Gonorrhoea

Gonorrhea is a sexually transmitted disease, an STD. The cause of gonorrhoea is a gonococcus bacterium called Neisseria gonorrhoeae. You can get it by having sex with someone who already has gonorrhoea, but also through hands and oral contact. It is also possible to infect from mother to child during a vaginal birth. 

The gonorrhoea bacteria can infect the mucous membranes of the vagina, penis, anus, throat or eyes and does not require penetration. Gonorrhoea occurs in men and women, and is highly contagious. Luckily, gonorrhoea is easy to treat. 

What is gonorrhoea? 

Gonorrhoea is caused by the gonococcus bacteria Neisseria gonorrhoeae. This bacterium lives on the mucous membrane of the penis (urethra), vagina, anus or throat and causes an infection there. Women may have gonorrhoea and yet not notice any symptoms. Even if you do not know that you have gonorrhoea and do not recognise any symptoms, you can still pass it on. Any form of sexual contact can lead to infection. It is very important to treat gonorrhoea. The consequences of a gonorrhoea infection can be serious. If it is not treated, there is a chance that the infection will further retract the body. This can lead to unpleasant complications such as fallopian tube inflammation and infertility in women, premature birth in pregnant women and testicular inflammation in men. 

Pregnant women with gonorrhoea can hand it over to their baby. The baby can then, for example, be born with inflamed eyes (conjunctivitis gonorrhoica). Untreated, this can lead to blindness.  Gonorrhoea testing is not standard during pregnancy, unless the mother indicates that she has had varying contacts. However, during a gonorrhoea treatment, you may simply breastfeed. 

What are the causes of gonorrhoea? 

Gonorrhoea is a sexually transmitted disease, caused by a bacterium called gonococcus. During unsafe sex, one infected person can transfer the bacteria to another. For example, if the infected mucous membrane comes into contact with the mucous membrane of the penis, vagina, anus or throat. This means that you can also get infected during oral sex (contact between infected penis and mouth). In this case, an infection of the throat. And after anal sex (contact between infected penis and anus) an infection of the anus is a risk. 

However, gonorrhoea is not transferable via a toilet seat, towel or swimming pool water, for example. There are no vaccinations against gonorrhoea, and the only effective way to prevent you from getting infected with gonorrhoea is safe sex. It is important that you inform former sexual partners if you are a diagnosed with gonorrhoea.  Talk to the doctor or nurse about the period you need to warn about. Usually all sexual partners from the last 6 months are informed. This partly depends on whether you have complaints. 

What forms of gonorrhoea are there? 

There is only one form of gonorrhoea, caused by the gonococcal bacteria Neisseria gonorrhoeae.  

Depending on the place of infection, the bacteria can cause an infection of: 

  • The urethra
  • The vagina and cervix
  • The anus
  • Or the throat

 

How do you recognise gonorrhoea? 

There is a big difference between the complaints in women and in men. Women often notice little or nothing of gonorrhoea, while men do have clear symptoms. For this reason, gonorrhoea in men is often referred to as the clap. Shortly after you have contracted the gonococcus bacteria, you may notice the first symptoms. Note: even if you have no symptoms, you are contagious and you can still pass on the bacteria.  

Complaints in women: 

  • An increase in vaginal discharge, which can be smelly and pus-like
  • Blood loss while you are not on your period
  • Pain or irritation when urinating
  • Irritation or itching around the anus
  • Mucilaginous or pus-like discharge in the faeces
  • Throat inflammation or swollen glands in the neck
  • Other inflammations in the body

Complaints in men: 

  • The 'clap': a lot of pus-like secretion, which is yellow or green in colour, from the urethra
  • Pain or irritation when urinating
  • Irritation or itching when urinating
  • Mucilaginous or pus-like discharge in the faeces
  • Throat inflammation or swollen glands in the neck
  • Other inflammations in the body

The symptoms of gonorrhoea are similar to those of chlamydia, cystitis or other vaginal infections. That is why it is important to go directly to the doctor. The doctor can use tests to make the correct diagnosis and make sure that you get the right treatment. Fast treatment is important to avoid complications. 

Test options to detect gonorrhoea are: 

  • A urine test: the first urine that comes out contains most of the bacteria. Therefore, the first bit of urine must be collected before the urine test. We call it the first urine stream. Examination of discharge from the vagina, urethra, throat or anus. The doctor can take this from you with a cotton swab. We call this a swab. You can also do this yourself. 
  • A self-test: if you do not want to or cannot go to a general practitioner, an STD self-test can be an alternative. There are all kinds of home tests for sale on the internet. There are many drawbacks: you do not get a consultation from a doctor and sometimes you lose a lot of money. Also, many self-tests are unreliable. 

