Brief overview
- Symptoms: Burning pain during urination, discharge from the urethra (in men), purulent or bloody discharge from the vagina, conjunctivitis if the eyes are infected, less commonly general symptoms of illness such as fever, joint pain, skin rash. Symptoms do not always occur.
- Treatment: Administration of two different antibiotics at the same time (so-called dual therapy), therapy of the infected person and their sexual partners.
- Diagnosis: Detection of the gonorrhea pathogen by a swab, creation of a bacterial culture, test for antibiotic resistance
- Prevention: use of condoms reduces risk, regular tests for people at increased risk of infection
What is gonorrhea?
Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is therefore one of the sexually transmitted diseases. The cause of gonorrhea is bacteria called gonococci (Neisseria gonorrhoeae). The dermatologist Albert Neisser discovered the pathogens in 1879.
Today, doctors treat newborns with a gonococcal infection with antibiotics, which the children receive as an injection. Such treatment of infants is rarely necessary because pregnant women are also screened for gonorrhea as part of preventive examinations.
Incidence and frequency of gonorrhea
The number of gonorrhea cases declined for several years. Since the mid-1990s, however, an increase in cases of gonorrhea has been observed. Gonorrhea particularly affects younger adults between the ages of 15 and 25, with both women and men becoming ill.
What are the symptoms?
Typical gonorrhea symptoms in the early stages are inflammation of the urinary and genital organs and a purulent discharge from the urethra. In many cases, however, gonorrhea infection is not accompanied by a typical appearance and no symptoms occur (silent infection).
The problem is that people who do not notice any signs of gonorrhea usually do not know that they have a contagious disease. Thus, gonorrhea is often passed on unknowingly. This means a high risk for the undetected spread of gonorrhea.
Acute gonorrhea symptoms in men:
- Burning pain when urinating (dysuria). In extreme cases, there is a feeling of “shattered glass in the urethra”. Causes of symptoms is inflammation of the urethra (urethritis).
- Gonorrhea causes redness of the glans around the urethral opening, possibly also painful swelling of the penis and foreskin
- In the absence of treatment, the bacteria ascend to the male genital organs, where they cause inflammation of the prostate or epididymitis, for example.
- In the case of anal intercourse, it is possible for gonorrhea to cause inflammation in the rectum (rectal gonorrhea). It is noticeable, for example, by mucopurulent admixtures in the stool and pain during defecation.
Acute gonorrhea symptoms in women:
- In the early stages, gonorrhea symptoms are usually very mild. Possible symptoms include vaginal discharge and a slight burning sensation when urinating. The discharge from the vagina sometimes smells bad.
- Inflammation of the cervix (cervicitis) is indicated, for example, by a purulent or bloody discharge.
- Rectal gonorrhea often occurs in women when the pathogen spreads from the genital tract to the rectum (secondary infection).
Without treatment, there is a risk of chronicity of gonorrhea symptoms. In this case, the local symptoms on the mucous membranes predominantly disappear, but the pathogens penetrate into deeper tissue layers, where they usually cause chronic inflammation.
In both sexes, there is the possibility in rare cases that the pathogens spread throughout the entire organism and cause gonorrhea symptoms in other parts of the body as well. About two to three weeks after infection, gonorrhea symptoms appear, including fever, skin changes (such as rash or punctate hemorrhages), painful joint inflammation, and tendon sheath inflammation. Doctors also speak of a disseminated gonococcal infection (DGI).
Even in adults, infection of the eyes with gonococci occasionally occurs. In most cases, these are “carried over” bacteria in persons with an existing genital gonorrhea infection. Eye infection (gonococcal ophthalmia) in adults is highly acute and usually has a worse course than in newborns.
If you suspect gonorrhea symptoms in yourself or your partner, don’t be afraid to see a doctor!
How do you get infected?
If the pathogens are in the throat of an infected person, infection with gonorrhea via contact with the tongue, for example when kissing, cannot be ruled out.
If a pregnant woman has gonorrhea, there is a high risk that the baby will become infected during the birth process. Typically, the child then develops conjunctivitis (gonococcal conjunctivitis). If left untreated, the infection spreads to other areas of the eye, such as the cornea, and in some cases leads to blindness (“neonatal blennorrhea”).
Especially in women, the symptoms of gonorrhea are often very mild and difficult to detect. As a result, there is a risk of spreading the infection unnoticed. People who offer or use sexual services and people with frequently changing sexual partners have a higher risk of contracting gonorrhea.
What helps against gonorrhea?
Antibiotics are suitable for gonorrhea therapy. In the past, penicillin was mainly used for gonorrhea treatment. In recent years, penicillin-resistant strains of gonococci from Asia and Africa are appearing more frequently. Therefore, doctors now use other antibiotics to treat gonorrhea.
In most cases of gonorrhea, the gonococci die within 24 hours after administration of the effective antibiotics and are then no longer detectable.
Nevertheless, in cases of gonorrhea it is important that the treatment extends over a sufficient period of time. If gonorrhea therapy is stopped too early, this promotes the development of resistance – and resistant germs are difficult to treat.
Newborns with purulent conjunctivitis due to gonorrhea receive a single administration of antibiotics as an injection into the muscle (intramuscular) or into the vein (intravenous). In addition, eyes and conjunctivae should be rinsed regularly with saline solution.
Antibiotic resistance
For this reason, experts today already recommend dual therapy of gonorrhea, i.e. with a combination of two antibiotics. One preparation alone no longer offers sufficient certainty of successful treatment. More and more completely resistant gonococcal strains are being found worldwide, especially in Asia.
Examinations and diagnosis
In the case of purulent discharge from the urethra or vagina, an examination is always advisable. It is important that all partners of infected persons or persons with unclear inflammatory abdominal complaints be examined for gonorrhea or other STDs. It is also advisable for sexually active men with testicular or epididymitis to be checked for gonococcal infection.
In order to make a reliable diagnosis, the laboratory also prepares a pathogen culture: For this purpose, the gonococci are transferred from the smear to a suitable nutrient medium. The pathogens multiply there and can then be reliably detected.
In gonorrhea-infected persons without symptoms (asymptomatic), test methods based on laboratory propagation of the bacterial genome (PCR, polymerase chain reaction) are more accurate than bacterial cultures. Even if no symptoms are present, infection of other people is possible.
Course of the disease and prognosis
Normally gonorrhea is curable and has a good prognosis: If gonorrhea is treated in time, you do not have to expect any late effects.
Without treatment, in very rare cases, the gonorrhea pathogens spread throughout the body via the bloodstream. Doctors speak of a disseminated gonococcal infection (DGI). The consequences are joint and tendon sheath inflammations, characteristic skin rashes with red pustules or small bleedings (petechiae), fever and chills.
Prevention
To date, no specific vaccination against gonorrhea is available. A 2017 study showed that vaccination against meningococcal type B also protects against gonococcal infection to a certain extent. Presumably, the close relationship of the pathogens is the reason for this.
Women with an increased risk of infection should also be tested for gonococci in case of pregnancy and be treated before birth.
