Gonorrhoea is an inﬂammatory disease caused by Neisseria gonococcous, aﬀecting especially the mucous membrane of the URETHRA in the male and that of the VAGINA in the female, but spreading also to other parts. It is the most common of the SEXUALLY TRANSMITTED DISEASES (STDS). According to the WHO, 200 million new cases are notiﬁed annually in the world. In the UK the incidence has been declining since 1991; in 1999 the rate per million of population was 385 for males (599.4 in 1991) and 171.3 for females (216.5 in 1991).
Causes The disease is directly contagious from another person already suﬀering from it – usually by sexual intercourse, but occasionally conveyed by the discharge on sponges, towels or clothing as well as by actual contact. The gonococcus is found in the discharge expressed from the urethra, which may be spread as a ﬁlm on a glass slide, suitably stained, and examined under the microscope; or a culture from the discharge may be made on certain bacteriological media and ﬁlms from this, similarly examined under the microscope. Since discharges resembling that of gonorrhoea accompany other forms of inﬂammation, the identiﬁcation of the organism is of great importance. A gram-stained smear of urethral discharge enables rapid identiﬁcation of the gonococcus in around 90 per cent of men.
Symptoms These diﬀer considerably, according to whether the disease is in an acute or a chronic stage.
MEN After an incubation period of 2–10 days, irritation in the urethra, scalding pain on passing water, and a viscid yellowish-white discharge appear; the glands in the groin often enlarge and may suppurate. The urine when passed is hazy and is often found to contain yellowish threads of pus visible to the eye. After some weeks, if the condition has become chronic, the discharge is clear and viscid, there may be irritation in passing urine, and various forms of inﬂammation in neighbouring organs may appear – the TESTICLE, PROSTATE GLAND and URINARY BLADDER becoming aﬀected. At a still later stage the inﬂammation of the urethra is apt to lead to gradual formation of ﬁbrous tissue around this channel. This contracts and produces narrowing, so that urination becomes diﬃcult or may be stopped for a time altogether (the condition known as stricture). Inﬂammation of some of the joints is a common complication in the early stage – the knee, ankle, wrist, and elbow being the joints most frequently aﬀected – and this form of ‘rheumatism’ is very intractable and liable to lead to permanent stiﬀness. The ﬁbrous tissues elsewhere may also develop inﬂammatory changes, causing pain in the back, foot, etc. In occasional cases, during the acute stage, SEPTICAEMIA may develop, with inﬂammation of the heart-valves (ENDOCARDITIS) and abscesses in various parts of the body. The infective matter occasionally is inoculated accidentally into the eye, producing a very severe form of conjunctivitis: in the newly born child this is known as ophthalmia neonatorum and, although now rare in the UK. has in the past been a major cause of blindness (see EYE, DISORDERS OF). WOMEN The course and complications of the disease are somewhat diﬀerent in women. It begins with a yellow vaginal discharge, pain on urination, and very often inﬂammation or abscess of the Bartholin’s glands, situated close to the vulva or opening of the vagina. The chief seriousness, however, of the disease is due to the spread of inﬂammation to neighbouring organs, the UTERUS, FALLOPIAN TUBES, and OVARIES, causing permanent destructive changes in these, and leading occasionally to PERITONITIS through the Fallopian tube with a fatal result. Many cases of prolonged ill-health and sterility or recurring miscarriages are due to these changes.
Treatment The chances of cure are better the earlier treatment is instituted. PENICILLIN is the antibiotic of choice but unfortunately the gonococcus is liable to become resistant to this. In patients who are infected with penicillin-resistant organisms, one of the other antibiotics (e.g. cefotaxime, ciproﬂoxacin or spectinomycin) is used. In all cases it is essential that bacteriological investigation should be carried out at weekly intervals for three or four weeks, to make sure that the patient is cured. Patients attending with gonorrhoea are asked if they will agree to tests for other sexually transmitted infections, such as HIV (see AIDS/HIV) and for assistance in contact tracing.