Gonorrhea: Understanding Symptoms, Treatment, and Prevention

Gonorrhea: Understanding Symptoms, Treatment, and Prevention

The infection, known as gonorrhoea, is the second most common sexually transmitted disease worldwide. The culprits are gonococci, spherical bacteria that only live on humans and are transmitted almost exclusively through direct contact with the mucous membranes, i.e. unprotected sexual intercourse.

Of microbes and humans

Every year, over 60 million people become infected worldwide. Since the mid-1990s, a significant increase in new cases has been observed again after the number has steadily declined for years.

There are probably several reasons – including mass and sex tourism in distant countries, especially Asia, the relapse into reckless sexual behaviour after the end of the anti-AIDS campaigns and increasing resistance to the pathogens. A trend that has some researchers worried. Critical voices note that the disease, which is currently accessible to treat, could develop into a problem child in the future, similar to other infections for which conventional antibiotics have already failed. Prevention would be comparatively easy.

Humans are the only reservoir for the pathogens known as Neisseria gonorrhoeae. Since they are susceptible to dehydration and cold, they have almost no chance of surviving outside their human host. Their extermination would thus theoretically be possible. And since the germs are almost only transmitted during sexual intercourse, the risk of infection can be minimized with a condom.


Hard facts and dark figures

Until 2001, gonorrhoea was notifiable in Germany. In addition to the then-officially known 2,200 annual cases of illness, there was an estimated number of unreported cases of 80-90%. Experts assume that these numbers are still valid or even higher. Younger adults of both sexes are particularly affected. On the one hand, this is due to the increasingly earlier start to sexual activity – up to the age of 16, 45% of girls and 36% of boys – combined with a higher number of sexual partners; on the other hand to the willingness to experiment with different sexual practices, both heterosexual and heterosexual homosexual nature and the reluctance to use condoms.

In addition, the anatomy and hormonal balance of younger girls appear to increase the risk of ascending infections. In addition, gonorrhoea is very contagious. About a third of men become infected through a single sexual contact with a sick woman. For women, the risk is as high as 60-90% if they have sex with an infected man. It is not uncommon for people suffering from gonorrhoea to be infected with the AIDS virus or the syphilis pathogen.

The symptoms in men and women

  • Women: If symptoms occur, they are primarily non-specific and express themselves as a burning sensation when urinating, an unpleasant-smelling vaginal discharge and swelling of the labia. The germs can ascend via the uterus into the fallopian tubes and ovaries and lead to inflammation with fever, abdominal pain and even infertility. Pregnant women with gonorrhoea can infect their child during birth and lead to an eye infection, formerly one of the leading causes of blindness in children in the Western world.
  • Men:  The disease begins with burning pain when urinating, followed by mucous discharge from the urethra that later turns yellowish-green. Its morning accumulation when urinating for the first time is also called “Bonjour drops”. The pathogens can migrate to the prostate and epididymis, where they can also cause inflammation, followed by infertility.

Depending on the location of the transmission path, inflammation of the rectum or oral mucosa can also occur. The pathogens rarely enter the bloodstream and trigger skin rashes, joint inflammation, fever and chills. Severe but rare complications include meningitis, heart muscle, eye and bone marrow inflammation.


detection and therapy

Smears make the diagnosis of secretions from the vagina and urethra and the detection of the pathogen under the microscope. Bacterial cultures can also be created. A nucleic acid amplification test can determine the number of pathogens in the blood. Therapy with antibiotic tablets is usually quick and successful. They rarely need to be injected.

Unfortunately, pathogens (mainly from Asia and Africa) have become increasingly resistant to common antibiotics in recent years, so reserve funds must be used. The sexual partner must also be treated to avoid a “ping-pong effect”. One week after the end of treatment, the success of the therapy should be checked with a smear test.

In a nutshell

  • The disease can initially be symptom-free and thus be unknowingly carried on.
  • Infection occurs almost exclusively through vaginal, anal, or oral intercourse.
  • A quick and complete antibiotic cure is possible if the diagnosis is made early. Otherwise, infertility and other complications can occur in both men and women.
  • The antibiotics must be taken correctly and long enough to prevent the pathogens from developing resistance.
  • The sexual partners must also be treated.
  • You can get infected with gonorrhoea again and again.

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