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 Male

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 education 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).En the women the risk of acquiring gonorrhea of an infected male is higher.

The causative germ can infect the gullet, producing an intense pain (pharyngitis gonocócica); the vagina, causing an annoyance of the vagina with drainage (vaginitis). It can become infected also the year and rectum, producing an illness to him called proctitis. Also, the germ can spread to other parts of the reproductive system of the woman, across the cérvix and womb up to the horns of falopio (conduits between the ovaries and the womb)

In the horns of falopio the infection is called an EPI (inflammatory pelvic illness), which happens between 10 and 15 % of the women with not treated gonorrhea. If the illness spreads beyond the Falopio horns, towards the peritoneum, there takes place an infection generalized in the abdomen (peritonitis). The bacteria also can extend across the blood stream, causing a gonococemia and, finally (more in young women) to be established in the joints (arthritis gonocócica).

In rare occasions the gonorrhea is transmitted by not sexual route. An infected woman can transmit the infection to his baby during the childbearing, causing an ophthalmia neonatal (conjunctivitis gonocócica). The girls can acquire the illness for the intimate contact with some object contaminated (like a humid towel), developing then a severe infection called vulvovaginitis.

Unfortunately, 50 % of the women with gonorrhea has no symptoms. They can be, this way, completely unconscious of his illness and not talk each other, what increases the contagion risk.

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 most frequent initial symptom is a vaginal discharge and increase in the urinal frequency, as well as urinal inconveniences (disuria). The germ dissemination towards the horns of Falopio and abdomen can cause pain in the low part of the abdomen, shrinkage, fever and widespread symptoms of bacterial infection.

Finally the gonorrhea can produce scars in the horns of Falopio and permanent sterility (inability to remain a pregnant woman). This scar formed about the womb and the horns can cause pain during the sexual act (dispareunia) and chronic pelvic pain.

The gonorrhea associates often with other illnesses transmitted sexually (ETS). Almost half of the women with gonorrhea become infected also with Clamidia, another very common bacterium that can produce sterility. The women with gonorrhea must ask for analysis of other ETS, including for the AIDS.

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.
• Labored micturition.
• Vaginal discharge.
• Pain or intense heat on having urinated.
• Painful sexual relation
• ulcers in the gullet.

ANALYSIS AND TEST

An immediate preliminary gonorrhea diagnosis can be done during the physical examination. A sample of the cérvix takes (or of another place, depending on several factors) 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 vagina, cérvix, urethra, year, or gullet (pharynx). 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 (especially in the asymptomatic cases).

When the gonorrhea talks each other immediately from the beginning, the result is good: there is neither permanent scars nor sterility.

COMPLICATIONS

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

• Salpingitis.
• Pelvic inflammatory illness.
• Peritonitis.
• Gonococemia.
• Arthritis gonocócica.
• Pharyngitis gonocócica.
• Conjunctivitis gonocócica.
• Vulvovaginitis
• Sterility
• Dispareunia.

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
• GYNECOLOGISTS

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