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clap disease, the clap, GC
Gonorrhoea (gon-ah-ree-ah) is a sexually transmitted disease, caused by bacteria called Neisseria (nye-sear-ee-ah) gonorrhoea. The infection usually begins in the genital area, but may spread to the blood, bones, heart valves, and other sites.
What is going on in the body?
Sexually transmitted diseases (STDs) are spread by intimate contact. The term intimate contact usually means sexual intercourse, but it also includes close body contact, kissing, oral sex, mouth-breast contact, and anal intercourse.
Many STDs can also be spread during childbirth. The infection is passed from mother to baby by contact with the placenta or during delivery. The organisms that cause STDs have adapted to growing in the genital tract. The organisms are present in body secretions or blood. Gonorrhoea bacteria can be found in the urethra, cervix, anal canal, and mouth. It has been estimated that after exposure to an infected partner, 20% to 50% of men and 60% to 90% of women become infected. Gonorrhoea may also be present with other STDs such as syphilis and chlamydia (klah-mid-ee-ah).
What are the signs and symptoms of the infection?
Most women with gonorrhoea do not have any symptoms. The symptoms that do occur are in the lower reproductive tract. These may include:
What are the causes and risks of the infection?
- vaginal discharge
- increased urination
- pain with urination
- pain with intercourse
- rectal discomfort
- urge to urinate frequently
- pelvic pain
- abnormal menstrual bleeding
- bleeding or spotting after sexual intercourse or exercise
- inflamed rectum or anus after anal intercourse
- sore throat after oral sex
- conjunctivitis (swelling and redness of the membrane that lines the eye), which is caused by self-introduction of the bacteria from the genitalia to the eyes
- bone pain, joint pain, and rash, which can indicate a spread to the bloodstream
The major complication in females is the development of salpingitis (sal-pin-jie-tis). This is the term for an infection that has spread from the cervix up to the uterus, fallopian tubes, and the abdominal cavity. It can cause infertility. Complications include:
What can be done to prevent the infection?
- endometritis (en-doe-mi-try-tis), or infection of the lining of the uterus
- cervicitis (sir-vis-sie-tis), or inflammation of the cervix
- pelvic inflammatory disease (PID)
- increased risk of ectopic, or tubal pregnancy
- pelvic adhesions (scar tissue)
- peritonitis (pare-it-ton-ite-is), or inflammation of the lining of the abdominal cavity
- Bartholinitis (bar-tah-lah-nye-tis), or infection or abscess of the Bartholin's gland (glands near the entrance of the vagina)
- scarring of the bladder, intestines and other pelvic organs
- ophthalmia (off-thal-mee-ah) neonatorum (nee-oh-nay-tor-um), or an infection of an infant's eyes at birth
- conjunctivitis, due to self-introduction of the bacteria from the genitalia to the eyes
- bone pain, joint pain, and rash which indicates a spread of the infection to the bloodstream
- transmitting untreated gonorrhoea to sexual partners
- meningitis (men-in-jie-tis), or an inflammation of the brain and spinal cord
- death from overwhelming sepsis or bloodstream infection
Gonorrhoea must be reported to health department authorities. Finding carriers of the disease who have no symptoms and treating known sexual partners can control it. Women who engage in high-risk behaviours, such as sex with multiple partners, should be routinely screened with cervical cultures. These are tests in which swabs are taken from the cervix to see if the Neisseria gonorrhoea organism grows. Some high-risk behaviours include unsafe sex practices, substance abuse, and alcohol abuse. The use of condoms during sexual intercourse and foreplay can lessen the risk of transmission.
How is the infection diagnosed?
Cultures for gonorrhoea may be taken from any body opening infected with the bacteria. These sites include the vagina, cervix, mouth, and urethra.
What are the long-term effects of the infection?
The effects depend on the length of the infection, and on whether or not treatment was begun early, the infection has spread to other organs, or the gonorrhoea has recurred. Because the infection can scar the fallopian tubes that lead from the ovaries to the uterus, the risk of a tubal, or ectopic, pregnancy is greater. Scar tissue, or adhesions, can also cause chronic pelvic pain. Both of these conditions may require future surgery.
What are the risks to others?
Any sexual partners of a person with gonorrhoea can become infected. They, in turn, could pass the infection on to someone else. If left untreated in a pregnant woman, gonorrhoea infection that is active at the time of delivery can infect the baby as it passes through the birth canal. This causes serious medical problems for the child.
What are the treatments for the infection?
Gonorrhoea is treated with antibiotics, such as, Penicillin, ceftriaxone or ciprofloxacin.
Sometimes the antibiotics are taken by mouth and sometimes the drugs must be injected into a muscle or a vein. If the infection is severe, antibiotic treatment may have to continue for a long time. If someone has more than one kind of infection, more than one antibiotic may be needed, for example, azithromyicn or doxycycline, may be taken in addition to one of the antibiotics mentioned above. It is important to take the antibiotic for the entire time it is prescribed, or the infection will come back.
What are the side effects of the treatments?
All antibiotics can have side effects. These include upset stomach, vomiting, cramps, and allergic reactions.
What happens after treatment for the infection?
Before having sex again, it is important to make sure that the infection is gone. A doctor should be seen for follow-up. Another culture will be done to make sure there are no more bacteria. It is important to tell sexual partners that they have been exposed to gonorrhoea. Then they can be screened and treated, if necessary. Condoms should always be used.
How is the infection monitored?
If any of the symptoms return, an individual should see a doctor immediately.
Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request