Gonorrhoea is one of the common and widely spread STDs caused by the bacteria Neisseria gonorrhoea which is also called as ‘clap’.  Neisseria gonorrhoea represents the major reason behind morbidity in individuals who are in their sexually active phase and also known to be the second largest communicable infection in the US.  They are known to infect both male and female equally and also new-born.  According to World Health Organization (WHO), the main concern for Neisseria gonorrhoea is the emergence of bacterial resistant strain which can in future make the treatment option complicated or not treatable due to inactivity of microbial agents against these particular bacteria.

Know the bacteria

These particular bacteria can only be found in humans and they generally do not survive outside the human body.  Inside the human body, Neisseria gonorrhoea can excellently adapt to reside in the genital tract.  It has the ability to stay inside the human body without affecting the host defence mechanism much. With the help of this higher adaptability, Neisseria gonorrhoea has become able to stay inside the human body for long periods of time, infecting other individuals and most of the time being asymptotic or show mild symptoms. The main site of infections is the mucous membrane present in reproductive areas like cervix, fallopian tube uterus for females and urethra for both females and males.  In addition to these, infections can also spread in mucous membrane present in eye, throat, mouth or rectum.

Mode of transmission

Sexual intimacy is the main mode of gonorrhoea transmission. Mostly the infection spreads with direct contact with organs such as vagina, mouth, penis or anus from an infected individual.  The male individual normally has a 20% chance to have the infection with a single sexual act, whereas for a female the chance is highly increased to 60-80% to get the infection from a single interaction.  If the infection exists at the time of pregnancy, then the bacterial infection may spread to the unborn baby. Additionally people also sometimes show reinfection once come in contact with an infected individual after getting cured. Mostly this particular STD occurs in high rate for younger people under 30.  Among all individuals, there are certain groups of person where the rate of being infected is high –

  • When an individual comes in contact with other individuals where a prior infection is already present.
  • Individual already diagnosed with HIV.
  • Individual with several sex partners.
  • Individuals having a persistent history of other STDs.

Gonorrhoea symptoms

In a lot of individuals, there are no symptoms of Gonorrhoea infection. But if there are symptoms it generally shows within seven day period after the bacteria entry into the body. Depending on the organs where bacteria have to colonize, there can be several clinical manifestations, such as –

Urogenital Infection in female:  During Gonorrhoea infection, the genital area specially cervix get involved and affects reproductive fitness of an individual.

Cervicitis- In females, the mucous membrane of the uterine cervix is one of the common areas of Gonorrhoea infection. However in a majority, almost 70% time, infected females do not show any symptoms. As a result, how long the bacterial infection has occurred is remain undetermined.  However, in the situation where there are symptoms, they will generally express within 10 days post infection. Symptoms such as – bleeding in-between menstruation cycle, mucopurulent discharge from the vagina is common.

Urethritis- In 90% of females, Urethra is the main site of isolation of gonococcal bacteria.  In most of the cases, urethral infection takes place together with cervical infection except for the individual with hysterectomy.  At the time of Urethra infection, there is almost no sy5mptoms present only frequent urination.

Pelvic inflammatory disease or PID:  PID is seen among 10-20% of female individuals who have already developed cervical gonorrhoea infection and almost 40% of the time, the presence of Neisseria gonorrhoea has been documented.  Visible symptoms of PID include abdominal pain, vaginal bleeding or dyspareunia quite similar to menstruation. There can also be the presence of fallopian tube inflammation and scarring.

Pregnancy Complications- In presence of gonococcal bacteria, pregnancy complications such as premature rupturing of the membrane, chorioamnionitis, premature birth, spontaneous termination of pregnancy are seen. Those events are occurring at a much higher rate than normal non-infected individuals. Additionally, if the bacterial infection remains untreated, the bacteria infection get transmitted from mother to newly-born baby which is observed almost 30%-50% cases. When such events occur, newborn babies mostly develop symptoms like neonatal conjunctivitis, pharyngitis or arthritis. If left untreated eye infection can lead to blindness to babies.

Urogenital Infection in male:  Urogenital infection in male includes symptoms like urethritis, epididymitis

Urethritis- Comparison to females, inflammation of urethra or urethritis in male mostly showed symptoms. They are generally starting to develop within 1 week to 1 month time period from the entry of bacteria. Symptoms such as –

  • burning sensation or pain in the time of urination
  • Irritation as well we secretion of pus from the male genital area.
  • Inflammation with pain in testicles.

If the infection left without treatment, there is a chance that the infection may spread to other body parts. In rare situations, urethritis caused by Gonorrhoea may lead to complications like periurethral abscesses, penile lymphangitis or penile oedema.

Epididymitis- Individuals under 35 years, epididymitis is the major symptoms which can be seen on Gonorrhoea infection. However, epididymitis caused by in combination with Gonorrhoea and Chlamydia is more common than infection caused by Gonorrhoea alone.

 Additionally, Gonorrhoea may infect areas such as eye, rectum, throat or Joints.

Rectum-Infection in the rectal area includes pus discharge, bleeding or itching.

Eyes- Eyes infected with Gonorrhoea shows symptoms like discharge like pus, pain or sensitivity towards the light.

Throat- Infected throat shows symptoms like a sore throat or presence of lymph nodes in the neck.

Joints- In presence of Gonococcal bacteria, joints become inflamed, red and painful.

 Risk Factors for Gonorrhoea infection

Risk factors for infections caused by gonorrhoea bacteria include-

  • Age- individual younger than 25 years are more prone to get infected by these bacteria.
  • Individuals having more sex partners.
  • Individuals having pre-exposure of Gonorrhoea.
  • Individuals are known to have different other STDs.