Diagnosis and treatment of GONORRHEA

Last week, I spoke of gonorrhea. I said it was caused by a bacterium that can be easily treated. I also said that it causes the same problems as chlamydia, just more intense. This week I will briefly tell you how we, as doctors, diagnose the infection and how we treat it.{{more}}

The diagnosis is made both clinically and using lab tests. The clinical diagnosis is made by what the patient tells you and what you observe. On questioning, the patient usually has a history of unprotected sex 2-7 days before and would complain of a burning sensation in the penis, followed by copious creamish-yellow, thick discharge. This discharge is usually seen on examining the penis. It is especially copious if the man has passed urine recently. If he has recently passed urine, then the discharge may be seen by “milking” the urine passage. Most men will have a discharge. Some of the discharge is collected on a cotton swab, placed in a special container and sent to the laboratory for testing. In the rare situation where the bacterium gets into the blood stream, some blood is taken and sent to the lab to get tested in a similar way as the discharge from the urine passage. These patients with the infection spreading to the blood are hospitalized for special antibiotics in their veins. The woman will have lower abdominal discharge, a foul smelling vaginal discharge and experience pain on sexual intercourse, or a fever. The discharge, like that in men, may be creamish, yellow, brown or green.

Traditionally, gonorrhea is treated just on seeing the discharge from the urine passage. The classic drug is penicillin. Unfortunately, as much as 40% of the bacteria are now resistant to penicillin, so penicillin is no longer recommended, even though it is still used. The bacteria developed resistance to penicillin because penicillin, was overused and sometimes abused. Everyone who had an abnormal penile discharge was treated with penicillin, whether it was needed or not. Eventually the bacteria started evading the antibiotic and developed resistance. This is the reason why not everyone with a cough and cold, or who has the “flu” or a fever should be given antibiotics, because bugs develop resistance. The best procedure to avoid antibiotic resistance is to take a swab of the penile discharge. The swab is then tested for the bug or any other bacterium that may be causing the infection. It is usually grown in the lab and testing done to tell us which antibiotic will effectively cure the infection. In women, a high vaginal or endocervical swab is taken and the same procedure is carried out. Patients with the blood infection also get a culture of the blood to confirm it is the bacterium and to determine the best antibiotic used to treat the infection.

The newer antibiotics used to treat gonorrhea are called the cephalosporins. These are the cousins to penicillin, but they are stronger. The specific one is given as an intramuscular injection. Other medications may be used if the person is allergic to the cephalosporins. These include one of the tetracyclines, or others like ciprofloxacin or erythromycin. Unfortunately, because these drugs were abused, about 20-25% of the bacteria are now resistant to them. It is important to note that both partners need to be treated and, as with chlamydia, both need to be treated at the same time, or else you will get the recurring “ping-pong” infection I discussed a few weeks ago. Both partners need to be tested for other sexually transmitted infections, especially chlamydia, as 30-40% of all gonorrhea infections are associated with chlamydia and chlamydia is more common than gonorrhea. Besides, as with chlamydia, treatment contact tracing should be done to effectively eradicate the disease. The discharge should be resolved within 2-3 days of effective treatment. Failure to do so should alert the doctors to issues such as the wrong diagnosis, the wrong antibiotics or others problems like diabetes or HIV that cause immunocompromised states and hence persistence of infections.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com