Gonorrhea (gonococcal infection / gonorrhea)

Gonorrhea, also known as the clap, is one of the most common sexually transmitted diseases. The cause of a clap is a certain bacterial pathogen, the gonococci. They cause inflammation of the urethra and the genitals. But other parts of the body can also be affected. Find out everything you need to know about this infectious disease that is widespread throughout the world and how you can effectively protect yourself from infection.

This happens with gonorrhea (gonococcal infection)

Gonorrhea, also known as the clap, is an infectious disease caused by the bacterial pathogen Neisseria gonorrhoeae.

The gonococcal pathogens are usually transmitted through sexual contact and for this reason gonorrhea is also a sexually transmitted disease (STD) or alternatively a sexually transmitted infection ( STI ). However, infection with gonococci can occur not only through unprotected genital sexual contact, but also through anal and oral sex with an infected person. A mother can also infect her newborn baby with the pathogens at birth.
The disease was discovered in 1879 by the dermatologist Albert Neisser.

Both names of the disease, i.e. gonorrhea and clap, refer to the discharge that is a characteristic sign of this sexually transmitted disease:

• "Gonorrhea" is a conceptual derivation from Low German: “drippen” = drip.

• "Gonorrhea" is a term from the Greek language and means “semen flow” in English.

The detection of gonococci and thus a gonorrhea infection are not reportable under the current Infection Protection Act. This is also the reason why there are no reliable statistical data on the current infection situation in Germany. Another major problem is that a gonococcal infection does not always cause clear symptoms of illness.

This sexually transmitted disease primarily causes inflammation of the genitals and urethritis. A characteristic symptom that occurs primarily in male sufferers is purulent discharge from the urethra. In female patients, the symptoms of gonorrhea are in most cases much milder, which often means that the sexually transmitted disease is not recognized, which in turn allows the disease to continue to spread unhindered.

However, without adequate medical treatment, the risk of bacterial pathogens spreading throughout the body increases.

In the ICD-10, the international classification of diseases, gonorrhea can be found in the chapter “Gonococcal infection” under numbers A54.-A54.9.

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Symptoms

The symptoms of gonorrhea primarily affect the genital organs. The classic signs include (purulent) discharge and pain when urinating. In addition, gonococcal pathogens can also infect the mouth and anal area. Both sexes are equally affected by this infectious disease, although gonococcal infection in the anal area is more common in men than in women.

Gonorrhea is hardly noticeable in the mouth or anal area. In most cases, the only symptoms that occur are slight redness and inflammation. This means that the sexually transmitted disease remains undetected for a long time and the risk of further spread is particularly high.

Gonorrhea typically causes different symptoms in women and men:

Typical gonorrhea symptoms in men

Once the first symptoms of the disease appear, the infection with the bacterial pathogens has occurred approximately two to three days at most.

The following acute symptoms are possible in men:

• Dysuria: burning pain when urinating. In severe cases, there is also a feeling of "glass particles in the urethra". The cause of this is urethritis (inflammation of the urethra).

• Painful swelling and redness of the penis, including the foreskin.

• A purulent discharge comes out of the urethra, initially only in small amounts, but over time it becomes more and more and has a slimy consistency. The amount increases quickly, however, and the discharge becomes creamy-yellow.

• If no treatment is given, the pathogens ascend into the male reproductive organs and cause inflammation of the epididymis (epididymitis) or the prostate (prostatitis).

• Anal sex can also lead to what is known as “rectal gonorrhea” (inflammation of the rectum). This manifests itself, for example, in purulent, mucous stool or pain during bowel movements. Both symptoms that also occur with other intestinal diseases, which can make the diagnosis of gonorrhea more difficult.

• In the case of an infection through oral sex, symptoms can be noticeable in the oral cavity, such as a sore throat with a severe sore throat (pharyngeal gonorrhea). However, in 90% of cases, a throat infection with gonococci causes no symptoms at all.

Approximately 25% of infected men do not show any symptoms of gonorrhea. Nevertheless, even an inconspicuous gonococcal infection must be treated medically, as it can otherwise lead to complications such as infertility.

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Typical gonorrhea symptoms in women

In general, gonorrhea is milder in women than in men. A gonococcal infection can even be completely symptom-free, so that neither the affected person nor doctors notice the sexually transmitted disease.

The following acute symptoms can occur in women:

• The early stages of gonorrhea are generally very mild. There may be vaginal discharge and a slight burning sensation when urinating. The vaginal discharge may have a foul odor.

• Cervicitis (inflammation of the cervix) is also possible: This manifests itself as bloody or purulent vaginal discharge.

• The gonorrhea infection can also spread to the internal genital organs, i.e. the uterus, fallopian tubes and ovaries. This is noticeable through symptoms such as fever, abdominal pain, vaginal discharge and spotting.

• If the gonococcal bacteria from the vaginal area reach the rectum, women can also develop rectal gonorrhea. In such a case, doctors speak of a secondary infection.

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Symptoms in pregnant women

If an expectant mother suffers from a gonorrhea infection, the pathogens can be transmitted to the baby during birth. However, the baby does not develop any classic symptoms of the disease. Instead, the infant develops purulent conjunctivitis. This so-called "gonococcal conjunctivitis" or "gonococcal conjunctivitis" in newborns is a separate disease. Prophylaxis against this is carried out using silver nitrate eye drops in newborns.

