Gonorrhea

• Symptoms for men: Discharge of pus from the tip of the penis, swelling or pain in a single testicle, painful urination, higher frequency of urination, soreness in the anus, pain while passing stool, discolouration at the penis opening, itching in the anus
• Symptoms for women: greenish, watery, and creamy vaginal discharge; sharp pain during vaginal sex, lower abdominal pain, urge to urinate more, rectal discharge or bleeding, pain while passing stool, more intense periods, painful sensation or burning while urinating 
• Causes: Transmission of N. Gonorrhoeae bacteria via bodily fluids through mouth, vagina, penis, or anus 
• Risk Factors: Under the age of 25, unprotected sex, sex with a new partner without protection, having sex with multiple untested partners
• Severity: Moderate to high 
• Which doctor to consult: OB-Gynaecologist, Infectious Disease Specialist, Primary Care Provider (PCP), Urologist

Overview:

Gonorrhea is a sexually transmitted infection (STI) caused by the Neisseria Gonorrheae virus. Also referred to as "drip" or "the clap", it spreads via bodily fluids such as semen and vaginal fluid. An individual can contract the STI through vaginal sex, oral sex, anal sex, or sex toys shared with an STI-infected person.

Sexually active individuals need to be wary of this ailment since there are possibilities that it might not show any symptoms. The individual might unknowingly have no knowledge of contracting the disease and pass it on to their partner. Hence, it is essential to get tested regularly.

The condition usually targets the penis, vagina, eyes, urethra, anus, and parts of the female reproductive tract like the uterus, cervix, and fallopian tubes.

The disease is more common among young adults and teens in the age bracket of 15-24. If the condition is ignored and goes untreated for long time, the individual might face heavy consequences like infertility.

However, detecting the condition on time and consuming antibiotics to eliminate the infection will reduce the chances of health complications. The oral variant of gonorrhoea might even transmit via kissing; however, not enough research has been done to back this claim. The individual is at a higher risk of contracting the ailment again if they have already had it in the past.

Gonorrhea can also be transmitted to a baby if the mother tests positive for it during childbirth.

When to Consult a Doctor?

Whenever the patient starts noticing mild symptoms of gonorrhea, he/she should consult a doctor. For men, this is a pus-like discharge from the tip of the penis, and for women, it is a greenish, creamy vaginal discharge.

An individual should also get checked for STI if any of his/her previous sexual partners have recently contracted STI. Patients might not experience symptoms, but STI might progress without apparent signs. Moreover, an individual must also get himself/herself tested if he/she is in sexual contact with multiple partners at once. The risk of contracting gonorrhea in this situation is relatively high.

Diagnosis:

The doctor will ask the patient preliminary questions about the symptoms he/she is experiencing and a complete medical and sexual history. The doctor will require swabs from the throat, cervix, urine, urethra, eyelid, and rectum.

The collected samples will then be sent to the lab, where these will be tested for the presence of the bacterium. The tests will also assess whether the patient is at risk of exposure to other STIs, such as chlamydia.

Lab Tests: The lab tests for gonorrhea use swab samples to test the bacteria's presence. For female patients, the sample will primarily be extracted from the cervix. The doctor will ask them to lie on their back on the examination table. Their knees will be bent, and their feet will rest on stirrups.

The doctor will then use a speculum and a plastic spatula or soft brush to extract the sample. For male patients, the doctor will extract a sample from their urethra.

In some instances, the sample may also be taken from the infected area. For example, if an individual has oral gonorrhea, doctors will extract a sample from their mouth.

Lastly, there are certain test preparations an individual must keep in mind before heading to the test. Female patients should avoid using vaginal creams or douching for 24 hours before the test.

Home Tests: Women can also perform home tests with home testing kits. These kits contain vaginal swabs, which they need to use to get a sample. These swabs are then sent to a lab for testing, and the individuals will be notified of the results.

Women can choose whether they want these results sent via text or email. They can view the results online or obtain them via the toll-free hotline.

Treatment:

The treatment for gonorrhea will proceed with antibiotics. These antibiotics help kill the bacteria in a gonorrhoeae-infected patient's bloodstream. There is a possibility that he/she might be immune to certain kinds of antibiotics. In this case, the individual will have to consume certain other drugs or take an injection. Patients must take all their medication on time, and in the correct dosage, since treatment depends heavily on medication.

For gonorrhea, typically, a patient will have to consume a single dosage of 500 mg IM of 3rd generation Ceftriaxone. If the patient weighs above 150kg, he/she must consume 1000 mg. Furthermore, he/she might be recommended to consume the antibiotic Azithromycin as a precautionary measure against chlamydia.

If an individual is allergic to Ceftriaxone, he/she can either consume an oral or injectable dose of Gemifloxacin. This class of drugs is referred to as Cephalosporin antibiotics.

The patient will have to mention any drug allergies he/she might have. These are potent dosages of antibiotics, and non-disclosure of such information can have adverse impacts.

Once the treatment has been completed, the individual must wait for at least seven days before indulging in sexual activity again. He/she might need a follow-up test to ensure that the infection has subsided completely.

If the symptoms do not recede after treatment, the patient might have antibiotic resistance. This happens because certain types of gonorrhoeae bacteria do not respond to antibiotics. In such cases, the patient will require a higher dosage of different antibiotics for longer durations.

Risks & Complications if Left Untreated

Female patients have a greater chance of experiencing untreated gonorrhea complications as it might move to their reproductive tract and impact their reproductive parts, such as ovaries, fallopian tubes, and uterus.

Furthermore, this can pave the way for a disease called Pelvic Inflammatory Disease (PID) causing chronic pain in the reproductive system. Their fallopian tubes might get scarred or blocked, which might lead to the following:

• Ectopic pregnancy, where the fertilized egg gets implanted outside the uterus 
• Difficulty in getting pregnant

Male patients with untreated gonorrhea will have to deal with the following symptoms:

• A very painful abscess inside the penis
• Urethra might get scarred 
• Semen-carrying tubes inside their testicles might get inflamed (epididymitis)

In severe cases, the infection might also enter their bloodstream, causing significant complications like heart valve damage and arthritis.

Additional information

Prevention

Here are certain practices individuals can adopt to reduce the risk of contracting gonorrhea:

• Monitoring sexual activity with multiple partners: The risk of gonorrhea goes up when an individual indulges in sexual activities with multiple sex partners. Therefore, individuals must ensure their partners are tested and indulge in only protected sex, reducing the risk of contracting the dangerous STI.
• Never forget to use protection: Since gonorrhea can be transmitted through all bodily fluids, especially during sex, individuals must use adequate barrier protection like condoms to limit contact with fluids. This refers to all types of sexual contact like oral, anal, or vaginal sex.
• Visit a doctor for regular gonorrhoea screening: Sexually active individuals must get tested at least once a year, especially if any risk factors are present.
• Don't indulge in sexual activity with a person who appears to be infected with an STI: If an individual has sexual relations with someone showing STI symptoms, he/she mustn't indulge in any sexual activity. These symptoms include a sore, genital rash, burning sensation, and so on.