 

Is there anything I can do myself about gonorrhoea? 

The only way to prevent a gonorrhoea infection is to have safe sex. However, the only treatment for an existing gonorrhoea infection is an antibiotic treatment, which must be completed at all times.  

What are the forms of treatment? 

Gonorrhoea is easy to treat with antibiotics. If the symptoms do not go away, you should go back to the doctor immediately. The bacteria may be insensitive to the medication used. This is hardly ever the case in the UK, but more so abroad. Attention: an antibiotic treatment must always be finished to prevent resistance of bacteria. The only medicine that can be used against gonorrhoea is antibiotics.  

Bacteria need proteins to grow. By ensuring that the specific proteins needed for the gonococcus bacterium called Neisseria gonorrhoeae are blocked or no longer produced, the bacteria will no longer be able to grow and multiply, and therefore die of starvation as it were. The antibiotics do that by blocking or inhibiting the production of the protein by the bacteria.  

There are different kinds of antibiotics. Below is a list of the types of antibiotics used for gonorrhoea: 

  • Chinolon-antibiotics: this is usually prescribed as a one-day cure. Examples are ciprofloxacin and ofloxacin. 
  • Tetracycline antibiotics: such as doxycycline and minocycline. 
  • Macrolide antibiotics: e.g. azithromycin. 
  • Antibiotics of the sulfonamide-type: for example, trimethoprim is used in combination with sulfamethoxazole. 
  • Cephalosporin antibiotics: like ceftriaxone. 
  • Penicillin antibiotics: in some cases doctors prescribe amoxicillin, but only if they are sure that the bacterium is sensitive to this antibiotic.  

 

Changing your lifestyle 

Safe sex is the best way to prevent STDs. The aim is to avoid contact between the mucous membranes of the penis, vagina, anus and mouth. 

Some tips for safe sex are:  

  • French kissing and satisfying each other with fingers is generally safe: make sure that no blood, sperm, pre-cum (fluid coming out of the penis before ejaculation) or vaginal fluid gets on the other person's mucous membrane. This increases the risk of STD transmission. For example, if you touch your partner's vagina or pre-cum first with your fingers and then your own vagina or other mucous membranes, you can already transmit gonorrhoea. 
  • Always use a new condom for penis-vagina sex and penis-anus sex. 
  • If you exchange a dildo (or artificial penis) when making love, put a new condom on it when making love or use your own dildo. 
  • In case of oral sex (contact between mouth and genitals) a condom or a dental dam provides protection. 

 

Additional risks and side effects 

The consequences of an untreated gonorrhoea infection can be serious. The infection can draw further into the body and this can have far-reaching consequences. Such as fallopian tube inflammation and infertility in women, premature birth in pregnant women and epididymis in men. 

In pregnant women with gonorrhoea, the baby can be born with inflamed eyes (conjunctivitis gonorrhoica). Untreated, this can lead to blindness. 

Contraindications of antibiotics may be: 

  • Proven severe allergy to cephalosporins or anaphylactic reaction to penicillin
  • Proven severe allergy to lidocaine

If the symptoms do not disappear after treatment with antibiotics, we advise you to make a new appointment with the doctor immediately. It is possible that the bacterium is resistant to the prescribed antibiotics and then a different choice has to be made. 

 

 

References

Dam, A.P. van (August 2015), Gonorrhea Directive, consulted on 24 November 2018, at https://lci.rivm.nl/richtlijnen/gonorroe 

Health Network (3 November 2015), Gonorrhoea reported in time, consulted on 24 November 2018, at https://www.gezondheidsnet.nl/seks-en-soas/gonorroe-wees-er-op-tijd-bi

Nederlands Huisartsen Genootschap (z.j.), I have gonorrhoea, on 24 November 2018, at https://www.thuisarts.nl/gonorroe/ik-heb-gonorroe  

Nederlands Huisartsen Genootschap (z.j.), Gonorrhoea, consulted on 24 November 2018, at https://www.apotheek.nl/klachten-ziektes/gonorroe#welke-medicijnen-worden-gebruikt-bij-gonorroe 

Soaids Nederland (z.j.) What is gonorrhoea, consulted on 24 November 2018, at https://www.soaaids.nl/nl/soas/veel-voorkomende-soas/gonorroe 

Soa Aids Nederland (z.j.), Why should I warn my (ex-)partner?, consulted on 24 November 2018, at https://partnerwaarschuwing.nl/waarom-moet-ik-mijn-ex-partner-waarschuwen 

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