DEFINITION

The gonorrhea is a sexually transmitted disease (also acquaintance like blenorragia) caused by the bacterium Neisseria gonorrhoeae (or gonococo). To see also Gonorrhea in the Woman.

CAUSES, INCIDENCE AND FACTORS OF RISK

The Gonorrhea is one of the most common bacterial illnesses, and his transmission usually takes place during the sexual relation, both for vaginal and anal or oral route. The gonorrhea is a highly contagious illness, and all the countries demand his communication from the sanitary authorities.

The incidence is 1 of every 687 inhabitants a year.

Although the gonorrhea happens in all the geographical areas and social classes, it does not present a uniform distribution in the population since it has a major influence in:

• Important urban areas.
• Populations at low educacin.ó levels
• Persons of low socioeconomic level.
• You present yourself with age understood between 15 and 29 years.
• You present yourself with common sexual couples.
• The risk factors also include to have a couple with a history gone on from any ETS, and to practise the sex without protection (sex without the use of a condom).

In adolescents and children, the transmission can happen for not sexual contact, but it is strange. In the male, the risk of acquiring gonorrhea after a vaginal exchange with an infected woman is of approximately 20 % (1 opportunity in 5). In the women the risk of acquiring gonorrhea of an infected male is higher.

The average period of incubation of the gonorrhea is located between the 2 and 5 days later to the sexual contact with an infected couple. The symptoms cannot appear up to the last 2 weeks.

The most frequent initial symptom is a discharge uretral mucous (whitish or clear) or purulent (thick, yellowish). It appears in the opening of the penis and can stain the underpants. Other initial symptoms include pain on having urinated and intense heat sensation in the urethra. A small number of men will not have symptoms. The gonorrhea anorrectal is more common in homosexual men (it meets also in approximately 50 % of women the gonorrhea). Most of the persons with gonorrhea anorrectal does not present symptoms but, case to have them, the most typical is the proctitis.

A - Testicle | B - Epididymis | C - Deferential Conduit | D - Prostate | And - Vejíga Urinaria | F - Urethra

A small percentage of persons with gonorrhea has only infection of gullet (pharyngitis gonocócica).

From 10 % to 25 % of homosexual men (10 to 20 % of women) with gonorrhea also develop pharyngitis gonocócica.

The conjunctivitis gonocócica (infection of eye) is very rare in adults. Normally only it happens in mother newborn babies with gonorrhea, and is called an ophthalmia neonatal.

The gonorrhea associates often with the presence of other illnesses transmitted sexually (ETS)

PREVENTION

The sexual abstinence is the only absolutely sure method of avoiding the gonorrhea, but it turns out to be neither practical nor reasonable for many persons. The behaviors of sure sex can reduce the risk. The sexual relation with the only free person of any ETS is, at present, the most acceptable preventive measurement.

The use of condom in both sexes diminishes significantly the probability of an ETS being contagious whenever it is used appropriately: the condom must be put from the beginning up to the end of the sexual act and it should be used whenever the sexual activity is practised with a couple in which the existence of an ETS is suspected.

The treatment of two components of the couple is essential to prepare the reinfection, and it is one of the reasons for which this illness is of obligatory declaration. The gonorrhea is an illness relatively easy to recover and to eradicate, since the causative germ only is on the mucous membranes of the human beings.

SYMPTOMS

• Urgency or urinal increased frequency.
• Urinal incontinence.
• It discharges uretral.
• Pain on having urinated.
• Reddening and burning sensation of the opening of the penis (urethra)
• Inflamed testicles.

ANALYSIS AND TEST

An immediate preliminary gonorrhea diagnosis can be done during the physical examination. A sample of the exudado uretral takes and it is examined under the microscope (with help of a skill known as coloring of Gram. The gérmenes Neisseria appear in red (negative Gram) and in grouped spheres of two in two (diplococos), inside the cells of the sample. The aspect of these diplococos negative Gram is sufficient for a diagnostic gonorrhea presumption.

The cultivation gives absolute information of infeccin.ó The Neisseria organisms can grow on any mucous membrane. The election of the place of the cultivation decides depending on the person, sexual preference, and sexual practices. Generally, the cultivation is obtained of the urethra, year, or gullet. The laboratories can give a preliminary diagnosis often in 24 hours and confirmee in 72 hours.

TREATMENT

There are two aspects to treat in an ETS, especially if it is so contagious as the gonorrhea. The first one is to treat the affected person. The second one consists of locating all the sexual contacts to try to prepare the additional dissemination of the illness.

During the war of Viet Nam it was proved that the gonorrhea was becoming resistant to the penicillin and tetraciclina. This resistance has increased in the last years. By it new treatment rules have been designed with several types of antibiotics of last generation, more powerful:

• Ceftriaxona, 125 mg intramuscular, once.
• Cefixima, 400 mg oral, once.
• Ciprofloxacino, 500 mg oral, once.
• Ofloxacina, 400 mg oral, once.
• Spectinomicina, 2 g intramuscular, once.
• Cefuroxima Axotal, 1 g oral, once.
• Cefpodoxima proxetil, 200 mg oral, once.
• Enoxacina, 400 mg oral, once.
• Eritromicina, 500 mg oral, four times per day for one of week.

It is important to do a pursuit visit to 7 days after the treatment and to do new cultivation to confirm the remedy of the infection.

When the gonorrhea talks each other immediately from the beginning, the result is good: there are permanent scars neither in the urethra nor dissemination of the infection to other parts of the body.

COMPLICATIONS

The not treated gonorrhea can be spread to other parts of the body, causing several complications:

• Abscess periuretral.
• Arthritis gonocócica.
• Pharyngitis gonocócica.
• Conjunctivitis gonocócica.
• Infection or inflammation of the reproductive system of the man:

• Epididimitis
• Prostatitis.
• Seminal Vesiculitis.
• Coperitis.

WHEN TO COME TO THE DOCTOR

If it has gonorrhea symptoms it must come to his doctor immediately.

To inform the sanitary authorities allows to realize precise statistics on the number of cases, and treat other infected contacts who can transmit the illness.

If you realize sexual risk practices (multiple couples, unknown, equal couples of high risk, etc...), it should be examined periodically to detect the possible asymptomatic presence of the illness.

WHAT DOCTOR CAN TREAT ME?

• UROLOGISTS
• ANDRÓLOGOS

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