Course

In general, a gonococcal infection is curable and the disease therefore has a good prognosis. If adequate treatment is started in a timely manner, those affected do not have to worry about any long-term effects.

However, if gonorrhea is left untreated for a long time, it can have health consequences. Possible complications are primarily chronic inflammation of the internal genital organs, severe, persistent pain and infertility. Treatment of the sexually transmitted disease is therefore very important!

Consequences of lack of treatment in women

Unfortunately, in about 50% of cases, women do not develop any clear symptoms of the disease. The infection therefore remains untreated and takes a chronic course.
The local symptoms of the disease on the mucous membranes mostly disappear, but the bacteria penetrate deeper into the body's tissue layers and usually cause chronic inflammatory processes. This increases the risk of inflammation of the ovaries or fallopian tubes (adnexitis). As a result, in some cases the fallopian tubes become stuck together, which ultimately leads to infertility. Blocked fallopian tubes also increase the risk of an ectopic pregnancy. In some affected women, the symptoms also intensify during their monthly period.

Consequences of lack of treatment in men

In men, a lack of treatment for gonorrhea often leads to chronic epididymitis or prostate inflammation. Only a small amount of pus is produced. During the night, a purulent drop forms, which typically comes out of the urethra before the first urination in the morning. In medicine, this is referred to as the "Bonjour droplet". The chronic inflammation can lead to a narrowing of the urethra (urethral stricture) over time.

In rarer cases, the gonococcal pathogens can spread throughout the body via the bloodstream in both sexes and cause various symptoms in other parts of the organism. In such a case, this is referred to as a disseminated gonococcal infection, or DGI for short.
As a result, the following symptoms may occur:

• Tendonitis

• Joint inflammation

• Characteristic skin changes with red pustules or bleeding

• Fever

• chills

In severe cases, DGI can also lead to meningitis (inflammation of the meninges) or endocarditis (inflammation of the inner lining of the heart). However, this is rare.

In some cases, adults can also develop a gonococcal eye infection. In most cases, these are “transported” pathogens. Such gonococcal ophthalmia (eye inflammation) is a highly acute case in adults, which usually has a less favorable course than in babies.

Causes and risk factors

The sexually transmitted disease gonorrhea is caused by gonococci. The medical name for the bacterial pathogens is Neisseria gonorrhoeae.
These bacteria only affect humans and mainly settle in the mucous membranes of the urethra, cervix, rectum and the mouth and throat. They can be passed from one infected person to another during unprotected sex.

Gonococci bacteria only survive for a short time outside the body. This means that infection via contaminated objects such as shared towels is unlikely. One exception to this is sex toys.

It is also possible for the pathogens to be transmitted to other parts of the body by a person themselves: This is the case, for example, when vaginal discharge enters the anus in women or when infectious secretions accidentally get into the eyes when wiping.

Gonococci can also be transmitted during birth: the bacterial pathogens pass from the genital area of ​​the infected pregnant woman to the baby and usually attack the eyes first.

Risk factors for gonococcal infection

Anyone can become infected with the pathogens through unprotected sex with an infected person. The risk of infection is increased if:

• frequent sexual contacts with different partners occur.

• Condoms should not be used during sexual intercourse.

• Sexual intercourse takes place under the influence of drugs and those affected forget, for example, to protect themselves with condoms.

Women also have an increased risk of infection if their vaginal flora is out of balance.

The risk of late complications may also be increased, especially in women who become infected with the pathogens before their menstruation or who contract gonorrhea shortly before or after giving birth.

therapy

The infectious disease is treated with antibiotics. In uncomplicated cases, a single application is sufficient.
The problem, however, is that gonococcal pathogens tend to become increasingly resistant to antibiotics. For this reason, many drugs are no longer as effective against gonorrhea. If there is a mixed infection of gonorrhea and chlamydia, the latter are automatically treated as well. In this case, the guideline recommends dual antimicrobial therapy with two different drugs.

In the case of a severe course of the disease, rapid admission to a hospital is urgently required.

After treatment has been completed and symptoms have subsided, those affected must refrain from all sexual activity for at least one week! A medical check-up is also carried out after treatment has ended.

Important NOTE: 

All sexual partners of infected people must also be tested for gonorrhea and receive medical treatment if necessary. Otherwise, the pathogens may continue to be transmitted.

What you can do yourself

This sexually transmitted disease is transmitted primarily through unprotected sexual contact. For this reason, you should definitely protect yourself from infection by using condoms. However, even these cannot offer 100% protection.

If you suspect that you have gonorrhea, you should definitely seek medical treatment and refrain from any sexual contact until the treatment is successfully completed!

Condoms can also protect against infection when sharing sex toys. In addition, these items should also be cleaned regularly and thoroughly with soap and water.

People who frequently have different sexual partners should be tested regularly for gonococci. This is the only way to detect a gonococcal infection early and treat it appropriately.

With the sexually transmitted disease test STI Essential from DoctorBox you can be tested for gonorrhea (the clap), among other things.