Gonorrhoea is a bacterial infection caused by the bacterium Neisseria gonorrhoeae, in urogenital, pharyngeal, rectal, and conjunctival sites.
The condition is frequently asymptomatic, especially among women, and when located in the pharyngeal, and rectal sites. The bacteria infects only humans, and operates through the colonising of mucosal surfaces. According to the World Health Organization, an estimated 82.4 million new infections were diagnosed among adults aged 15 to 49 years, globally, in 2020. It is also reported that gonococcal infections are higher in men than in women since 2013.
What are the causes and symptoms?
The common cause of gonorrhoea is unprotected vaginal, oral or anal sex. Besides this, chemical irritants, spermicides and trauma are other causes. In women, trauma from intercourse, cervical procedures, yeast infections, allergic reactions to spermicides, latex condoms, diaphragms and intrauterine devices could also cause the condition.
Gonorrhoea could cause pain or a burning during urination, an increased urgency to urinate, a pus-like or clear discharge and itching or tenderness at the tip of the penis. Some may have hematuria (blood in urine). Though most women may have no symptoms in those who do, it could be abnormal vaginal discharge,which could be yellow, grey or pus-like, pain during sexual intercourse, bleeding between periods, pain during a pelvic exam, painful, frequent urination and pelvic or abdominal pain
Transmission, diagnosis
Since the condition is asymptomatic, the infection can be transmitted to others. If left untreated in women, gonococcal infections could result in scarring of the fallopian tubes leading to infertility or ectopic pregnancies.
Gonorrhoea is diagnosed through identification of the bacteria in the cells, either through a urine test or a swab test of the affected region. The Nucleic Acid Amplification Test (NAAT) is the gold standard for diagnosing gonorrhea.
A study, ‘Anatomic site distribution of Neisseria gonorrhoeae in men who have sex with men attending a tertiary care hospital in north India’, published in the July-Dec 2024 edition of the Indian Journal of Sexually Transmitted Diseases and AIDS, found the infection is common in the men who have sex with men (MSM) group. The article, by Verma, Rachna, Gupta et al. was based on their survey of 127 MSM patients attending the STI clinic in the dermatology outpatient department of AIIMS, Delhi. The study found that 20% of the patients in the study (26 persons) tested positive for Neisseria gonorrhoeae. It also found that around 60% of the infections were missed if the testing site was limited to genitals alone.
NACO rules for treatment
The National Technical Guidelines on STI and RTI of the National AIDS Control Organisation, India, advises that all infected persons should be instructed to abstain from sexual intercourse until they complete treatment for 7 days following a single-day of therapy and until resolution of symptoms in them and their sexual partners.
Treatment is with antibiotics. The NACO guidelines recommends giving Ceftriaxone 500 mg, intramuscularly, in a single dose.
NACO further states that diagnosed persons should be screened for HIV, chlamydia and syphilis as well. If symptoms do not resolve within 3-5 days post treatment, a laboratory culture test is recommended and all suspected cases for treatment failure should be assessed for antimicrobial resistance.
Protecting newborns
If left untreated, the bacteria could infect newborns, which manifests 2–5 days after birth. Babies contract the infection during birth from the mother’s infected birth canal, causing redness, swelling and discharge in the eyes. This condition, ophthalmia neonatorum can result in perforation of the globe of the eye and blindness. Babies less than 28 days old are especially susceptible. The babies could also contract sepsis, which can include arthritis and meningitis. Less severe manifestations include rhinitis, vaginitis, urethritis, and scalp infections.
Babies who develop gonorrhea are also treated with antibiotics. Prenatal screening and treatment of pregnant women, to prevent the infection being passed on to babies, is the optimum solution.
(R. Sujatha is an independent journalist based in Chennai. sujatha.raghunath@gmail.com)
