Also known as blenorrhagia, or popularly as drainage, gonorrhea is a bacterial infection caused by the bacterium Neisseria gonorrhoeae. To grow and reproduce, this microorganism needs a warm and humid environment. Therefore, the urethra in men, the urogenital tracts in women and the anal mucosa represent ideal habitats. More rarely, the bacterium can also settle in the mouth and throat, in the rectum or even in the eye.
Gonorrhea is mainly transmitted through sexual intercourse, whether vaginal, oral or anal. Contagion can also occur by direct contact with infected secretions, typically with sperm or vaginal secretions. The literature also reports the risk of contagion through the "mixed use of objects, such as the toilet or infected linen. This last possibility, that is indirect transmission, is less likely; in fact, the gonococcus is poorly resistant in the external environment and is easily inactivated by heat and disinfectants. A certain risk could be linked to the exchange of objects for erotic use, such as vibrators, during intercourse. Gonorrhea can also be passed on from a sick mother to her child during childbirth. Regardless of the mode of contagion, once contact has occurred, the microorganism adheres to epithelial cells and settles in the mucous membranes where it causes infection. Any sexually active person can be affected by gonorrhea. For this reason, young adults, from the onset of sexual activity up to the age of 30, are particularly at risk. Gonorrhea is clearly more common among people with numerous sexual partners. The presence of debilitating diseases such as AIDS and the non-use of condoms increase the risk of contracting the disease exponentially.
In humans, the first symptoms of gonorrhea appear after a period of 2-7 days from infection. The most common symptoms in men are burning when urinating, with itching, redness and swelling at the orifice of the penis. The most evident sign, however, remains the loss of secretions from the penis, first serous, then purulent, then yellow-greenish; precisely because of this loss, favored by the squeezing of the glans, gonorrhea is also known as discharge. Also in men, testicular swelling and pain during erection and ejaculation can sometimes appear. In addition, if gonorrhea is neglected, the infection can extend to the prostate and epididymis, which are small ducts located in each testicle. In one in 10 men, the infection is asymptomatic. Turning to the typical symptoms of women, asymptomatic courses are more frequent in women; in about 30% of cases, the infection does not produce significant symptoms and can therefore go unnoticed for a long time. When present, symptoms in women are generally mild and difficult to distinguish from other vaginal or urinary tract infections. Initial symptoms include burning and difficulty in urinating, frequent and painful urination, swelling of the external genitals, yellowish vaginal secretions and blood loss between one menstrual cycle and the next. Depending on sexual practices, symptoms may also arise in the mouth or throat, in the form of redness or irritation. In the anorectal region, infections are generally asymptomatic, but discharge, bleeding, itching or irritation can occur in both men and women, all typical symptoms of a proctitis.
It should be clear to everyone that, if not treated properly, gonorrhea can have serious and permanent consequences. Unfortunately, this is true regardless of the presence and severity of symptoms. Basically, serious complications can also appear in cases with mild, nuanced or even absent symptoms. First, gonorrhea in women shows a strong tendency to become chronic. In addition, although the infection generally remains confined to the site of infection, the bacterium can travel up the genital tract, infecting the uterine tubes, and causing pelvic inflammatory disease (PID). This syndrome can cause fever accompanied by chronic abdominal and pelvic pain. Furthermore, it represents one of the major causes of infertility and increases the risk of miscarriages and ectopic pregnancies. Also in women, Neisser's gonococcal infection can reach the ovaries and abdominal cavity, causing peritonitis. In humans, however, the most common and fearful complication of gonorrhea is epididymitis. It is an inflammation that can be painful and which, when neglected, can lead to infertility. In 1% of cases, especially in debilitated and immunosuppressed subjects, the bacterium responsible for gonorrhea can enter the blood, causing septicemia, and affect the joints, causing gonococcal arthritis. There are also cases of conjunctivitis associated with gonorrhea. some of it is destined for gonorrhea in newborns. The infection can be transmitted from the infected mother to the newborn during the passage through the birth canal, and cause a purulent infection of the ocular conjunctiva, which if left untreated becomes more complicated and leads to blindness. This is why all newborns, as soon as they are born, are instilled with a drop of disinfectant eye drops, according to Crédé prophylaxis. Let's now turn to the diagnosis.
The diagnosis of gonorrhea is made by culture and microscopic examination of the infected secretions. The aim is obviously to identify the bacterium responsible for gonorrhea, as well as allowing sensitivity tests to be carried out to antibiotics. The samples to be analyzed are taken with swabs from the infected parts of the body. In practice, depending on the case, a kind of cotton swab is inserted into the cervix, urethra, rectum or pharynx; the search for gonococcus can also be carried out in the blood or in the synovial fluid in case of complications. Some recent techniques of analysis allow to identify the bacterium by looking for traces of its genetic material; these tests, such as real-time PCR, can also be performed in the urine and are more sensitive than traditional tests. In practice, they are also able to identify infections that escape the traditional microbiological cultures.
Gonorrhea is a bacterial infection; therefore, it can be effectively treated with antibiotic therapy. Healing is usually achieved within a few days, provided that treatment is timely and appropriate. Treatment should always be extended to recent sexual partners, even if they have no symptoms. While it can be embarrassing, raising this need to your partner or partners is important to avoid re-infection and limit the spread of the disease. An emerging and alarming problem consists in the spread of strains resistant to the same antibiotics that until a few years ago were able to brilliantly cure the disease. For this reason, the choice of the drug should be based on the characteristics of the strain identified during the diagnostic tests. Furthermore, it is important for the patient to refrain from sexual intercourse until complete recovery and to complete the treatment without interrupting it after the first improvements. Before concluding, it must be remembered that all sexually active people are at risk of infection. To reduce the risk of contagion it is advisable to limit the number of partners or at least use the necessary protections. Although the condom does not guarantee absolute protection from infection, if used correctly it greatly reduces the risk of transmission of gonorrhea. I conclude by mentioning that there are currently no vaccines available for gonorrhea.
