Gonorrhea: one of the diseases of love

Gonorrhea, also known as blennorrhagia or, in popular language, drain (by virtue of the abundant losses it can cause especially in humans), is a venereal disease caused by the bacterium Neisseria gonorrhoeae, more simply known as Neisser’s gonococcus (named after the scientist who first identified it).

According to the latest guidelines issued by the World Health Organization (WHO), it is one of the most frequently detected sexually transmitted diseases worldwide, in second place, with 78 million new diagnoses every year, behind chlamydia (131 million new diagnoses every year) and syphilis (5.6 million new diagnoses every year).

How it is transmitted

Gonococcal infection is transmitted almost exclusively through unprotected sexual intercourse, by direct contact with the mucous membranes or secretions of the infected partner. Infection can occur through vaginal, and orogenital intercourse.

There is also the possibility of a so-called vertical transmission from mother to child, which occurs at the time of birth during the passage of the baby in the birth canal.

The transmission of Neisser’s gonococcus through indirect contact, i.e., for example, through the exchange or promiscuous use of linen, is instead a rather rare eventuality, although not impossible, because this microorganism survives for a short time in the environment.

It is man, in fact, the natural host of this pathogen, which prefers warm and humid environments to grow and reproduce, such as:

• the urethra (the duct that carries urine from the bladder to the outside), in both men and women
• female genitalia
• the uterus and fallopian tubes.

In addition, the mucous membranes of the mouth, throat, eyes and rectum also have the ideal characteristics to promote engraftment and survival.

How it manifests itself

The infection has an incubation period (which corresponds to the period of time from infection to the appearance of symptoms) rather variable, indicatively from 2 up to 30 days.

In men, the disease mainly gives rise to gonococcal urethritis, resulting in the appearance of burning and discomfort during urination, as well as muco-purulent discharge from the urethra, generally greenish-yellow. In some cases you may also feel pain in the genitals.

In women, gonorrhea can cause the appearance of urethritis or cervicitis, most often, however, asymptomatic. When they occur, they generally do so with less obvious symptoms than those of men, which include the increase or variation of the characteristics of vaginal secretions, with the appearance in some cases of muco-purulent discharge, bleeding between menstrual cycles and dysuria (ie difficulty urinating).

At the rectal level, the infection is generally symptom-free, but can sometimes cause, in men and women, itching, secretions and irritation at the level of the anus.

The oral infection, much less frequent than the others, is also often asymptomatic or, possibly, manifests itself with irritation of the mucous membrane of the throat and tonsils.

Newborns who contract the infection from their mother generally experience gonococcal conjunctivitis, which is manifested by redness, a sense of sand and itchy eyes, and mucus-purulent discharge from the tear ducts.

Possible complications

If left untreated, blennorrhagia can lead to serious health consequences.

In women, it can cause the appearance of bartholinitis (inflammation of the Bartholin glands), endometritis (inflammation of the endometrium), peritonitis (inflammation of the peritoneum) or pelvic inflammatory disease (PID). The latter consists of an inflammation of the upper tract of the female reproductive structures (uterus, fallopian tubes, ovaries), which can lead to abdominal pain, pelvic and fever; In addition, it represents one of the possible causes of female sterility and increases the risk of ectopic pregnancy (i.e. when the implantation of the embryo takes place in locations other than the uterine cavity).

In humans, two of the most frequent complications are orchitis and epididymitis. The first is inflammation of the testicles, while the second concerns the epididymis, a seahorse-shaped structure located close to each testicle and consisting of a set of tubules that flow into a single supple tubule, which carries sperm. These complications, if left untreated, as well as painful can be the cause of male sterility.

If contracted during pregnancy, blennorrhagia can cause chorioamnionitis, i.e. an infection of fetal membranes and amniotic fluid, rupture of the membranes themselves or even a preterm birth. In addition, there is a risk that it is transmitted to the unborn child at the time of delivery.

If a gonococcal eye infection is left untreated, the greatest risk is that of blindness. Finally, although rarely (in less than 1% of cases), there is a possibility that untreated gonococcal disease can spread into the bloodstream and then to the whole body, including the joints.

Diagnosis

Early diagnosis is essential to discover and deal with the disease as soon as possible and thus avoid that, even if asymptomatic, it can progress leading to the complications described above.

For this reason, whenever you have had a risky relationship, it would be advisable to undergo a check-up visit to the doctor (the gynecologist for women, the andrologist or urologist for men) both in the presence and in the absence of suspicious symptoms. A check is also essential if the usual partner is diagnosed with a sexually transmitted infection.

During the visit, the doctor will collect information about the date of the risk relationship, the presence and duration of any symptoms; In addition, he will have to perform a visual examination, verifying the characteristics of any leaks and also evaluating the appearance of the genitals.

Precisely because the symptoms may not be manifest or clear, to confirm or not the suspicions about the possible infection and the possible triggering pathogen, the visit alone is not enough. Generally, therefore, the doctor also performs urethral, vaginal, cervical and, if necessary, rectal and pharyngeal swabs. That is, it takes samples of secretions to be subjected to laboratory tests (in particular a culture examination and a microscopic examination after Gram staining).

How do we cure it

Since it is a bacterial infection, the treatment of gonorrhea requires the use of antibiotics, either orally or with intramuscular injections. The treatment should also be proposed to the partner (all subjects with whom the patient has had sexual intercourse at least in the month preceding the possible appearance of symptoms are considered at risk, even if the incubation is variable and the possibility of an asymptomatic infection does not allow to exclude any previous sexual partners).

If the infection is discovered during pregnancy, more attention and precautions will be needed from the doctor because not all antibiotics are recommended during gestation.

Antibiotic treatment is generally effective, but in recent years, as a result of the indiscriminate and incorrect use of this category of drugs, many bacteria have developed forms of antibiotic resistance. in particular, gonococcus, among those responsible for sexually transmitted diseases, is the bacterium that most of all has developed resistance, so much so that multi-resistant strains of gonorrhea have already been identified that do not respond to any of the available antibiotics.

Traditionally, the treatment of gonorrhea involved the use of antibiotics of the category of cephalosporins and/or quinolones. But the new WHO guidelines no longer suggest the use of the latter, since it is an antibiotic class characterized by high levels of resistance.

In order not to further contribute to the development of resistant strains, care should be followed carefully, without independently changing the dosage of the antibiotic or the duration of its intake, even if any symptoms disappear quickly. At the end of the treatment it is advisable, indeed, to undergo a further medical evaluation to be sure of healing.

How to prevent

The risk of contagion concerns all sexually active people. Prevention, therefore, passes primarily from contraception, especially with occasional partners or in any case whose real health conditions are ignored.

The condom, if used correctly from the beginning of intercourse and also in the case of and oral intercourse, protects against contagion by avoiding contact with both mucous membranes and fluids and is the only protective tool: hormonal or barrier contraceptives (such as spirals) or spermicides have no protective action against any venereal disease, including blennorrhagia.

It is part of the preventive strategies, for all those who have an active sex life, also to undergo periodic annual check-ups by the gynecologist and the urologist or andrologist, regardless of whether or not they have had a risky relationship.

In terms of prevention, women who have a planned pregnancy may be advised to undergo a visit with a vaginal control swab, to know if they are affected by infections, such as gonococcal infection, which could then occur during gestation, in order to deal with them before pregnancy or in any case to better plan the latter.

Finally, it should also be remembered that, by law, every child at birth is subjected to a conjunctival prophylaxis (or Credè’s prophylaxis), with the instillation of drops of silver nitrate eye drops or, alternatively, with the use of an antibiotic ophthalmic ointment, precisely to prevent any gonococcal infections.