears under the microscope in the form of a diplococcus, with an average size of 0.8 micrometers. This microorganism grows best in a temperature range of 35-37°C, a CO2 concentration of 3-5% and a pH between 7.2-7.6.

Attending to the physiological needs of this organism, we can see that the perfect place for its proliferation is the genital area of the human body.

Symptoms

Gonorrhea, in more than 50% of the cases of female patients, is asymptomatic. As indicated by the Pan American Health Organization (PAHO), this means that many of the infections are never treated and the contagion rate is even higher, as the patient doesn’t realize their transmission potential.

In cases where quantifiable clinical signs do appear, these tend to be prevalent in the genital area. In women who are physically affected, the following symptoms are common:

• Increased vaginal discharge
• Pain when urinating
• Vaginal bleeding between periods, that is, outside the normal menstrual cycle
• Abdominal or pelvic pain

In men, the clinical picture is more remarkable. According to the MSD Manuals portal, about 25% of men show minimal symptoms, but almost none of them are asymptomatic. Some of the most common problems in the male gender are the following:

• Pain when urinating
• A discharge of a purulent nature in the area of the penis
• Pain or swelling in a testicle

In cases where only one of the two testicles hurts, doctors will confirm that the bacteria have settled in the epididymis, the tube that carries semen to the back of the testicle. Due to the presence of harmful foreign agents, this duct becomes inflamed and takes on an atypical appearance.

You should bear in mind that, in addition to this, the bacteria that cause gonorrhea can spread to other parts of the body. Next, we’ll show you how the organism responds to the different infectious sources.

1. Anus

This is usually asymptomatic. It occurs mostly in men who have receptive anal sex and in women who also have anal sex. In cases where clinical signs appear, anal itching, purulent discharge from the rectum and bright colored spots in the stools are usually detected, as if it were a hemorrhoid.

2. Eyes

Newborns are susceptible to eye infections caused by the bacteria Neisseria gonorrhoeae and Chlamydia trachomatis. The infant is infected by passing through the birth canal and, unfortunately, the bacteria settle in their eyes.

In any case, this event isn’t limited only to newborns. As some reports show, adults can also have this infection. The eyes are red, purulent, with lesions, and very intense itching and pain.

3. Throat

Gonococcal pharyngitis is usually asymptomatic, but there’s a risk of developing it when you have oral sex with an infected person. In the few cases where signs do appear, these usually manifest with a sore throat, difficulty swallowing, fever, and swollen lymph nodes.

4. Joints

If the bacteria pass into the bloodstream, different generalized symptoms can appear. Among them is pain in the joints, which are swollen, red, hot and very painful.

Other complications

When the gonococcal infection gets out of control and becomes generalized, the patient’s condition worsens considerably. People with this severe medical condition have a fever, migratory pain, and pustule-shaped skin blisters. This can be confused with other disorders, but needs to be addressed immediately.

How is contagion produced?

As indicated by sources already cited, gonorrhea is transmitted through sexual contact, hence it falls into the group of STIs. We’re not only talking about penetration, because as we have said, oral and anal sex are also potential routes of transmission. You must bear in mind that the bacteria travel through genital fluids.

It can also be passed from mother to child through the birth canal once the child is born, although this isn’t as common. Finally, it’s necessary to emphasize that this disease isn’t transmitted by acts such as kisses, caresses or by sharing glasses and cutlery: the vehicle of contagion is sexual fluids, such as semen and flow.

Diagnosis

As indicated by the United States National Library of Medicine, gonorrhea can be detected quickly. To do this, you only need to obtain a sample of the mucosa of the affected area and analyze it under a microscope. However, even though this test is the fastest, it isn’t the most reliable.

The best detection method is DNA testing on the sample. Usually, sections of the mucosa of the cervix, bladder, urethra, vagina, anus, or throat are collected with a swab and then subjected to a ligase chain reaction (LCR). Although this test is more expensive and time consuming, it certainly leaves no room for error.

Treatment

Possible treatment should take into account the existence of antimicrobial resistant strains (ADRs).

As indicated by the WHO, multidrug-resistant gonorrhea is a major health problem today, as it can show resistance to penicillins, sulfonamides, tetracyclines, quinolones, and macrolides (including azithromycin) and even to last-resort antibiotics, such as cephalosporins.

If there’s no evidence of the presence of these strains in the society the patient comes from, then one of the following approach options is usually used:

1. A large dose of oral antibiotics or smaller doses over a week. In the first case, the preferred option is cefixime in a dose of 400 milligrams orally by a single dose plus azithromycin in a dose of 1 gram orally by a single dose.
2. Injected and oral antibiotics. Ceftriaxone in doses of 250 milligrams intramuscularly in a single dose and azithromycin in doses of 1 gram orally in a single dose.
3. The most serious cases may require hospitalization and healthcare, in addition to the drugs described above.

Prevention

The use of condoms is the key, not only to avoid gonorrhea, but all sexually transmitted infections.

Sex is necessary for people’s physical and emotional well-being, but this doesn’t mean that precautions shouldn’t be taken before practicing it.

Also, oddly enough, it’s recommended that sexually active women in non-monogamous settings (especially young ones) get tested for gonorrhea relatively regularly.

As we’ve said, in many cases the infection is asymptomatic, and so it will always be better to prevent the disease than to spread it.

Having more than one sexual partner doesn’t imply an increased risk of suffering gonorrhea, as long as the appropriate measures are taken in all types of practices.

Summary

As you may have seen in this article, gonorrhea isn’t a disease to be underestimated. Despite not showing complications in most cases, when it does, it can cause generalized infections, infertility, and blindness in neonates, among other things.

Therefore, we can’t emphasize enough the following advice: protect yourself and others, and use a condom. It’s true that the heat of the moment during sex can cloud our thoughts, but you should always think about the consequences and manage your emotions accordingly.