October 5, 2022 Author : Saraiva da Cunha Gonorrhea is a very common sexually transmitted infection , affecting both men and women. European Union countries reported 100 673 cases in 2018, an increase of 22% over the previous year. In Portugal, gonorrhea is a notifiable disease and 789 cases were reported in 2018: 708 in men, 81 in women; 50% living in the Lisbon metropolitan area and 17% in the Porto metropolitan area; About 70% of cases between 15-34 years old. Gonorrhea is caused by a bacterium – Neisseria gonorrhoeae , also known as gonococcus – that is almost always transmitted through sexual contact : vaginal, anal or oral. Ejaculation is not necessary for transmission of the disease. Neisseria gonorrhoeae infects epithelial cells mainly of the urethra, cervix, anus, and oropharynx and is a major cause of urethritis (inflammation or infection of the urethra). Symptoms and complications of gonorrhea Many cases of gonorrhea are asymptomatic (do not cause symptoms), especially in women. However, even when there are no symptoms, it is possible to transmit Neisseria gonorrhoeae as long as someone is infected. The incubation period after infection is about a week. In men , symptoms of gonorrhea begin 2 to 14 days after infection. In women , they usually don't start until 10 days after the infection. The signs and symptoms of gonorrhea are related with the place the bacteria enter the body and, therefore, those related to the urethra and genital area are the most common. In men: Symptoms begin with discomfort in the urethra, followed by burning sensation of varying intensity when urinating, urinary urgency and the presence of a greenish-yellow discharge from the penis; The urethral orifice area may become red and swollen; In some cases, the bacteria can reach the epididymis (the tube that carries sperm out of the testicles) and the scrotum becomes sensible when touched. The infection of the epididymis (epididymitis), if left untreated, can lead to infertility. In women: Symptoms are discomfort in the genital area and odorous vaginal discharge, resembling pus; Increased urinary frequency and burning sensation when urinating, bleeding outside the menstrual period and pain during sexual intercourse may also occur; Bacteria can reach the Fallopian tubes causing salpingitis (infection of the tubes), which is associated with abdominal pain, especially during sexual intercourse; The infection can also spread to the peritoneum causing pelvic inflammatory disease or peritonitis, with intense pain in the lower abdomen; Women who have had salpingitis and pelvic inflammatory disease are at an increased risk of infertility and ectopic pregnancy. Anal sex and oral sex with people infected with gonococcus can cause other symptoms in both men and women: In the case of anal infection : digestive disorders, anal itching, rectal bleeding, presence of secretion from the rectum. The anal area becomes inflamed and reddish and the stool is covered in mucus and pus. In the case of oral infection : gonococcal pharyngitis without or with sore throat. Contact with gonococcal-infected fluids can cause conjunctivitis, in one or both eyes, with swelling and pus in the eyes. The infection can also spread through the body via the blood and give rise to inflammatory problems of the skin (dermatitis) and joints (arthritis), which become swollen, red, tender to the touch and less mobile, accompanied by fever and malaise. Babies of infected mothers can become infected during delivery, with neonatal conjunctivitis which, if left untreated, can lead to blindness. Diagnosis and treatment The diagnosis is based on the patient's history and examination, with a special focus on behaviors and signs. Infection can be confirmed by analyzing a sample of the discharge under a microscope or by laboratory testing to look for the bacteria or their DNA in discharge or urine samples. When joints are affected, joint fluid may also be obtained for analysis. Other sexually transmitted infections are usually looked for at the same time. As gonorrhea is an infection caused by bacteria, it is treated with antibiotics . However, over the years, Neisseria gonorrhoeae has developed resistance to several antibiotics, which makes treatment difficult. Prevent gonorrhea Measures to prevent gonorrhea also prevent other sexually transmitted infections and are: Always use condoms during sexual intercourse; Not having sex, even protected, whenever there is an abnormal discharge or a burning sensation when urinating; Avoiding risky sexual behavior: not changing sex partners frequently or having sex with people who have other partners; Seek medical care in case of suspicious symptoms; In case of infection, correctly identify and allow all sexual contacts to be traced and treated. Source Gonorrhoea The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
