By Dr Ananya Mandal, MD
Gonorrhea is a sexually transmitted infection (STI) that may be detected on regular visits at the local sexual health or genitourinary medicine (GUM) clinic for a sexual health test. It is a treatable infection.
Detection and diagnosis
Early diagnosis and detection of gonorrhoea is important since it may cause long term complications in both men and women. Further early infections are easier to treat using antibiotics but later complications are more difficult to treat.
Since almost half of infected women and around one in 10 men do not show any symptoms but may be transmitting the infection to their sexual partners and possibly new born babies, it is important that those at risk get tested regularly.
For detection, a swab is used to collect samples of the discharge from the cervix or vagina of the tested woman. In me,n a swab is used to collect a sample from the entrance of the urethra or they may be asked to provide a urine sample. Those with suspected infections elsewhere need to be tested from their rectum or throat. Those with conjunctivitis are examined and samples of their eye discharge are taken.
Rapid detection tests include the positive nucleic acid amplification test (NAAT) for gonococcus.
Who needs to be tested?
young sexually active individuals
those with symptoms of gonorrhoea or those whose partners have symptoms of gonorrhoea
those who or whose partners have had unprotected sexual intercourse with a new or unknown partner
those who have another STI or whose partner has another STI
signs of inflammation of vagina and cervix are seen on internal examination
those who are pregnant or planning a pregnancy
Where are tests performed?
Tests can be performed at the genitourinary medicine (GUM) or sexual health clinic, at the general practitioner’s office, at a contraceptive and young people’s clinic or a private clinic.
Treatment of gonorrhoea
It is important to receive treatment for gonorrhoea quickly. The infection rarely goes away without treatment. Those who delay treatment increase their risk of complications and this may lead to more serious health problems. Also an infected person can transmit the infection to others.
Gonorrhoea is treated with a single dose of antibiotics, usually one of the following:
A common regimen applied is Ceftriaxone 500 mg IM given plus azithromycin 1 g given orally as pills. Both are given at a single sitting.
Cefixime - 400 mg single oral dose.
Cefotaxime 500 mg as IM injection or cefoxitin 2 g IM as a single dose plus probenecid 1 g orally.
Spectinomycin - 2 g intramuscularly (IM) as a single dose.
Cefpodoxime can be given orally at a single dose of 200 mg.
Ciprofloxacin 500 mg orally as a single dose or ofloxacin 400 mg orally as a single dose in patients who have responded to these antibiotics earlier.
High-dose azithromycin (2 g as a single dose).
Pregnant and breast feeding mothers may be given Ceftriaxone 500 mg IM with azithromycin 1g orally as a single dose or they may be given Spectinomycin 2 g IM as a single dose with azithromycin 1g orally.
Those with infection of the pharynx may be treated with Ceftriaxone 500 mg IM with azithromycin 1 g orally as a single dose or may be given Ciprofloxacin 500 mg orally or ofloxacin 400 mg orally.
Those with pelvic inflammatory disease are prescribed Ceftriaxone 500 mg IM followed by oral doxycycline 100 mg twice daily plus metronidazole 400 mg twice daily for 14 days. Those with epididymo-orchitis (inflammation of epididymis or testes) are prescribed Ceftriaxone 500 mg IM plus doxycycline 100 mg twice daily for 10-14 days.
Gonorrhoea has become resistant to penicillins and thus these are not commonly used in treatment. Those with symptoms of gonorrhoea may be given initial antibiotic therapy before the results of the tests come in.
Sexual partners of an infected person is also tested and offered treatment. Both individuals are advised to avoid sexual intercourse and intimate contact with other partners until they have completed the course of treatment. This is to prevent reinfection or passing the infection onto anyone else.
Those with severe, more widely spread gonococcal infections or those with complications of gonorrhoea may need hospital admission for treatment.
Treatment for babies with ophthalmia neonatarum
Babies with ophthalmia neonatarum or eye infections with gonococcus at birth will usually be given antibiotics immediately after birth. This is to prevent blindness and other complications.
For gonococcal conjunctivitis Ceftriaxone 500 mg IM daily for 3 days is prescribed. If there is history of penicillin allergy spectinomycin 2 g IM daily for 3 days or azithromycin 2 g orally stat plus doxycycline 100 mg twice daily for 1 week plus ciprofloxacin 250 mg daily for 3 days may be prescribed.
Recovery from symptoms
Most patients recover fully after taking antibiotics. Most of them show improvement in the pain and urethral or vaginal discharge in a day or two. Pain and discharge from rectum also eases in two to three days. Bleeding between periods usually improved before onset of next periods. Pain in the lower abdomen, testicles or epididymis start to improve quickly but could take up to two weeks to go away.
Follow up visits
In 95% cases treatment is effective. Some patients may need to visit the clinic again for a follow up visit. This is needed if the signs and symptoms do not go away, patient has had unprotected sex with their partner in the week following treatment, patients feels they may have contracted the disease again or has gonorrhoea of the throat.
Prevention of infection and re-infection
Promotion of safe sex practices.
Regular and consistent use of barrier contraception like condoms.
Routine testing of sexually active and those at risk of acquiring gonorrhoea. This includes inner-city residents, those who attend GUM clinics, prisoners and men who have sex with men as well as military personnel.
Early detection followed by prompt treatment. Testing and treatment of sexual partner(s) of the affected persons as well.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)
Last Updated: Apr 18, 2013