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Gonorrhoea contents

Essential facts

More information

Diagnosis and management
(includes clinical photographs)

Statistics

Antibiotic Sensitivity 1999

Pamphlet
(pdf format)

Pelvic inflammatory disease

PID diagnosis and management

STD information for students

Gonorrhoea
More details/information for students

Statistics

Signs and symptoms

Complications

Transmission

Testing

Treatment

Prevention

Definition

Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae. It produces inflammation and infection of the lining of the genital tract (cervix in women, urethra in men), throat, and rectum.

Statistics

The incidence of gonorrhoea declined significantly in most developed countries during the 1980s, but remains common in some urban centres in the world. It is prevalent in many developing countries.

The South Australian gonorrhoea rate has reached its lowest-ever point. In 1990, there were 173 cases, a rate of 0.17 cases per 1,000 people (in 1982 there were 889 cases in South Australia). The male:female ratio is 2:1. The infections were asymptomatic in 11.5% of men and 32.6% of women. Of all gonorrhoea cases in 1990, 59.5% in men and 38.4% in women occurred either among Aboriginal people or were contracted from overseas or interstate sexual partners.

See Statistics page for recent data.

Signs and symptoms

In women, the primary site of infection is usually the endocervix (inside of the cervix), although organisms are also found in the urethra and rectum. Many women with gonorrhoea infection have no symptoms. When symptoms do occur they often include unusual vaginal discharge and dysuria (difficult or painful urination). Infection of the throat can occur following mouth-to-penis or mouth-to-vagina sex, and of the rectum following anal intercourse. These infections usually show no symptoms.

In men, gonorrhoea usually produces acute gonococcal urethritis (infection of the urethra). Symptoms include dysuria and a discharge of pus from the urethra. The symptoms usually appear within 2 to 10 days of infection, but the incubation period is sometimes much longer, and some men never develop symptoms.

Typical thick yellow urethral discharge associated with gonococcal infection.  Heavy discharge and dysuria usually develops within one week of infection.  However, some infected men remain asymptomatic.

Gonococcal conjunctivitis is an infection of the thin, transparent conjunctiva (skin) covering the eye and inner eyelids. It occurs mostly in infants infected during vaginal birth, but adult infection can occur via the fingers of either the individual or her or his partner. Gonococcal infection of the eye is an ophthalmic emergency and needs urgent medical attention.

Complications

In both men and women, infection can ascend into the upper genital tract. In men, infection can spread to the prostate gland, epididymis, and the testes, although this is not common.

Spread of the infection is more common in women, and is associated with more serious complications. In approximately 10% to 20% of women the infection spreads to the fallopian tubes, which transport egg cells from the ovaries to the uterus. Inflammation of the tubes, called "salpingitis", often becomes apparent after the first menstrual period following infection, and may be accompanied by lower abdominal pain of varying severity. Salpingitis is a form of PID, and often causes partial or complete blockage of the fallopian tubes, which can lead to infertility or ectopic pregnancy (development of the foetus in the fallopian tubes), which is potentially fatal to the woman and usually requires surgery to prevent serious consequences. See "Pelvic Inflammatory Disease".

In about 1% of gonorrhoea cases, the infection enters the bloodstream and causes fever, chills, loss of appetite, blisters on the skin or arthritis in the joints - usually the hands.

Transmission

The risk of infection for men who have unprotected vaginal intercourse with an infected partner is about 20% after a single exposure. The risk of transmission from men to women is as high as 70% to 80%. Oral to genital transmission is more common from the penis to the mouth, but can also occur from vagina to mouth. Anal intercourse probably transmits infection at rates similar to those for vaginal intercourse.

Testing

In both women and men, laboratory testing of smears taken from infected areas (eg cervix, male urethra) is the only accurate method for diagnosing gonorrhoea.

The Gram stain and the culture test are the two standard tests for gonorrhoea.

The Gram stain involves placing a smear of the discharge on a slide where it is stained with a dye and examined for gonorrhoea bacteria under a microscope. The culture test is more reliable but takes longer. It involves taking a swab of the discharge, rolling it on to a culture plate, and incubating it under special laboratory conditions for 16 to 48 hours to let the gonorrhoea bacteria multiply.

Treatment

Uncomplicated gonorrhoea is effectively treated with a large, single dose of an injectable short-acting penicillin, or a single dose of an oral penicillin derivative such as amoxycillin or ampicillin (other drugs are available for those allergic to penicillin). Treatment is often started before test results are received or diagnosis is certain because:

• tests are not always accurate:
• the person may not return for treatment
• the earlier gonorrhoea is treated, the easier it is to cure.

If the infection has spread, the drugs must be taken for longer, and sometimes hospitalisation is required. In most parts of the world, including other States of Australia, penicillin is no longer used because of the high incidence of penicillin resistant infections. There are alternative drugs that can be used.

Prevention

• The use of condoms during mouth-to-penis sex, and vaginal and anal intercourse.
• Sexual practices other than intercourse carry less risk of transmitting gonorrhoea, although gonorrhoea can occur in the throat and oral sex can therefore be unsafe.
• Because gonorrhoea can infect the eyes, care must be taken to avoid transmitting the infection by getting sexual fluid in the eyes.
• Where infection has occurred, it is important to avoid sexual contact involving the genitals during the course of treatment until a negative test result is obtained. This will aid healing and prevent transmission.

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