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gonorrhea(gŏnərē`ə), common infectious disease caused by a bacterium (Neisseria gonorrhoeae), involving chiefly the mucous membranes of the genitourinary tract. It may occasionally spread to membranes in other parts of the body, especially those of the joints and the eyes. Since the principal mode of transmission is sexual contact, gonorrhea is classified as a sexually transmitted diseasesexually transmitted disease
(STD) or venereal disease,
term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, lymphogranuloma venereum, and
..... Click the link for more information. . Gonorrheal conjunctivitis was once a prominent cause of blindness in the newborn, the infection being transmitted during delivery. Routine use of silver nitrate solution in the eyes of every infant at birth has largely overcome this problem.
The usual site of infection in women is the cervix. From there it can spread to the uterus and fallopian tubes and cause pelvic inflammatory disease, ectopic pregnancy, or infertility. Other complications, in both sexes, include infection of the joints, heart valves, and brain. Women are often asymptomatic, but may have a vaginal discharge or burning sensation on urination; men may have a discharge from the penis and pain on urination. Examination of the discharge reveals the presence of the bacteria. In most cases, the disease can be cured by adequate treatment with a cephalosporin antibiotic such as cefixime or ceftriaxone. Failure of treatment is usually due to resistant strains (see drug resistancedrug resistance,
condition in which infecting bacteria can resist the destructive effects of drugs such as antibiotics and sulfa drugs. Drug resistance has become a serious public health problem, since many disease-causing bacteria are no longer susceptible to previously
..... Click the link for more information. ); gonorrhea is now resistant to many antibiotics formerly used to cure it. Prior infection does not confer resistance and reinfection is common.
A common sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae. Humans are the only natural hosts for N. gonorrhoeae, which directly infects the epithelium of the mucous membranes of the human genital tract, pharynx, rectum, or conjunctiva. Local epithelial cell destruction usually occurs, but the organisms may spread to adjacent organs or disseminate via the bloodstream. In women, local complications include inflammation of the uterine lining (endometritis), inflammation of the fallopian tube (salpingitis), inflammation of the abdominal wall (peritonitis), and inflammation of Bartholin's glands (bartholinitis); in men, periurethral abscess and inflammation of a duct connected to the testes (epididymitis). Systemic manifestations such as arthritis or dermatitis may develop, and rarely endocarditis or meningitis.
Women are disproportionately affected by the complications of gonorrhea. Acute pelvic inflammatory disease and salpingitis, the most serious complications of gonorrhea, result in ectopic pregnancy and infertility. Gonococcal infection during pregnancy may also predispose women to premature rupture of membranes, delivery in less than full term, and postpartum endometritis. During childbirth, the gonococcus may infect the conjunctiva of the infant and result in the infection ophthalmia neonatorum. This infection is a serious complication that remains common in less developed countries and can lead to permanent damage to the eye and blindness.
Gonorrhea continues to be the most commonly reported communicable disease in the United States, although incidence has declined since 1984. Risk factors that may influence the probability of infection include number of sexual partners, lack of barrier contraceptives, and young age.
Gonorrhea is an infection spread by physical contact with the mucosal surfaces of an infected person, usually a sexual partner. The risk of infection depends on the anatomic site, the amount of substance containing bacteria, and the number of exposures. Variations in host susceptibility have not been well defined. In a small but significant proportion of infections, there are no symptoms. These individuals are important in the epidemiology of this disease because gonorrhea is usually spread by carriers who have no symptoms or have ignored symptoms.
Control of gonorrhea depends on early diagnosis, effective treatment, and identification of asymptomatic individuals. The last has been accomplished, in part, through screening programs. However, complete control has not been possible because of the emergence and spread of strains that are resistant to less-expensive antimicrobial treatments such as penicillin and tetracycline.
There is no evidence that infected individuals develop long-lasting immunity to reinfection, and vaccination is not available. Thus, the prevention of gonorrhea relies on behavior modification and risk reduction, use of appropriate screening and diagnostic tests, routine use of highly effective antibiotics, early identification and treatment of sexual partners of individuals with gonorrhea, and the appropriate use of barrier methods such as condoms.
An increasing proportion of infections are due to antibiotic-resistant strains of N. gonorrhoeae. Chromosomally mediated resistance to multiple antibiotics as well as plasmid-mediated resistance to beta-lactam antibiotics and tetracycline occurs in strains from both developed and developing countries. Nevertheless, infections can be effectively treated with third-generation cephalosporins (for example, ceftriaxone) or fluoroquinolones (for example, ciprofloxacin or ofloxacin). See Sexually transmitted diseases
an infectious venereal disease.
