Gonorrhoea

History

Gonorrhoea, thought to be known dating back to the Old Testament, is one of the

first human diseases ever discovered with biblical references (Unemo, M. & Shafer, W.

M., 2014). The Greek physician Galen (130-200 A.D.) first used the term gonorrhoeae in

describing the unwanted excretion of semen (J. D. Oriel, 1994). Gonorrhoea was

referred to as the clap. According to historians, the term originated in 1378 that is derived

from Les Clapiers (a district in Paris where prostitutes lived). The name is said to be

originated because in order to remove the pus-like discharge from the penis, the penis

had to be clapped on both sides. But still others believe that the name comes from French

brothels (known as les clapiers) and men who visited these brothels invariably ended up

with the infection (A. Mandal, 2012). In 1879, Albert Neisser discovered the gonococcus

or Neisseria gonorrhoeae (and also named after him) and it was soon proven to be the

causative agent of gonorrhoea (J. Pommerville, 2010).

Pathogenesis

The causative organism Neisseria gonorrhoeae is a gram-negative diplococcus

with a marked tropism for human mucosal surfaces. It is also often referred to as

gonococcus. The ability of this organism to cause disease develops from the properties

of the surface pili, a small hair-like extensions of the surface membrane. The pili of this

organism prevent ingestion of bacteria by neutrophils. Also, the pili contain on IgA

protease which digests the IgA on the surface of the urethra, fallopian tubes and

endocervix allowing attachment to these surfaces. Adherence to the surface of

spermatozoa allows transmission of the organism to the fallopian tube, the presumed

mechanism of ascending infection. Initial infection may not produce or show symptoms

but the organism stimulates a severe inflammatory reaction resulting into a discharge of

pus.

The clinical consequences of gonorrhoea are due to classic pyogenic infection with

resolution by the thickening of connective tissue. Initial infection is usually seen in the

cervical region, but due to the adherence to spermatozoa, the infection may ascend

through the uterus into the fallopian tubes and finally out into the peritoneal cavity.

A discharge of pus in vagina is often seen, but frequently the purulent material

exudes from the fimbriated end of the fallopian tubes into the peritoneal cavity. Untreated

infections may progress to fibrosis. The fibrotic reaction, depending on its location can

lead to a variety of complications, such as urethral stricture, fallopian tube stricture, tubo-

ovarian abscess, pelvic inflammatory disease (PID) and infertility. Peritonitis may present

in PID and cause life threatening acute bowel obstruction.

As early as possible, it is important to aid the symptoms of gonorrhoea before it

would lead to other serious complications. When the infection is confined to the lower

genital tract, it is much more responsive to antibiotic therapy. Once the infection arises

and becomes well established, it is difficult to deliver the needed concentrations of

antibiotics and the infection is much more difficult to cure with drugs alone. This is due to

the lack of blood flow in the walled off areas and is the reason that surgery often becomes

necessary.

In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery.

This results in infection of the conjunctiva of the eye. This appears 1 to 4 days after birth
as severe discharge with marked swelling and redness of the eyelids and conjunctiva.

This can lead to corneal perforation and blindness. Diagnosis is made by gram stain of

the exudate and culture (2016 copyright by Tulane University. All rights reserved.).

Prevalence
Gonorrhoea is the second most commonly reported notifiable disease in the United

States. Sexual behaviour and community prevalence increases the risk of acquiring the

disease. Also, social determinants of health such as socio-economic status,

discrimination, and access to quality health care, may contribute to the burden of

gonorrhoea in a community (Hogben & Leichliter, 2008). In 2008, the World Health

Organization (WHO) estimated a global incidence of Neisseria gonorrhoeae was 106.1

million cases for women and 36.4 million cases for men. As a result, there is a percentage

increase of 21% from 2005. The prevalence of gonorrhoea among adults is estimated to

be 8.2 million in African region, 3.6 million in American region, 9.3 million in South-East

Asian region, 1.0 million in European region, 1.0 million Eastern Mediterranean region,

and13.3 million in Western Pacific region. Estimates of global prevalence and incidence

of gonorrhoea in adult men and women remain high. The estimates highlight the urgent

need for the public health community to take action in ensuring that the health care is

widely available.

Signs and Symptoms

Most common symptoms include the following:

Throat and anal infections can occur following receptive oral and anal intercourse

and infections at these sites are often without symptoms.

