What is gonorrhoea?

Gonorrhoea, also known as "the clap," is a curable infection caused by the bacteria Neisseria gonorrhoea.

The bacteria infects:

• The urethras of men and women

• A variety of genital glands, such as the Tyson's gland in men and the Bartholin's gland in women

• The uterine cervical canal and tubes

• The epididymis

• The anal and distal rectum

• The conjunctiva in the eye

• The mouth and the pharynx

How can I get gonorrhoea?

• Gonorrhoea is transmitted by oral, vaginal, or anal sex.

• Gonorrhoea can be passed even if the penis or tongue does not go all the way into the vagina, mouth or rectum, and even if body fluids are not exchanged.

• If penetration or body fluids are exchanged, the risk of infection may increase.

• Gonorrhoea can be passed from mother to newborn as infant passes through the infected birth canal. This may result in infections in the eyes or blood.

• In children, gonorrhoea is a possible sign of sexual abuse.

What are the symptoms of gonorrhoea?

Many men exhibit symptoms within two days to five days after exposure, with a possible range of one to 30 days. Although most women infected will remain asymptomatic (without symptoms), women who develop symptoms will do so within 10 days of infection.

Men may be asymptomatic (without symptoms) but might experience:

• Discharge from the penis

• Burning or pain when urinating (peeing)

• Urinating more often than usual

Women are usually asymptomatic (without symptoms) but might experience:

• Discharge from the vagina

• Pain during sex

• Burning or pain when urinating (peeing)

• Abdominal pain or abnormal vaginal bleeding especially post-coital (may be an indication that the infection has progressed to PID).

In both men and women, infection without development of symptoms is common and early symptoms are often mild.

Men or women who have anal sex with an infected partner might have a rectal (anal) infection; most (90 percent) have no symptoms, but there might be:

• Rectal itching

• Discharge

• Pain on defecation

Women often have rectal infection without rectal sex, probably due to contamination from cervical/vaginal discharge.

Men or women might also have an oral infection; most (90 percent) are asymptomatic (without sypmtoms), but some might have a sore throat.

How can I find out if I have gonorrhoea?

• It is possible to transmit gonorrhoea even when you are asymptomatic (without symptoms), so testing is important for someone who has been at risk even if they are not having any symptoms.

• Testing can be done either by by taking a specimen from the infected area.

• For the purpose of accurate testing, patients need to tell their doctor what kind of sex (oral, vaginal, anal) they have had.

• A false-negative result is possible with a gonorrhoea culture.

• The Centers for Disease Control and Prevention(CDC) recommends that persons with gonorrhoea be treated for both gonorrhoea and chlamydia. The symptoms of chlamydia are similar to the symptoms of gonorrhoea, thus it is often misdiagnosed.

Culture or gram stain tests are performed by inserting a swab into the cervix or urethra, and sometimes the rectum or pharynx, to take a sample. Though the Gram stain is faster than the culture test, it is not as reliable.

Nucleic acid amplification tests detect the genetic material of gonorrhoea bacteria. These can be done on a urine sample or the discharge collected from the cervix, urethra, rectum, or throat. Advantages of this test are its reliability and ability to test for both chlamydia and gonorrhoea using one sample.

For the purpose of accurate testing, patients need to tell their doctor what kind of sex (oral, vaginal, anal) they have had. Since coinfection with chlamydia is common, the CDC recommends that persons with gonorrhoea be treated for both gonorrhoea and chlamydia.

What is the treatment for gonorrhoea?

A person must be considered infectious from the time of exposure until treatment is successful.

Recommended treatments include:

• Penecillin

• Cefixime (cephalosporin class)

• Ceftriaxone (cephalosporin class)

• Ciprofloxacin (quinolone class)

• Ofloxacin (quinolone class)

• Azithromycin (macrolide class)

• Doxycycline (tetracycline class)

Doxycycline, Ofloxacin, Quinolone and Ciprofloxacin are not recommended for pregnant women, but they may be treated with cephalosporin.

Alternative Treatment:

• - Spectinomycin

• - Quinolone

Follow-up:

• Take all medications as directed.

• All partners should be examined and treated.

• Do not have sex until you and your partner(s) have been treated and cured.

• Persons with symptoms after treatment should be tested again by culture.

• Infections detected after treatment with one of the recommended treatments more commonly occur because of re-infection rather than treatment failure.

What can I do to reduce my risk of getting gonorrhoea?

• Abstain (do not have sex).

• Use latex condoms for vaginal, oral and anal sex from the very beginning of sexual contact until there is no longer skin contact.

• Mutual monogamy (have sex with only one uninfected partner). Multiple sex partners can increase your risk for getting any STI, including gonorrhoea.

• If you have an STI, do not have sex (oral, vaginal or anal) until all partners have been treated and cured. Treatment and follow-up are important steps in breaking the disease cycle.

• Use water-based spermicides (foams, jellies, creams or suppositories) for vaginal intercourse. Use of spermicides is not recommended for oral or anal sex.

• Since gonorrhoea can be transmitted even if the penis or tongue does not completely enter the vagina, mouth or rectum, using latex condoms from the beginning of sexual contact until there is no longer skin contact is the best form of prevention.

Why worry about gonorrhoea?

Untreated gonorrhoea infections in men may lead to:

• Sterility (unable to have children)

• Epididymitis (inflammation of the epididymis, the elongated, cord-like structure along the posterior border of the testes)

• Prostatitis (inflammation of the prostate)

• Scar tissue can develop that can lead to urethral stricture (a narrowing or closing of the urethra)

Untreated gonorrhoea infections in women may lead to:

• Pelvic inflammatory disease (PID), which can make a woman sterile (unable to have children)

• Chronic menstrual problems

• Post-partum endometritis (inflammation of the endometrial lining after child birth)

• Tubal (ectopic) pregnancy

• Spontaneous abortion (miscarriage)

• Cystitis (inflammation of the bladder)

• Mucopurulent cervicitis (MPC) - a yellow discharge from the cervix

Untreated gonorrhoea infections in men, women and infants may lead to:

• DGI. About 1 percent of men or women may have Disseminated Gonococcal Infection (DGI). DGI is the spread of gonorrhoea in the circulatory system throughout the body.

• Fever, skin lesions and/or painful swelling of joints (arthritis)

• conjunctival infection (gonorrhoea in eye) in babies if treatment to prevent this is unsuccessful

• Arthritis or sepsis (bacterial infection of the blood) in babies

Do I need to talk to my partner about gonorrhoea?

Yes. Telling a partner can be hard, but keep in mind that most people with an STI don't know they have it. It's important that you talk to your partner as soon as possible so she or he can get treatment. It is possible to pass gonorrhoea back and forth, so if you get treated and your partner doesn't, you may get infected again.

Should I talk to my health care provider about gonorrhoea?

Yes. If you are having unprotected sex or discover that your partner is having unprotected sex with another person, you may want to ask your doctor about being tested.

Where to go for help

GU (Genitourinary) Clinic
Boffa Hospital
Floriana

To make an appointment please phone 21227981. You might find an answering machine. Please be patient; either leave a contact number or else try later.

In this clinic confidentiality is guaranteed. Samples taken during examination are only marked by a code number; your name is not used.

Nobody will be told of your visit without your express permission.