Medicine for Africa - Medical Information Service

ONORRHEA

Definition:
 
Gonorrhea is one of the most frequently sexually transmitted diseases, caused by the bacterium Neisseria gonorrhea. The organism can be transmitted during any sexual contacts between two people. 'Sexual contact' does not only imply sexual intercourse, it also includes any close bodily contact, that is oral as well as anal contact and intercourse. In pregnant women, the organism can be transmitted from mother to baby during delivery, when the baby passes through the birth canal.
 

Symptoms:
 
Symptoms can be very mild to the point that an infected woman does not realize that she is infected for up to several months. If symptoms develop, they usually appear 2 to 10 days after sexual contact with an infected partner. Pain and burning sensation while urinating and a vaginal discharge which may be yellow and purulent (pus containing) or bloody, as well as itching in the genital and anal area are typical symptoms. In women, the infection is often accompanied by the presence of Trichomonas vaginalis and Candida albicans. In men, symptoms are more prominent and almost always occur within 2 to 10 days after sexual contact with an infected partner. In addition to the burning sensation while urinating, itching and a purulent (pus containing) discharge from the penis are present.

If not treated adequately or treated too late, the infection in women can extend from the cervix into the womb, into the Fallopian tubes and up to the ovaries (=Pelvic Inflammatory Disease, PID). The disease can appear between several days and several months after the initial infection and can prevent the fertilized eggs from entering the womb. This is the most frequent cause of an 'ectopic pregnancy', a pregnancy that occurs elsewhere than in the womb (uterus), with the potential hazard of perforation of the Fallopian tube, leading to peritoneal infection with possible shock and even death for the mother. PID can also prevent the woman from ever again becoming pregnant, because the tubes are scarred and thus narrowed, which does not permit an egg to enter the womb. PID can also lead to long-lasting pain of the affected area. Accompanying symptoms, aside from pain or tenderness in the lower abdomen and vaginal discharge, are bleeding between menstrual periods, pain during sexual intercourse and non-specific symptoms such as fever and chills, and nausea with or without vomiting. The organism can also invade the blood and joints and cause arthritis-like joint pain; the knee is an often affected joint.
 

Diagnosis:
 
This can be made directly by putting some of the discharge on a glass slide, staining it and looking at it under the microscope for the bacteria. This test requires little time and can be done during an office visit; it is, however, not very sensitive, especially not for women. More sensitive is a culture test which is done by incubating the discharge on a culture plate for about two days in order to multiply the bacteria and therefore facilitate its detection. Newer ways of detecting bacterial genes or its DNA strands are very sensitive but still rather expensive and not easy to perform in a routine practice.

Recently, a so-called Rapid Diagnostic Test has also become available. These tests are rapid immunochromatographic assays, performed on uncut cards, with dipsticks, or on strips or cassettes, and therefore also called 'dry tests'. For diagnosing gonorrhea, a swab will be taken from the infected area. Dry tests are easy to perform and usually provide results within less than one minute. Because of their easy handling and reading of the results, they can be performed by nursing staff and even less well trained medical personnel. This makes these tests ideally suited for less developed countries where physicians and well trained medical personnel are often a rarity. The price for dry tests is low for developed country standards - usually around US-$ 1.00 - 2.00 per test - but still relatively high for less and least developed countries in Africa and elsewhere.
 

Therapy:
 
Antibiotic treatment can be given in one single dose by injection or by mouth. The organism has often become resistant to regular penicillin, therefore, newer kinds of antibiotics have to be given. Since gonorrhea is often accompanied by Chlamydia, a combination therapy can be indicated.
 

Prevention:
 
Prevention of all sexually transmitted diseases lies primarily in avoiding and eliminating sexual contact with an infected person. Since one cannot always be assured of the sexual hygiene of a partner, prevention is best achieved, with a relatively high degree of success, by using a latex condom. Non-latex condoms are not as certain to prevent contact with the infected person's organisms, since some organisms can penetrate non-latex materials and infect the partner. In addition to the condoms used by men, there are now also condoms for women who can take the initiative if the man does not. A condom should never be used more than once, because contamination with or leaking of semen occurs frequently upon repeated usage of any kind of condom. If a person knows that he/she is infected by one of these diseases, he/she should take responsibility and abstain from sexual contacts with anybody during the time of contagion.

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