1. What is gonorrhoea?
  2. How is gonorrhoea transmitted?
  3. Symptoms and complications
  4. Diagnosis, treatment and prevention

What is gonorrhoea?

Gonorrhoea is a sexually transmitted disease caused by the Neisseria gonorrhoeae bacterium; it is transmitted through oral, vaginal or anal sex. This type of bacteria infects the urethral tract in men and uro-genital tract in women. Gonorrhoea is the second most common sexually transmitted disease, with higher rates for young males and females and adolescents.

How is gonorrhoea transmitted?

The transmission of gonorrhoea can occur through unprotected vaginal, oral or anal sexual intercourse with an infected partner. The infection may also be transmitted from mother to baby during delivery.

Once there is contact with the microorganism, this adheres to epithelial cells and penetrates in the sub-epithelial area where it starts the infection. Bacteria grow and reproduce in a warm and humid environment, thus female and male genital organs like the urethra represent the ideal environment for this to happen. However, the infection can also develop in the mouth, throat, eyes and rectum.

Symptoms and complications

Very often, the infection causes no symptoms at all, especially in women. In men, symptoms can show after 2 or 3 days from contagion and are mainly pain and stinging during micturition, discharges of a weird colour, or also pain and swelling of the testicles. Symptoms in women are usually very subtle and not easily distinguishable from other vaginal infections or infections of the bladder. Main symptoms are stinging during micturition and increase of vaginal secretion with bleeding. If the infection is not treated it can cause serious and permanent complications. In particular, it may cause pelvic inflammatory disease with fever and chronic pelvic and abdominal pain and infertility because it can damage the Fallopian tubes increasing the risk of extra-uterine pregnancies and miscarriage. In men, it can cause epididymitis with a painful inflammation that can bring to male infertility. In pregnant women, gonorrhoea can cause blindness, inflammation of the libs and serious blood infections in babies. The infection can also affect the rectal area with no symptoms but can cause, both in males and females, discharge, rectal itching, rash, bleeding or painful bowel movement.

Diagnosis, treatment and prevention

Diagnosis is usually easier in men than women. To diagnose gonorrhoea, samples to be analysed are taken through smear test and urethra, rectum or pharyngeal swabs. It is necessary to undergo laboratory tests like molecular tests or Gram stain with an optical microscope. The samples that need to be analysed are taken with cervix, urethra, rectum and pharyngeal swabs, which are the parts of the body that become infected with the bacteria. Gonorrhoea of the cervix or of the urethra can also be diagnosed with urine samples.

Since gonorrhoea is a bacterial infection, it can be effectively treated with antibiotics like cephalosporin even though there are some new drug-resistant strains that make treatment less effective. For this reason, the choice of the medication is based on the strain’s characteristics and on the patient’s situation, as particular attention is required for pregnant women. Additional therapy also covers chlamydia, which frequently occurs together with gonorrhoea. Double therapy has been recommended since 2010 due to the increased resistance of Neisseria gonorrhoea to cephalosporin.

Patients that have already been infected with gonorrhoea and that have been treated can be infected again; therefore it is advisable to repeat screening for those adolescents that have resulted positive to gonorrhoea in 3 or 6 months. All sexually active subjects are at risk of infection. To avoid contagion, it is necessary to have protected sex and to use the condom correctly. The bacteria’s extreme antigenic variability is one of the factors that have prevented the development of a vaccine against gonorrhoea even though research is making great progress in this direction.