Let's talk about GONORRHOEA!! Want to know of it's SYMPTOMS and COMPLICATIONS?

Can you believe that gonorrhea is primarily associated with uncomplicated infection of the lower genital tract, which is symptomatic in most men (over 90%) and in women of approximately 50%?

Let's talk about GONORRHOEA!! Want to know of it's SYMPTOMS and COMPLICATIONS?

Written by Bukola/ Published 12/11/22

Gonorrhoea is the second most common bacterial sexually transmitted infection (STI) worldwide.

Gonorrhoea infection is strongly associated with deprivation, mainly amongst young heterosexuals in urban areas. Transmission is perpetuated by higher rates of partner change and complex sexual networks, which can lead to localized outbreaks.

[PHE, 2021; WHO, 2021].

 

WHAT IS GONORRHOEA?

 

Gonorrhoea is a sexually transmitted infection (STI) caused by the Gram-negative bacterium Neisseria gonorrhoeae.

Uncomplicated gonorrhoea infection primarily affects the mucous membranes of the urethra, endocervix, rectum, pharynx, and conjunctiva.

 

HOW COMMON IS IT?

In 2020, there were 57,084 diagnoses of gonorrhoea made in England, a 20% decrease compared with 2019.

Gonorrhoea infection is concentrated in core risk groups, including men who have sex with men (48% of all diagnoses) and people of black Caribbean ethnicity.

In general, young people (aged 15–24 years) have the highest diagnosis rates of STIs, including gonorrhoea. In 2020, there were 19,262 diagnoses of gonorrhoea in young people made in England, a 25% decrease compared with 2019

 

[PHE, 2022; PHE, 2021].

 

HOW IS IT TRANSMITTED?

Gonorrhoea is transmitted by direct inoculation of secretions from one mucous membrane to another.

Infection of the eye most commonly results from autoinoculation.

Gonococcal infection among infants usually results from exposure to infected cervical exudates at birth.

 

(WHO, 2016; Fifer, 2020; Unemo, 2020; PHE, 2021; BMJ, 2022).

 

RISK FACTORS ARE?

Young age (15–24 years).

New sexual contact in the last year, or more than one partner in the last year .

Inconsistent condom use.

Certain sexual activities, for example men who have sex with men (MSM). 

Current or prior history of sexually transmitted infection (risk factor for repeat infections).

History of sexual or physical abuse.

Previous incarceration.

Deprivation

[BMJ, 2022; Yonke, 2022; PHE 2021]

 

CLINICAL FEATURES ARE:

In men:

 Urethral infection: This causes mucopurulent or purulent urethral discharge (in more than 80% of cases) and/or dysuria (burning sensation when passing urine) (in more than 50% of cases), appearing 2–8 days after exposure. Urinary Frequency and urgency are usually absent. Rarely, the person may complain of testicular and epididymal pain. Urethral infection is asymptomatic in less than 10% of men.

Rectal infection is usually asymptomatic but may cause anal discharge, acute proctitis, perianal/anal pain or discomfort, tenesmus, or rectal bleeding. Rectal pain is more common in men who have sex with men.

Pharyngeal infection is asymptomatic in most cases but is occasionally associated with a sore throat.

 

In women:

Urethral infection may present with dysuria without urinary frequency.

Endocervical infection may present with: Increased or altered vaginal discharge (up to 50% of cases).

Lower abdominal pain (up to 25% of cases).

Intermenstrual bleeding or menorrhagia (rarely).

Pain during intercourse (dyspareunia) if the infection spreads from the endocervix.

Rectal infection is usually asymptomatic but may cause anal discharge and perianal/anal pain or discomfort. Rectal infection in cisgender women is present in up to 30% of cases of urogenital infection, and individuals may not report a history of anal sex. Limited evidence suggests that rectal infection in the absence of urogenital infection is uncommon.

Pharyngeal infection is asymptomatic in most cases but is occasionally associated with a sore throat.

 

COMPLICATIONS OF UNTREATED GONORRHOEA INCLUDE:

 

IN MEN:

Epididymitis or orchitis.

Prostatitis.

Infertility.

Urethral stricture.

 

IN WOMEN:

Pelvic inflammatory disease — this occurs in up to 33% of women with gonorrhea and can result in chronic pelvic pain, tubal infertility, or ectopic pregnancy.

Rarely, peritoneal spread, including perihepatic abscesses (Fitz-Hugh-Curtis syndrome).

Pregnancy complications, including spontaneous abortion, premature labour, early rupture of fetal membranes, perinatal mortality, and gonococcal conjunctivitis in the newborn.

Disseminated gonorrhea is a potentially serious complication that is thought to occur in 0.5–3% of untreated gonorrhea cases. It occurs with bacteraemia and spreads, leading to septic arthritis, polyarthralgia, tenosynovitis, petechial/pustular skin lesions, or, on rare occasions, endocarditis, or meningitis.

[WHO, 2016; Fifer, 2020; BMJ, 2022; Marrazzo, 2010; CDC, 2019]

 

PLEASE REFER TO YOUR PRIMARY CARE PROVIDER FOR ADVICE, DIAGNOSIS AND TREATMENT.

 

 

REFERENCE

BMJ (2022) Gonorrhoea infection. BMJ Best Practice. http://bestpractice.bmj.com

Fifer, H., Saunders, J., Soni, S., et al. (2020) 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae. International Journal of STD and AIDS 31(1), 4-15. [Abstract]

Marrazzo, J.M., Handsfield, H.H. and Sparling, P.F. (2010) Neisseria gonorrhoeae. In: Mandell, G.L., Bennett, J.E. and Dolin, R. (Eds.) Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 7th edn. Philadelphia: Chuchill Livingstone, 2753-2770.

 

NICE (2017) Child maltreatment: when to suspect maltreatment in under 18s. National Institute of Health and Care Excellence. http://www.nice.org.uk

NICE (2022) Reducing sexually transmitted infections. National Institute for Health and Care Excellence. http://www.nice.org.uk

PHE (2021) Guidance for the detection of gonorrhoea in England. Public Health England. http://www.gov.uk

PHE (2022) Sexually transmitted infections and screening for chlamydia in England, 2020. Public Health England. http://www.gov.uk

Preston, C.L. (2020) Stockley's Drug Interactions. Medicines Complete. Pharmaceutical Press. https://about.medicinescomplete.com

Unemo, M., Ross, J., Serwin, A.B. et al. (2020) 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults. International Journal of STD and AIDS, 1-17. [Abstract]

WHO (2016) Treatment of Neisseria gonorrhoeae. World Health Organization. http://www.who.int

WHO (2021) Gonorrhoea: latest antimicrobial global surveillance results and guidance for vaccine development published. World Health Organization. http://www.who.int

Yonke, N., Aragón, M. and Phillips, J.K. (2022) Chlamydial and gonococcal infections: screening, diagnosis, and treatment. American Family Physician 105(4), 388-396. [Abstract