• Camelia Brande

Gonorrhea- on its way of becoming a superbug

April is STD Awareness Month and we believe it is time to focus on this important topic. According to the WHO (World Health Organization) around 1 million STIs are acquired every day worldwide.

In the previous weeks we talked about STIs, STDs and VDs and the differences between them and about one of the most common STIs, Chlamydia.


Today, we are shedding a light on another very common STIs, Gonorrhea, a sexually acquired infection that has become a public health concern. How do you know you have an infection with Gonorrhea and what should you do next? Read further!


Gonorrhea is a sexually transmitted infection by the bacteria Neisseria gonorrhoeae. Worldwide it is the second most common STI of bacterial origin, affecting more than 60 million people annually. The infection attacks the immune system, making it susceptible for repeated infections.


Gonorrhea can be transmitted through:

  • Direct contact between two individuals during sexual intercourse: vaginal, anal, oral

  • Direct contact with an infected cervical canal during birth

  • Hand contact from genital area to eyes

  • Transmission is more efficient from men to women rather than from women to men

  • After a single exposure, a man has a 20% risk of acquiring the infection and can increase up to 80% upon more exposure



Risk factors

  • Young age: below 25 years old (as studies show that young age is correlated with a riskier sexual life)

  • Previous infection with Gonorrhea or other STIs

  • Inconsistent condom use

  • New or multiple partners

  • A partner with an existent Gonorrhea infection


Prevalence

  • In the last 20 years, infections with gonorrhea increased, especially in populations with higher frequency of spreading STIs (men who have sex with men, young sexually active adults < 25 years)

  • In the US, the highest incidence of infections with gonorrhea are amongst people aged 15 to 24. A number of reasons explain these numbers: increased number of sexual partners, decreased access to healthcare providers, decreased use of barrier contraceptives (condoms, diaphragm, cervical cap, contraceptive sponge); up to 60% of infections happen to people younger than 25 years

  • In women with an HIV infection, especially those that use drugs or practice sex for drugs (drug use is correlated with riskier sexual behavior)


The infection with Gonorrhea can be classified depending on the infected region: anogenital (anal and genital area), urogenital (urinary and genital area) and pharyngeal (pharynx) chlamydia


The infection can enter the bloodstream as well, causing gonococcemia (infection presented by skin wounds, fever, inflammation of joints )and have negative effects on the joints, cardiovascular system and skin.



Urogenital infections


Symptoms in women

  • 50% of women with gonorrhea present symptoms

  • The most common one is cervicitis (cervical inflammation) accompanied by discharge of mucus (liquid produced by the inner lining of the organs) or bleeding


When undetected and left untreated, the bacteria travels across the cervix and uterus towards the upper genital tract where it can develop complications such as:

  • ectopic pregnancy

  • Infertility due to salpingitis (inflammation of the fallopian tubes)

  • PID (pelvic inflammatory disease)

  • Complications of PID: ovarian abscesses, pelvic peritonitis (inflammation and infection of the peritoneum, the membrane that lines the abdomen in the pelvic area.) and perihepatitis ( swelling of the tissues around the liver)


Symptoms of PID (pelvic inflammatory disease)

  • Lower abdominal pain and sensitivity

  • Sensitivity during vaginal examination

  • Dyspareunia (painful intercourse)

  • Abnormal bleeding: between menstruations, after intercourse and menorrhagia (heavy or prolonged menstrual bleeding) as a result of associated cervicitis (inflammation of the cervix), endometritis (inflammation of the endometrium - the inner lining of the uterus) or bacterial vaginosis

  • Fever (more than 38C)


Symptoms in men

  • The infection usually show symptoms

  • Symptoms can appear after a period of 3-7 days after acquiring the infection

  • Urethritis: green or yellow discharge, dysuria (painful or difficult urination), macerated skin in the genital area (part of the skin gets soft and breaks down as a result of prolonged exposure to moisture)

  • This is why in the past alternative names were “clap” or “drip”, because of the high volume of discharge during an acute infection


When undetected and left untreated, the bacteria travels across the urethra towards the upper genital tract where it can develop complications such as epididymitis (inflammation of the epididymis, a tube located at the back of the testicle that is in charge with carrying sperm)


Anal infections

- one third of men present symptoms such as pruritus (itchiness), tenesmus (feeling of the need to evacuate the bowels) and discharge

- usually presents no symptoms in women, making it an infection hard to detect


Pharyngeal infections (infection of the pharynx, part of the throat behind the mouth and nasal cavity)

  • Infection with Gonorrhea acquired during oral sex

  • Usually it does not present any symptoms, both in men and women


Ocular (eye) infections

  • Neonates (newborn babies) can get Neonatal gonococcal conjunctivitis (inflammation of the conjunctive, the layer that covers the white part of the eyeball) transmission through birth from an untreated infection in mothers

  • adults can get ocular infections with Gonorrhea through transmission from genitalia by hands

  • Symptoms: inflammation of the eyelid and purulent exudate (a thick yellowish or greenish opaque liquid produced in infected tissue, consisting of dead white blood cells and bacteria)

  • Complications of eye infections are corneal scarring (injury on the cornea - the transparent front part of the eye that covers the iris, pupil, and anterior chamber) and blindness


How often should you get tested?

  • Sexually active young (< 25 years of age) women and men should undergo annual testing and without regards of age for MSM (men who have sex with men)


What should you do if you tested positive for Gonorrhea infection?

  • Follow the doctor’s recommendations for treatment

  • Test yourself for other STIs, such as gonorrhea, syphilis and HIV

  • Inform current and previous partners that you were in contact with

  • Abstain from sexual intercourse for seven days after the end of the treatment


Screening

  • Screening and diagnosing can be conducted by analyzing samples taken from cervix, vagina, anus, throat, or urine; many times the patients can collect themselves samples by using home test kits that contain a swab for collection and send them to certified clinics

  • Recurring testing is necessary, as early detection and treatment can prevent further complications such as reproductive issues, especially in women

  • It is a cost effective measure as it prevents developing complications that result in hospitalization and costly services

  • Increasing access to testing, diagnostic methods, treatment and follow-up with gonorrhea positive patients is crucial in order to control its spread


Treatment challenges

  • Currently, antibiotics are the only treatment available, prescribed by doctors, upon screening

  • Neisseria gonorrhoeae is a strong bacteria that can acquire and develop resistance to antibiotic treatment

  • Many treatments do not work anymore due to its capacity to adapt making it a serious public health problem

  • It is feared to be the next “superbug” (bacteria, viruses, parasites and fungi that are resistant to antibiotics and other medication that is normally used to treat the infections they produce) as recently the resistance has been increasing also against current treatment

  • Researchers are working on developing a vaccine, unfortunately until now no effective vaccine has been realized

  • In the meantime, let’s stay safe and test ourselves.


Be smart. Be (c)LIT. Fly with us!🌺🐝


Sources:

https://pubmed.ncbi.nlm.nih.gov/24559563/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750764/

https://pubmed.ncbi.nlm.nih.gov/28357376/

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