The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.
Gonorrhoea, a sexually transmitted disease (STD) or infection (STI), was first discovered during the 16th century and is commonly known as the clap. The bacteria responsible for this infection is known as Neisseria Gonorrhoea (N. Gonorrhoea), medically classified as a gram negative diplococcus.
Anyone who is sexually active can get gonorrhoea, and when left undiagnosed or untreated, it can lead to complications. However with the appropriate medication, Gonorrhoea can be cured. Moreover, in the last six years there has been an increasing incidence of antimicrobial resistant strains of Gonorrhoea. The WHO reported in 2017 a troubling fact that 77 countries have reported resistant Gonorrhoea making it much harder if not impossible to treat when resistance to the newest generation of antibiotics occur. Efforts has been suggested and put into place to try and eradicate this STD, but still around 700,000 new gonorrhoea infections occur annually in the US alone, with half not reported to the CDC (center for disease control). Worldwide, around 88 million cases of gonorrhoea occur every year. According to a study conducted in 2012, it was found that this STI affects around 0.8% of women and 0.6% of men.
It is generally accepted that looking for the presence of bacterial DNA in our urine (also called a Gonorrhoea PCR test, or just Gonorrhoea DNA) or swab is more sensitive and more accurate than looking for antibodies to gonorrhoea in the blood. It is also much quicker than culturing the bacteria from urine or swab in a culture media, although this latter method does allow a sensitivity test to be performed on the bacteria grown (this tells doctor which antibiotics are likely to be effective).
How is it Spread?
Since N.gonorrhoea survives in warm and moist environment, sexual transmission is favourable for its spread. This STD is highly contagious and spreads through unprotected intercourse with someone infected. Newborns can also be infected during birth through vertical transmission. The only way to stop the transmission of this disease is by engaging in safe, protected sex by using barrier methods like condoms, sticking to one sexual partner, screening for and treating the infection for those at risk.
Signs to Watch Out For
The clinical manifestations of gonorrhoea vary in both men and women. Many infected men remain asymptomatic and do not suffer from any clinical signs or symptoms of gonorrhoea – the only way they know is by a laboratory test or when their partner get diagnosed. Others, however, may experience any of the following symptoms:
- Burning micturition
- Yellowish white discharge from the penis
- Pain in the testis; occasionally infectious swelling (epididymitis)
Women, on the other hand, mostly do not have clear-cut signs and symptoms and diagnosing the disease by a general examination can often be difficult. Despite its asymptomatic nature, gonorrhoea can cause serious complications in women if left untreated. Some women, who do have symptoms, suffer from:
- Abnormal vaginal discharge
- Burning micturition
- Pain during sex
- Bleeding between periods (cervicitis)
- Pelvic or abdominal pain
The symptoms of gonorrhoea are not restricted to only the genitalia and pelvic region. Although the mucous membrane of the genitals is primarily infected, the bacterium can also disseminate and affect other parts of the body as well. This includes the eyes (purulent discharge, pain and photophobia), the anus (itching, discharge, blood), throat (swollen cervical lymph nodes, sore throat), and joints (septic arthritis).
Complications of Gonorrhoea
Gonorrhoea can have serious, disabling complications if left untreated. Sterility in both men (through epididymitis) and women (through pelvic inflammatory disease or PID) is the most common complication along with infection of the uterine tubes and ectopic pregnancies.
Newborns that are affected during birth are at risk of partial or complete blindness, conjunctivitis and infections.
Tests and Diagnosis of Gonorrhoea
Because of the unreliable symptoms profile of a patient with gonorrhoea, a simple physical examination is not enough to rule out the infection. The most commonly practiced method of diagnosis is a urine test that identifies the bacteria N.gonorrhoea in the urine or by a swab of an affected mucosal surface. Culture of the bacteria on the appropriate media will reveal if the suspected bacteria is involved.
Other tests that can be useful in identifying N.gonorrhoea include sugar fermentation tests and fluorescent antibody staining.
Despite the wide options of diagnostic tests available, the most sensitive and accurate lab tests are the nucleic acid amplification tests (NAAT). These tests are used for screening and diagnosing a case of gonorrhoea and are highly accurate in results. These NAAT include the PCR (polymerase chain reaction) and the LCR (ligand chain reaction). Both of these techniques can be used on urine samples for gene amplification. The NAAT are highly sensitive (78.6%) and highly specific (96.4%).
Because of their easy detecting abilities, accuracy and non-invasive nature, these amplification tests are now the most widely used screening tests performed. The older serological tests are not useful for the detection of this bacterium and are more likely to produce erroneous results.
Gonorrhoea – Prevention and Cure
Gonorrhoea is a preventable disease. Like all sexually transmitted infections, the spread of gonorrhoea can be restricted or prevented by protected intercourse, the proper use of condoms and avoidance of multiple sexual partners. Intercourse should also be avoided with a person with preexisting symptoms of gonorrhoea.
Antibiotics can help treat gonorrhoea. Over the years, several antibiotics have been employed to combating gonorrhoea; however, due to the emergence of resistant strains of the bacteria, newer antibiotics are continuously being developed.
Back in the 1950’s, the bacterium was highly sensitive to penicillin, and penicillin was the drug of choice for many years. Over the years, penicillinase producing strains were found in patients of gonorrhoea which implied that the bacterium was now resistant to penicillin.
Currently, the treatment of choice is ceftriaxone, a third-generation cephalosporin. The drug acts by inhibiting bacterial cell wall synthesis. Alternatively, azithromycin and ciprofloxacin are also used in patients allergic to cephalosporin. The CDC recommends dual therapy: a single dose of 250mg of intramuscular ceftriaxone AND 1g of oral azithromycin. People who are infected with gonorrhoea should consider having proper treatment and abstain from spreading this disease to their partner. A repeat urine Gonorrhoea PCR test can be performed to ensure eradication of the disease.
People with Gonorrhoea infection are also at higher risk of having other STDs such as HIV (virus that causes AIDS). Consult your doctor and have the appropriate screening, as HIV has a much better prognosis if diagnosed and treated earlier.
In newborns with gonorrhoeal infection, conjunctivitis is often treatable with the use of topical erythromycin and, less frequently, silver nitrate.
The Eradication of Gonorrhoea – A Possibility!
Part of the big four STDs that make up the biggest social concern to the WHO, since they can all potentially be eradicated. Each year, there are an estimated 357 million new infections with 1 of 4 STDs: chlamydia, gonorrhoea, syphilis and trichomoniasis. And these are all curable if we can stop the spread through common sense measures.
With careful use of condom and engaging in safe sexual behaviour, gonorrhoea can be completely eliminated. This is important because although gonorrhoea does not always cause distressing symptoms, it can lead to serious complications and rob the patient from their reproductive abilities. Infertility is the number one complication of gonorrhoea and the only way to avoid it is by promptly seeking medical care at the onset of symptoms and making an effort in controlling the spread of infection.
Screening of sexually active individuals who are at greater risk (multiple partners, men having sex with men, people working or participating in sex industry, infected partner) is highly recommended, and if suspected should abstain from spreading this disease further until disease is cleared. The absence of symptoms in many men and women with the disease makes it even more compelling for screening to eradicate this disease.
If you want to find out more about gonorrhoea and diagnosing the infection, take a look at our lifestyle article here!
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