Gonorrhoea
Introduction/Definition
Gonorrhea is a highly contagious sexually transmitted disease (STD), which occurs only in humans and is caused by infection with the so-called gonococci (Neisseria gonorrhea). These Gram-negative, oxygen-dependent (aerobic) bacteria can infect the mucous membranes of the reproductive organs, urinary tract, intestine, throat and conjunctiva of the eyes after transmission. The reasons for an infection with the gonococci are usually due to infection through unprotected sexual intercourse (without a condom) with an infected person.
Other sexual practices, such as anal or oral sex, can also lead to transmission of the bacteria. People with frequently changing sexual partners who have unprotected sexual intercourse are particularly at risk of infection with gonococci. Since the symptoms of the disease are initially absent, the infection remains undetected for a long time and can thus spread. Furthermore, infection can also be passed from a gonorrhea-infected mother to the child during birth and should therefore be diagnosed in the mother before birth.
Frequency distribution
The World Health Organization (WHO) estimates the number of new cases (incidence) per year at about 60 million (1% of the world population). In Germany there are about 11-25 cases per 100,000 inhabitants. Mostly the younger population (around the age of 30) is affected by gonorrhea. Since 2000, gonorrhea is no longer a notifiable disease in Germany.
Diagnosis
The typical symptoms described by people infected with gonorrhea are already a first indication of an infection with the bacteria (Neisseria gonorrhea). As a next step, the doctor should inspect the affected body parts closely. For a more detailed examination, it is necessary to take samples of the possibly infectious fluid secretions (e.g. from the cervix or urethra).
These can then be examined under the microscope using a so-called Gram stain. However, microscopic examination is not always sufficient. In order to confirm the diagnosis, the fluid sample should be sent to a laboratory where a culture is prepared on a nutrient medium.
It is now examined whether the gonococci causing gonorrhea settle. At the same time, a so-called antibiogram is also made, in which it is tested whether there is any resistance to certain antibiotics used to treat gonorrhea, so that another form of therapy is needed. A further possibility to secure the diagnosis of gonorrhea can be an examination of the pathogen’s genetic material using a so-called PCR = polymerase chain reaction.
It usually takes several days before the first signs of gonorrhea infection appear. Women in particular often have very few or no symptoms at all in the beginning, which makes further infections and complications of the disease possible by starting therapy later. In women, an infection with the bacterium Neisseria gonorrhea can manifest itself through a slight discharge from the vagina.
However, this is often not considered unusual. If the glands at the entrance to the vagina (Bartholini glands) are inflamed, which can be caused by the bacteria, those affected complain of pain in the vaginal area, which mainly occurs when sitting. Inflammation of the cervix (cervicitis) or the urethra, which is expressed by pain, discharge or other complaints, is also possible.
Severe lower abdominal pain and fever indicate an ascending infection with inflammation of the fallopian tubes or ovaries, which must be treated as soon as possible. In addition to uterine inflammation and inflammation of the ovaries or fallopian tubes, inflammation of the peritonitis and infertility due to adhesions and adhesions of the fallopian tubes are possible complications of gonorrhea in women. In men, a morning so-called purulent “bonjour” drop is usually seen, which is caused by an inflammation of the urethra by the gonococci.
This secretion usually emerges from the urethra before the first morning urination. In addition, pain during urination and redness and swelling of the urethral orifice can also occur. An ascending infection, which is a complication of gonorrhea infection, can lead to pain in the lower abdomen and testicles.
Other complications worth mentioning are epididymitis (inflammation of the epididymis), prostatitis (inflammation of the prostate) or the threat of infertility (sterility).Infection with gonococci as a result of anal or oral sex with a gonorrhea-infected person may cause inflammation of the throat (sore throat) or the intestinal mucosa (pain during defecation/mucus congestion). Conjunctivitis caused by contaminated hands is also possible. In both men and women, the spread of bacteria via the bloodstream is a serious complication of gonorrhea. This can lead to joint pain and inflammation, fever and skin changes (blistering). Blood poisoning (gonococcal sepsis), meningitis (gonococcal meningitis) or heart inflammation (gonococcal endocarditis) are also dangerous complications.