Topic Tuesday: Gonorrhea

Gonorrhea is hard to spell! Maybe that’s why there are so many slang words for it. It’s also called the ‘clap’, ‘a red hot poker in the pipe,’ ‘pissing broken glass or like razor blades.’ Gonorrhea is caused by a bacteria that lives on warm, moist parts of the body such as the anus, vagina, penis, mouth, throat and urethra.

But first, here’s some interesting info for the next time you play ‘Trivial Pursuit: The STD Version”

The Old Testament, Leviticus, Chapter 15, devotes several verses to what is almost certainly gonorrhea!

And here is a suggestion that the myth of the catching something from a toilet seat happened in Biblical times, from the same chapter!

So gonorrhea seems to have been around a long time! In fact, it was recognized by sages and historians such as Hippocrates, Plato and Aristotle for many centuries before Galen named it gonorrhea in 1526 from the Greek = seed and flow.  (Back in those days, mucous discharge was mistaken for semen.) 353 years later, in 1879, scientist Albert Neisser obtained experimental evidence about the pathogen for gonorrhea so the full name is Neisseria Gonnorrhoeae.

It kind of rhymes!

Gonorrhea (pronounced: gah-nuh-REE-uh) is a sexually transmitted disease (STD) caused by bacteria called Neisseria gonorrhoeae. Easy to see using a microscope’s high magnification, the gonococci are pink, kidney-shaped bacteria inside white cells, arranged in pairs that can be passed from one person to another through vaginal, oral or anal sex, even when the person who is infected has no symptoms.

The bacteria can be spread by the exchange of sexual fluids (semen and vaginal secretions) through vaginal, anal (most common) and oral intercourse. Mouth-to-mouth transmission between adults is theoretically possible but it’s unlikely. It has sometimes been found in the throats of women or gay men who perform fellatio (oral sex), but it is unusual in men who have oral sex with infected female partner, cunnilingus. Doctors have never come across a case of direct mouth-to-mouth transmission.

No one really knows how infectious it is. A man with gonorrhea might have a 95% chance of passing it on from one episode of vaginal sex.  If the woman has gonorrhea, the risk of her passing it on may be lower.

The usual sites for infection are the urethra, throat and rectum in men, and cervix, urethra, rectum and throat in women. Rectal gonorrhea in men is mostly the result of bottoming, (being the receiving partner) although an infection can be passed by vibrators or through digital insertion (fingers). In 40% of women with gonorrhea, the infection is found in the rectum, not necessarily as a result of rectal intercourse. Gravity can allow the secretions to come into contact with anal tissue during intercourse.

You cannot catch gonorrhea from a towel, a doorknob, or a toilet seat.

Gonoccocus rapidly dies away from the warmth and moisture of a human being. So the only way to catch it from a toilet seat would be for a man’s penis to leave a little discharge on the seat while sitting, and a second man’s penis coming into contact with that discharge. That’s highly improbable and no single case has ever been recorded this way. The gonococcus cannot infect ordinary skin surfaces; it needs mucous membrane or internal tissue. It is therefore unlikely that a woman could either infect a toilet seat or bring an infect-able part of her anatomy into contact with one.

That settles that!

A female who has gonorrhea may have no symptoms at all or her symptoms may be so mild that she doesn’t notice them until they become more severe. In some cases, females will feel a burning sensation when they urinate, or they will have a yellow-green vaginal discharge. There also may be vaginal bleeding between menstrual periods. Some experience frequent urination and abdominal pain, as well. Remember: 50% of women show no signs.

If the infection becomes more widespread and moves into the uterus or fallopian tubes, it may result in an infection called pelvic inflammatory disease (PID), which can cause abdominal pain, fever and pain during sexual intercourse, as well as the symptoms above.

Guys who have gonorrhea are much more likely to notice symptoms, although a guy can have gonorrhea and not know it. Guys often feel a burning sensation when they urinate, and yellowish-white or greenish discharge may ooze out of the urethra (at the tip of the penis).  A guy may feel like he wants to urinate but can’t or only can a little.  Discharge in acute gonorrhea starts as a slight bit of mucus, developing into full-blown pus after a day or two – off-white and staining the underwear.

Here’s more trivia for you: clinic workers recognize the “tissue paper” sign – when a man attends with a piece of toilet paper on the inside of his underwear, the diagnosis is gonorrhea until proven otherwise.

Dysuria (which is a fancy word for “painful burning during urination”) is a classic symptom of gonorrhea but we rarely see patients complaining of the really severe discomfort mentioned in the old textbooks.  50% do not mention any discomfort at all.

The incubation period, the time between infection and the development of symptoms, has progressively lengthened since the 1930s. In that pre-war era, an infected person noticed something wrong within 2 or 3 days. By the 1990s, the average time had increased to a few more days.

Symptoms usually appear 2 to 7 days after a person has been exposed to gonorrhea, and in females they may appear even later. In some cases, they can appear up to 14 days after the initial infection. No one knows how soon you are infectious, but there have been anecdotes of transmission within an hour or two of catching gonorrhea.  It is best to wait at least three days and some say a week, for detection.