The causative agent of gonorrhea is the gonococcus; the source of infection is a person affected with the disease. The infection is transmitted chiefly through sexual contact, although children are often infected at birth from infected mothers (the gonococcus may enter the eyes, causing ophtalmia, or, in girls, it may enter the vulval cleft), and infection may also occur from nursing personnel or from a common bed, towels, or chamber pots contaminated with the discharge. Immunity to gonorrhea does not exist—every person may become infected with gonorrhea and, moreover, may be reinfected many times. Gonorrhea is not hereditary. Duration of the incubation (latent) period varies from a few days to two or three weeks (most often, from three to five days).
The gonococcus, having contacted the mucous membrane of the urogenital organs, multiplies rapidly and causes an inflammatory process accompanied by the formation of an inflammatory infiltrate and a purulent discharge. With further development of the disease the infiltrate cicatrizes, which may result in constriction of the urethra. With cicatricial changes to the epididymis in males and to the fallopian tubes in females, these tubular organs become impassable to spermatozoa and ova, leading to infertility. Upon entering the blood the gonococci die, releasing gonotoxin; this may cause headaches and loss of appetite, as well as affection of the joints, tendon sheaths, and nervous system. Without treatment, or with improper treatment or failure to observe the prescribed regime, the process usually takes a chronic, lingering course; the process is exacerbated by alcohol, spicy foods, sexual arousal, and sexual intercourse.
In men the gonococci at first affect the mucous membrane of the urethra. Inflammatory phenomena gradually increase. Cloudy discharges appear from the urethra (urethritis), and acute inflammation develops three to five days after infection. The labia of the exterior aperture of the canal grow red and edematous, pain is experienced upon urination, and profuse purulent discharges appear (anterior urethritis). When the inflammation reaches the posterior urethra there are frequent urges to urinate and severe pain at the end of urination, frequent and painful erections, and nocturnal emissions, sometimes with an admixture of blood in the seminal fluid. The most frequent complication is inflammation of the prostate gland (prostatitis), seminal vesicles, and epididymides (unilateral or bilateral), which again may be the cause of sterility.
In women the gonococcus initially affects the mucous membrane of the cervix of the uterus. The process takes place without producing painful sensations and may remain undiagnosed for a long time. Not knowing of her disease, the woman does not seek medical care and, continuing her sex life, becomes a source of infection. According to the course of the inflammatory process, one may distinguish gonorrhea of the lower urogenital system and gonorrhea of the upper section of the system. Gonorrhea of the lower urogenital tract includes disease of the urethra, paraurethral passages, Bartholin’s glands, cervix, and rectum. The external sex organs and the vagina are rarely affected. When there is inflammation of the urethra, urination is frequent and painful. With affection of the cervix, there are profuse purulent discharges, which produce irritation and a sensation of burning and itching in the area of the external sex organs. Erosion (epithelial damage) occurs at the cervix. With the discharge of pus from the vagina, inflammation of the rectum (proctitis) may occur. In gonorrhea of the upper system, the process spreads to the uterus, tubes, ovaries, and peritoneum of the lesser pelvis; this process is promoted by sexual activity, menstruation, abortions, and hard physical labor. This “ascending” gonorrhea begins with sharp pains in the lower abdomen, elevated temperature, and hemorrhage. This form of gonorrhea may lead to female infertility, even with modern methods of treatment.
Gonorrhea in children occurs chiefly in girls (most often aged three to eight), and extremely rarely in boys. In girls the inflammatory process as a rule involves the vagina, urethra, and more rarely the rectum; the uterus and its adnexa are not affected. The disease begins acutely. The mucous membranes of the labia minora, the entrance to the vagina, and the clitoris become edematous and reddened, and there are profuse purulent discharges from the vagina. The skin of the labia majora becomes covered with dried, suppurative crusts. There are frequent, painful urges to urinate, and the external aperture of the urethra reddens. With affection of the rectum the skin around the anus becomes edematous and bright red in color; sometimes fissures appear between the folds of skin.
The treatment of gonorrhea includes antibiotics, immunotherapy, and physiotherapy, in addition to local treatment. With proper treatment, recovery occurs regardless of the duration and severity of the disease; however, the earlier treatment is begun, the more rapid and complete is the recovery.
Public prophylaxis is practiced through outpatient clinics. Dermatology and venereology clinics and the venereology departments of polyclinics offer medical care to infected persons, handle their treatment, find those persons who may be sources of the infection and bring them in for examination, examine the members of the patient’s family, and conduct prophylactic examinations of certain groups of the population. Personal prophylaxis consists in avoiding casual sexual contacts, the use of a condom, and also, in the first hours after a suspicious sexual contact, special treatment of the urethra in men and of the vagina in women at the antivenereal first aid stations of venereology outpatient clinics, which operate around the clock.
REFERENCEPorudominskii, I. M. “Gonoreia.” In Venericheskie bolezni. Moscow, 1956.
O. I. NIUNIKOVA