Neisseria gonorrhea is a common bacteria that causes sexually transmitted diseases (STDs). The disease, called Gonorrhea, can occur in various parts of the body. The most common are the penis’s urethra in men causing Urethritis, and the cervix of the uterus in women (and sometimes the urethra as well) [see Diagrams: Anatomy of the Urinary System and Genital Systems — Male and Female]. If it spreads, it can reach the man’s testicles (epididymitis) or the woman’s Fallopian tubes. The germ can also infect the rectum or throat by rectal or oral sex.
Symptoms can begin in a day or two (Chlamydia, another STD, can take a week). However, many people have no symptoms at all. The bacteria can live silently, and still get transmitted. If you get gonorrhea from a sex partner, it’s always possible that they had no idea they were infected (especially women).
Diagnosis is made by a test (DNA probe) from the body part that’s involved. So if someone has gonorrhea in the rectum, a urine test won’t find it. The main exception is gonorrhea arthritis (see below), where it’s found in joint fluid only 50% of the time. So it’s necessary to check areas of the body where the patient had sex.
Treatment is easy, for now. It involves a shot of the antibiotic ceftriaxone. Unfortunately, the germ is now often resistant to penicillin, tetracycline, and ciprofloxacin, and is becoming more resistant to the 2 medications we now use. Good reason to use condoms, because unable-to-treat gonorrhea is a real catastrophe.
To check for drug-resistant gonorrhea, the regular test done nowadays won’t find it. It’s necessary to do a culture by swab from the actual area (like we used to do routinely), and essential to order antibiotic sensitivity tests too. If the order isn’t specific, the lab won’t do them automatically. This is especially important for Gonorrhea of the Throat (see below)
Male Genital Organs: Men get an itchy, uncomfortable sensation in the penis. It hurts to urinate. Pus oozes out. Symptoms can occur a few days after transmission. Complications include permanent scars that can interfere with urination, and sterility if there’s spread to the testicles. The germ can be found by a urine test, so it’s no longer necessary to stick a (painful) swab inside the penis.
Female Genital Organs: Women may have discharge from the vagina. If the germ moves up to the uterus (womb) and tubes, it’s called “Pelvic Inflammatory Disease” (PID) with fever and abdominal pain. PID can cause chronic abscesses, and sterility. If the right-side tube is infected, the germ can work its way up a ligament to the liver (called Fitz-Hugh-Curtis Syndrome). Gonorrhea of the vagina (and uterus) can be now found by a urine test, so it’s no longer necessary to do a pelvic exam.
Throat: Caused by oral sex with a man (regardless of the gender of the patient him/herself). Women with gonorrhea in the vagina don’t spread it to their partner’s mouth, because the germ has to be deposited far back in the throat to take hold.
Gonorrhea in the throat often has few symptoms, and may eventually go away on its own. Still, who’d want it? The main problem is that other normal throat bacteria may harbor genes for drug-resistance, which they can pass on to the gonorrhea bacteria. In fact, after treatment for Gonorrhea of the Throat, it’s important to do a follow-up test 1-2 weeks after treatment, to be sure it was successful. If not, it’s necessary to do a culture, and if that’s positive, to look for resistance. Not all labs can do this; it may be necessary to find a Public Health Department with capacity.
To test for Gonorrhea of the throat, we use a different swab than the one for Strep. If you have a sore throat & recently had oral sex with a new male partner, tell your provider so they get the right test.
Rectum: Can occur in either man or woman who had rectal sex with a man. Symptoms may include pus from the rectum, or pain with bowel movements. However, lots of people have no symptoms at all, but can pass it to a man who has rectal sex with them. Condoms prevent transmission.
Arthritis: Uncommon. This usually affects the knee, wrist, and/or ankle, which become red, warm, and swollen. It mainly occurs in women shortly after a period — if they have genital gonorrhea (often without symptoms), the germ gets into the blood, travels throughout the body, lodges in the joint. Diagnosis is only 50% accurate from joint symptoms, so it’s essential to also obtain genital specimens. Treatment requires IV antibiotics, often begun before results are back if the case seems likely enough.
Eye: Rare, but blinding if it occurs. It’s mainly a risk to newborn babies, who get it from mothers during delivery. All newborns receive antibiotic eye drops immediately after birth, for prevention. If a baby is born out-of-hospital, it’s crucial to obtain this treatment as soon as possible.
Disseminated Gonorrhea: Like with arthritis of one or two joints, gonorrhea can spread through the blood and cause fever with lots of achy joints, tendonitis (painful tendons that are sometimes red), and funny skin rashes that come and go (usually pustules — small blisters with pus). Sometimes gonorrhea can be found in a blood culture, but it’s easier to test areas of the body where the patient had sex. Treatment usually uses IV antibiotics.
MORAL — Use condoms until you get to know & settle in with one partner only.