Remember, many people experience no symptoms, especially with gonorrhea of the throat. However, a sore throat can be a symptom of the infection there.

Infection of the throat is not associated with any particular symptoms, although it seems that men or women who practice oral sex are more prone to sore throats than others.

Gonorrhea of the rectum tends to produce no symptoms in more than 80% of men or women infected there. Some notice pus on their feces and others may complain of a little dampness or itching around the anus, but most are unaware of their infection.

Gonorrhea can be very dangerous if it is left untreated, even in someone who has mild or no symptoms. In females, spread of infection inwards to the uterus can give rise to endometritis, followed by involvement of the Fallopian tubes, salpingitis, and into the pelvis to cause pelvic peritonitis. Chlamydial and gonococcal salpingitis share the same signs and symptoms; both infections may be found together in the same patient and both may lead to ectopic pregnancy, scarring or infertility. Gonorrhea infection during pregnancy can cause problems for the newborn baby, including meningitis (an inflammation of the membranes around the brain and spinal cord) and an eye infection that can result in blindness if it is not treated.

A woman’s ovaries are as sensitive as a man’s testicles and are normally protected within the bony pelvis; but there are certain occasions during sex when the erect penis will bang the ovary. This is known as ‘anvil syndrome’ after the metal block on which a blacksmith fashions a horseshoe.

In guys, gonorrhea can spread to the epididymis (the structure attached to the testicle that helps transport sperm), causing pain and swelling in the testicular area, known as epididymo-orchitis.  This can create scar tissue that might make a guy infertile.  Guys are less likely to develop blood-borne complications but may develop infection of the various glands in the genital area, including the Littre’s glands inside the urethra and Cowper’s, Tyson’s and the prostate gland.

In both males and females, spread of infection internally can give rise to the Fitz-Hugh-Curtis syndrome, a condition in which the lining outside the liver becomes inflamed, a ‘peri-hepatitis.’  Rarely, gonorrhea spreads via the bloodstream to elsewhere in the body, usually the skin and the joints. It can affect other organs and parts of the body including the throat, eyes, heart, brain, although this is less common.

At the beginning of the 20^th century, gonorrhea could be seen using the microscope and a diagnosis made in this way was very likely to be correct. It was possible to grow (culture) the gonococcus, the bacterium, in a laboratory. But this sort of “horticulture” is time-consuming. It takes a good 48 hours for gonococcus to grow and it is expensive in labor and equipment. Now it’s a NAAT – nucleic acid amplification test (more trivia!!) which detects part of the bacterium rather than the whole organism. The tests tend to be highly sensitive; if the infection is there, they will find it.

If you think you may have gonorrhea or if you have had a partner who may have gonorrhea, you need to see your doctor or gynecologist. He or she will do an exam which may include checking a urine sample, or for a female, swabbing the vagina or cervix for discharge, which will then be analyzed. Talk to your doctor about which test is best for you. The doctor may also test for other STDs, such as syphilis or chlamydia. Let the doctor know the best way to reach you confidentially with any test results.

In more understandable terms, a diagnosis can be performed in days simply on a sample of urine, if it’s a urethral infection. A doctor will need to take a culture from the back of throat, if it’s an oral infection and from the anus, if it’s an anal infection – whether or not there are symptoms.  Blood tests are discounted; none are reliable.

If you are diagnosed with gonorrhea, your doctor will prescribe antibiotics to treat the infection. Anyone with whom you’ve had sex should also be tested and treated for gonorrhea immediately. This includes any sexual partners in the last 2 months, or your last sexual partner if it has been more than 2 months since your last sexual experience.

If a sexual partner has gonorrhea, quick treatment will reduce the risk of complications for that person and will lower your chances of being re-infected if you have sex with that partner again. (You can become infected with gonorrhea again even after you have been treated because having gonorrhea does not make you immune to it.)

It’s better to prevent gonorrhea than to treat it, and the only way to completely prevent the infection is to abstain from all types of sexual intercourse. If you do have sex, use a latex condom every time. This is the only birth control method that will help prevent gonorrhea.

1. You cannot catch gonorrhea from a toilet seat.
2. One in ten men and half of women with gonorrhea have NO symptoms.
3. Although most men have a discharge, only 50% have pain during urination.
4. Gonorrhea and chlamydia are like 1^st cousins: if you test positive for one, you will most likely be treated for the other, as well.

The information above was gathered from these great resources. I encourage you to check them out if you want to keep learning!

• http://en.wikipedia.org/wiki/Albert_Ludwig_Sigesmund_Neisser\
• http://dictionary.reference.com/browse/gonorrhea
• http://kidshealth.org/teen/sexual_health/stds/std_gonorrhea.html
• Sexually Transmitted Infections (The Facts) by Barlow, David (Mar 3, 2011), $12.49 Kindle Edition