Green Health

The risk factors for gonorrhea are not unlike those for all sexually transmitted diseases. Both men and women can become infected through a variety of sexual contact behaviors, including oral, anal, or vaginal intercourse. The disease is transmitted very efficiently. In fact, women run a 60-90% chance of contracting the disease after just one sexual encounter with an infected male. The disease can also be transmitted from an infected mother to her infant during delivery.

If treated early, gonorrhea can be cured. Unfortunately, many individuals with gonorrhea, particularly women, will experience no symptoms to alert them to the possibility that they have contracted gonorrhea, and therefore, many do not seek treatment. When present, the symptoms and complications of gonorrhea are primarily limited to the genital, urinary, and gastrointestinal systems and usually begin between one day and two weeks following infection. If left untreated, serious complications can result if the disease spreads to the bloodstream and infects the brain, heart valves, and joints. Untreated gonorrhea can also result in severe damage to the reproductive system, making an individual unable to conceive a child (sterile).

As many as 80% of women with gonorrhea show no symptoms. If present, symptoms may include the following:

Because women often do not show any symptoms, complications are more likely to occur as the disease progresses. The most common complication is pelvic inflammatory disease (PID). PID can occur in up to 40% of women with gonorrhea and may result in damage to the fallopian tubes, a pregnancy developing outside the uterus (ectopic pregnancy), or sterility. If an infected woman is pregnant, gonorrhea can be passed on to her newborn through the birth canal during delivery. These infants may experience eye infections that could lead to blindness.

Men are more likely to experience the following symptoms:

In men, complications can affect the prostate, testicles, and surrounding glands. Inflammation, tissue death and pus formation (abscesses), and scarring can occur and result in sterility.

The diagnosis of gonorrhea can be made at a public health clinic or a family physician office. First, the doctor will discuss symptoms and the patient's known contact or at-risk behavior. There are three methods available to test for the presence of Neisseria gonorrhoeae. These include a culture, a Gram stain, and an ELISA test. Culture of secretions from the infected area is the preferred method for gonorrhea screening in patients with or without symptoms. A cotton swab can be used to collect enough sample for a culture. The sample is incubated for up to two days, providing enough time for the bacteria to multiply and be accurately identified. This test is nearly 100% accurate.

Gram stains are more accurate in the diagnosis of gonorrhea in men than in women. To perform this test, a small amount of discharge from the infected area will be placed on a slide, stained with a special dye, and examined under a microscope for the presence of the gonococcus bacteria. The advantage to this test is that results can be obtained very quickly at the initial visit. Because it requires that the physician or technician be able to recognize and accurately identify the bacteria simply by looking at it under a microscope, however, this test is only about 70% accurate. As a result, one of the other methods may also be used to confirm the diagnosis.

ELISA, or enzyme-linked immunosorbent assay, has emerged as a rapid and sensitive test for gonorrhea. It is much more sensitive than the gram stain and is more convenient than the culture test, which involves the transport and storage of samples. As of late 1997, several other diagnostic tests were being researched with the goal of providing a cost-effective method of screening for a variety of sexually transmitted diseases. One of the most interesting of these is a home test that can be taken by the patient themselves, allowing for a degree of privacy and confidentiality.

When a patient suspects exposure to or experiences symptoms of gonorrhea, he or she may see a public health provider or family practice physician. Physicians trained in obstetrics or gynecology may also be involved, particularly if gynecological complications occur. Men who experience complications may be referred to a urologist. There are also infectious disease physicians who specialize in the treatment and research of all infectious diseases, including those transmitted sexually. All physicians must report this highly contagious disease to public health officials, and patients are asked to provide the names of sex partners during the suspected period of infection so that they can be notified of the risk.

Gonorrhea has become more difficult and expensive to treat since the 1970s, due to the increased resistance of gonorrhea to certain antibiotics. In fact, according to projections from the Centers for Disease Control and Prevention, 30% of the strains of gonorrhea were resistant to routine antibiotics in 1994, and resistance has been increasing steadily. Furthermore, many patients have both gonorrhea and chlamydial infections. Therefore, two drug treatment regimens are common. Medications used to treat gonorrhea include ceftriaxone, cefixime, spectinomycin, ciprofloxacin, and ofloxacin. Ceftriaxone and doxycycline or azithromycin are often given simultaneously to treat possible co-existing chlamydia (in pregnant women, erythromycin should be substituted for the aforementioned anti-chlamydial agents). In 2004, reports said that oral antibiotics were preferred over intramuscular forms of the drugs. Also, researchers reported that cefixime had not been available and that fluoroquinolone had been used by more physicians to treat gonorrhea. However, fluoroquinolone resistance was rising among patients with gonorrhea, and in June 2004 the Centers for Disease Control recommended that clinicians no longer prescribe the drug as first-line treatment for gonorrhea in men who have sex with men.

An extremely important consideration is to make sure that all of the prescribed medication is taken. If a course of antibiotics is not completed, the medication will only kill those organisms that are susceptible to the antibiotic, allowing those that are resistant to the effects of that particular antibiotic to multiply and possibly cause a new infection that will be more difficult to treat. Patients should refrain from sexual intercourse until treatment is complete and return for follow-up testing. Any sexual partners during the time of infection, even if those partners do not show symptoms, should be notified and treated when any sexually transmitted disease is involved.

Although there is no known alternative to antibiotics in the treatment of gonorrhea, there are herbs and minerals that may be used to supplement antibiotic treatment:

The prognosis for patients with gonorrhea varies based on how early the disease is detected and treated. If treated early and properly, patients can be entirely cured of the disease. Up to 40% of female patients who are not treated early may develop pelvic inflammatory disease (PID) and the possibility of resulting sterility. Although the risk of infertility is higher in women than in men, men may also become sterile if the urethra becomes inflamed (urethritis) as a result of an untreated gonorrhea infection. Following an episode of PID, a woman is six to 10 times more likely, should a pregnancy occur, to have a pregnancy develop outside the uterus (ectopic pregnancy), which can result in death. Liver infection may also occur in untreated women. In approximately 2% of patients with untreated gonorrhea, the gonococcal infection may spread throughout the body and can cause fever, arthritis-like joint pain, and skin lesions.

Currently, there is no vaccine for gonorrhea, but several are under development. The best prevention is to abstain from having sex or to engage in sex only when in a mutually monogamous relationship in which both partners have been tested for gonorrhea, AIDS, and other sexually transmitted diseases. The next line of defense is the use of condoms, which have been shown to be highly effective in preventing disease (and unwanted pregnancies). To be 100% effective, condoms must be used properly. A female birth-control device that blocks the entry of sperm into the cervix (diaphragm) can also reduce the risk of infection. The risk of contracting gonorrhea increases with the number of sexual partners. Any man or woman who has sexual contact with more than one partner is advised to be tested regularly for gonorrhea and other sexually transmitted diseases.