Medical Guides - Gonorrhoea

What causes the condition?

Gonorrhoea is a sexually transmitted disease (STD) caused by the bacteria neisseria gonorrhoeae. As the bacteria are unable to survive outside human tissues, its transmission is mainly by close sexual contact. Gonorrhoea is one of the four major curable STDs (along with chlamydia, trichomoniasis and syphilis).

The outer cell membrane of neisseria gonorrhoeae is covered with large protein and sugar molecules and it is these components which help the bacteria to attach to and infect the host’s (infected individual’s) cells.

Symptoms

In some individuals, gonorrhoea infection is not associated with any symptoms (asymptomatic). It has been estimated that 60% of females infected with neisseria gonorrhoeae do not show any outward signs of the disease.

In those individuals that do develop symptoms, the effects can be divided onto three categories - local symptoms, local complications and systemic (body-wide) complications.

Local symptoms

Neisseria gonorrhoeae bacteria grow on mucosal surfaces (the linings of the cavities and tubes of our body). Local symptoms, which generally develop 2-10 days after becoming infected, therefore, depend upon which mucosal surface is infected.

  1. in men, inflammation of the urethra (the tube which urine is excreted from the bladder) is the most common consequence of genital gonorrhoea infection following vaginal intercourse with an infected women. The associated symptoms may include pain upon urination and urethral discharge.

  2. the most common site of infection in females is the cervix and urethra, resulting in increased vaginal discharge, a burning sensation during urination, uterine bleeding between periods and increased bleeding during periods.

  3. when acquired through anal sex, anal and rectal infection and inflammation may occur. Rectal infection can also occur in females with cervical infection. Symptoms may include rectal pain, bleeding and constipation.

  4. infection of the throat (pharynx), acquired through oral sex, results in pharyngitis (inflammation of the throat), the primary symptom of which is a sore throat and occasionally mouth ulcers.


Local complications: sometimes, if not treated immediately, gonorrhoea infection can spread beyond the initial site of infection, causing further and potentially more serious complications. These include:

  1. in females, spread of the bacteria into the organs of the upper reproductive tract (uterus, fallopian tubes and ovaries) can cause inflammation of these structures, with ongoing pain, abnormal pregnancies and, sometimes, infertility.

  2. in males, bacteria can similarly spread into other reproductive organs, including the testes, in some cases causing infertility.


Systemic (body-wide) complications

In approximately 0.5-3% of individuals with untreated gonorrhoea, body-wide symptoms may occur. These most commonly include arthritis (inflammation and pain in the joints) and dermatitis (skin inflammation). Gonorrhoea infection has been shown to facilitate the transmission of HIV.

Epidemiology

Gonorrhoea is most common in young adults who have had multiple sexual partners.
The disease usually affects more females than males. This is because 50-90% of women who have sex with men infected with neisseria gonorrhoeae, will themselves become infected. In contrast, only 20% of men who have vaginal sex once with an infected women will become infected. The risk of becoming infected increases with the number of exposures.

Determining trends in prevalence statistics (that is, whether the occurrence of the disease in increasing or decreasing) of gonorrhoea is difficult because studies from different times are generally not comparable. However, where public campaigns have been directed towards reducing STDs (for example, in Norwa

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