What Is Gonorrhea: Symptoms, Treatment And Complications

Gonorrhea is one of the most common Sexually Transmitted Infection (STI) in women. It can cause infections in the vagina, rectum, and throat. Gonorrhea is known to be easily transmittable via both penetrative and oral sex. It can infect the reproductive system and less commonly, the throat or eyes. Again, a maternal to child transmission is also possible here. 

In women, gonorrhea affects the cervix and its functions 90% of the time. 

• Multiple sexual partners
• New partner
• Unprotected sex
• Men that have sex with Men (MSM)
• A sexual partner who has an STI
• Having concurrent STI

Gonorrhea can be a silent infection in most of the population. 

Symptoms can differ between men and women.
Gonorrhea may sometimes take days to months to manifest after initial exposure to the bacteria. Gonorrhea infection can also show no symptoms.

• Abnormal vaginal discharge – thin, purulent, yellow or green
• Mild odour (from discharge)
• Pain while passing urine
• Unusual pain in the cervix or lower abdomen during sex
• Lower abdominal pain without precipitating factor
• It may rarely present as abnormal vaginal bleeding (in between period cycles or after sex)

• Penile discharge – colour may vary from white, yellow, green, or occasionally blood tinged
• Pain when passing urine
• Pain in the testicles – rare

Depending on the nature of the sexual activity and the severity of the infection, both men and women may experience pain, itchiness or discharge from the anus. They may also have pain, swelling, irritation, or discharge from the eye or both eyes (otherwise diagnosed as conjunctivitis). 

As with most bacterial infections, gonorrhea is treated with antibiotics. The first choice is a wide spectrum antibiotic like Ceftriaxone. It is, however, proving to be getting more resistant to antibiotics.

Gonorrhea is also challenging to treat because most people who have this STI also have concurrent sexually transmitted illnesses like chlamydia.

Also, like with any other sexually transmitted illness, treatment must be extended to all partners, and once treatment is completed, routine testing is highly recommended in view of relapse due to the increasing resistant nature of the gonorrhea bacteria.

Abstinence is recommended during treatment. 

Rarely, untreated gonorrhea can spread throughout the body giving rise to skin pustules, infection of the joints (fingers, ankles, knees, and toes), brain or heart valves.

PHOTO: WIKIPEDIA

More commonly, in men, infections of the epididymis, prostate and urethra is noted. Gonorrhea can cause subfertility in some patients.

In women, similar to other sexually transmitted diseases, untreated gonorrhea may cause pelvic inflammatory disease (via an ascending infection involving the uterus, fallopian tubes, and ovaries) in up to 20% of patients.

With inflammation, scarring and/or multiple infections, issues of subfertility and extra-uterine pregnancy will arise.

More annoyingly is the chronic, relapsing pelvic pain. This pain is characteristically stubborn and may require multiple analgesic medications in some women. 

This article was contributed by Dr Michelle Chia. Dr Michelle Chia is the resident doctor at DTAP Clinic Bencoolen, specialising in women’s health. She has extensive experience in managing a variety of women’s health, general gynaecology issues and antenatal care for pregnancy.

She was awarded the prestigious SingHealth OBGYN Academic Clinical Program research grant in 2017 for her research work in contraception awareness & practices amongst women in Singapore.

Dr Michelle Chia, resident physician, DTAP Clinic Group

She has done extensive research especially in the fields of Obstetrics and Gynaecology, and presented at many international conferences, such as the Royal College of Obstetrics and Gynaecology World Congress, the world’s largest O&G conference in South Africa in 2017, the FIGO World Congress in Brazil, and other conferences in Vienna and Canada. 

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