 Joint pain and infection (arthritis).

Conjunctivitis (inflammation of the lining of the eyelids and eye) in both adults and

children.

In addition to the above signs and symptoms, gonorrhoea in men causes urethritis

(infection of the urethra, the urinary canal leading from the bladder to exit at the tip of the

penis) causing:

discharge of pus from the penis

a burning sensation in the penis when urinating

In women, gonorrhoea usually affects the cervix (opening of the uterus at the top of the

vagina) causing:

vaginal discharge

discomfort on urination

bleeding between periods, often after having sex

The infection may spread from the cervix to the Fallopian tubes (tubes leading from the

ovaries to the uterus), causing pelvic inflammatory disease (PID). Pelvic inflammatory

disease due to gonorrhoea is often without symptoms, but there may be:

fever

low abdominal pain

pain on intercourse

If untreated, pelvic inflammatory disease may lead to scarring of the Fallopian tubes and

ectopic (tubal) pregnancy or infertility.

Prevention and Control

Presently, scientist havent yet developed a vaccine that could help prevent

gonorrhoea. On the other hand, there are certain medications that could relieve the

disease before any complications arise (e.g. antibiotic ceftriaxone).

The following are the ways to prevent and control gonorrhoea:

You can reduce, but not eliminate, your risk of getting gonorrhoea by practicing

safe sex.

Always use reliable protection during sex (e.g. latex male condom and etc.)

You should not have unprotected sex of any type with someone unless you are

both sure you do not have any sexually transmitted diseases.

Uphold fidelity and/or abstinence, otherwise, limit your number of sexual partners

and avoid high-risk partners.

Engage with a long-term mutually-monogamous relationship with an uninfected

partner to avoid gonorrhoea and other STDs.

Know the sexual history of your partners. Talk to each potential partner about both

of your sexual histories before beginning a sexual relationship. These discussions

are important regardless of gender. Women who have sex with women and men

who have sex with men are also at risk for STDs.

Other things you can do to help prevent gonorrhoea and other STDs:

Avoid douching. Douching removes the protective bacteria normally found in the

vagina. As a result, you are more likely to become infected if you are exposed to

an STD.
 Wash your vagina with soap and water after sexual activity. This may help to

eliminate parasites and bacteria that have entered the vagina.

Urinate after sexual activity. This may help to flush out bacteria that have entered

the urethra.

Perform regular genital self-examinations. To become familiar with the normal

appearance of your genitals. This will help you to identify any symptoms that may

develop if you are exposed to an STD.

Get regular gynecological examinations, including testing for STDs. While this

won't stop you from contracting gonorrhoea, early detection and treatment can

prevent more serious complications from developing.

Be aware of signs or symptoms in your partner(s). People may be dishonest about

their sexual history or STD status. Therefore, you should be aware of any signs

and symptoms in your partner (although gonorrhoea does not always produce

symptoms).

Pregnant women should be tested for gonorrhoea and treated if necessary. Babies

born in hospitals are treated with special eye drops to prevent a gonorrhoea

infection in the eyes.

References

Unemo, M. & Shafer, W. M. (2014). Antimicrobial resistance in Neisseria gonorrhoeae in

the 21st century: past, evolution, and future. Clinical Microbiology Reviews, 27(3),

587 613.

Pommerville, J. (2010). Alcomos fundamentals of microbiology. Massachusetts: Jones

and Bartlett Publishers. p. 78

Orielle, J. D. (1994). The scars of venus: a history of venereology. United Kingdom:

Springer Verlag.

Mandal, A. (2012, November). Gonorrhea history. Retrieved from: http://www.news-

medical.net/health/Gonorrhea-History.aspx

Hogben M. & Leichliter J. S. (2008). Social determinants and sexually transmitted disease

disparities. Sexual Transmitted Disease, 35(12), pp. 13 8.

Tulane University, Dept. of Pathology & Laboratory Medicine. Pathogenesis of

gonorrhoea. New Orleans, Louisiana. Retrieved from:

https://www2.tulane.edu/som/departments/pathology/pathogengono.cfm

http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/heal

th+topics/health+conditions+prevention+and+treatment/infectious+diseases/gono

rrhoea/gonorrhoea+-+including+symptoms+treatment+and+prevention

http://www.njfamilyhivaids.org/gonorrhea-treatment.htm