Gonorrhoea

Overview of Gonorrhoea:

• Generally,Gonorrhoea is cause by infection with Neisseria gonorrhoeae and may involve columnar epithelium in the lower genital tract, rectum, pharynx also eyes.
• Moreover, Transmission is usually the result of vaginal, anal or oral sex.

Gonococcal conjunctivitis may cause by accidental infection from contaminated fingers.

• Untreated mothers may infect babies during delivery, resulting in ophthalmia neonatorum.
• Additionally, Infection of children beyond the neonatal period usually indicates sexual abuse. [1]
• Gonorrhea passes from person to person through unprotected oral, anal, or vaginal sex.
• People with numerous sexual partners or those who don’t use a condom are at greatest risk of infection.
• Besides this, the best protections against infection are abstinence, monogamy (in other words; sex with only one partner), and proper condom usage.
• Behaviors that make a person more likely to engage in unprotected sex also increase the likelihood of infection.
• All in all, these behaviors include alcohol abuse and illegal drug abuse, particularly intravenous drug use. [3]

Epidemiology of Gonorrhoea

Causes of Gonorrhoea

• Gonorrhoea is cause by bacteria called Neisseria gonorrhoeae.
• They can live in the cervix (entrance to the uterus), the urethra (tube where urine comes out), the rectum (back passage), the throat and, occasionally, the eyes.
• Gonorrhoea is spread during vaginal, oral or anal sex.
• Gonorrhoea can also spread by sharing sex toys without washing them or when a new condom is not used for each person.
• Gonorrhoea may possible to spread gonorrhoea on fingers when you touch an infected part of the body, then touch other parts of your or someone else’s body.

Gonorrhoea can passed on via oral sex, so using flavoured condoms or dental dams can help reduce the risk.

• Other types of contraception, such as the contraceptive pill, offer no protection against gonorrhoea or other sexually transmitted infections (STIs).
• Gonorrhoea can also passed from a mother to her baby during childbirth, which can cause conjunctivitis in the baby’s eyes.
• A woman can take antibiotics to treat gonorrhoea either during pregnancy or while breastfeeding.
• It’s possible for an adult to get conjunctivitis as a result of their eye coming into contact with gonorrhoea bacteria, but this is rare. [4]

Types of Gonorrhoea

Risk factors of Gonorrhoea:

Pathogenesis of Gonorrhoea:

The pathogenesis of gonorrhoea, caused by the bacterium Neisseria gonorrhoeae, involves a complex interplay between the bacterium’s virulence factors and the host’s immune response.

Pathophysiology of Gonorrhoea:

Sign & Symptoms of Gonorrhoea:

The incubation period is usually 2–10 days.

Symptoms in men:

Men may not develop noticeable symptoms for several weeks. Additionally, Some men may never develop symptoms.

Typically, the infection begins to show symptoms a week after its transmission.

The first noticeable symptom in men is often a burning or painful sensation during urination.

As it progresses, other symptoms may i.e.:

• Greater frequency or urgency of urination.
• A pus-like discharge (or drip) from the penis (for example; white, yellow, beige, or greenish).
• Examination will usually show a mucopurulent or purulent urethral discharge.
• Pain may also spread to the rectum.
• Swelling or redness at the opening of the penis
• Swelling or pain in the testicles
• Rectal infection in MSM is usually asymptomatic but may present with anal discomfort, discharge or rectal bleeding.
• Proctoscopy may reveal either no abnormality, or clinical evidence of proctitis such as inflamed rectal mucosa and mucous.
• A persistent sore throat. 

The infection will stay in the body for a few weeks after the symptoms have been treated.

In rare instances, gonorrhea can continue to cause damage to the body, specifically the urethra and testicles.

Symptoms in women:

In general, Many women don’t develop any overt symptoms of gonorrhea.

When women do develop symptoms, they tend to be mild or similar to other infections, making them more difficult to identify.

In detail; Gonorrhea infections can appear much like common vaginal yeast or bacterial infections.

In women, the urethra, paraurethral glands/ducts, bartholin’s glands/ducts or endocervical canal may be infected. Additionally, the rectum may also be involved either due to contamination from a urogenital site or as a result of anal sex.

Occasionally, the rectum is the only site infected.

About 80% of women who have gonorrhoea are asymptomatic.

There may be vaginal discharge or dysuria but these symptoms are often due to additional infections, such as chlamydia, trichomoniasis or candidiasis, making full investigation essential.

Lower abdominal pain, dyspareunia and intermenstrual bleeding may be indicative of PID.

Clinical examination may show no abnormality, or pus may expressed from urethra, paraurethral ducts or Bartholin’s ducts.

Symptoms i.e.:

• Discharge from the vagina (e.g. watery, creamy, or slightly green).
• Either Pain or burning sensation while urinating.
• The need to urinate more frequently.
• Heavier periods or spotting.
• Sore throat.
• Pain upon engaging in sexual intercourse.
• Cervix may inflamed, with mucopurulent discharge also contact bleeding.
• Sharp pain in the lower abdomen.
• Fever [1] [3]

Other Conditions:

Gonococcal Conjunctivitis

Gonococcal Conjunctivitis In New Born

• Pharyngeal gonorrhoea is the result of receptive orogenital sex and is usually symptomless.
• Gonococcal conjunctivitis is an uncommon complication, presenting with purulent discharge from the eye(s), severe inflammation of the conjunctivae and oedema of the eyelids, pain and photophobia.
• Gonococcal ophthalmia neonatorum presents similarly with purulent conjunctivitis and oedema of the eyelids.
• Conjunctivitis must treated urgently to prevent corneal damage.
• Disseminated gonococcal infection (in other words; DGI) is seen rarely, and typically affects women with asymptomatic genital infection. Symptoms include arthritis of one or more joints, pustular skin lesions and fever. [1]

Diagnosis of Gonorrhoea:

To determine whether the gonorrhea bacteria is present in your body, your doctor will analyze a sample of cells.

Gram-negative diplococci may seen on microscopy of smears from infected sites.

Pharyngeal smears are difficult to analyse due to the presence of other diplococci, so the diagnosis must be confirmed by culture or NAAT.

Samples can be collected by:

Urine test:

• This may help identify bacteria in your urethra.

Swab of affected area:

• A swab of your throat, urethra, vagina or rectum may collect bacteria that can be identified in a laboratory.

For women, home test kits are available for gonorrhea.

Home test kits include vaginal swabs for self-testing that are sent to a specified lab for testing.

Testing for other sexually transmitted infections:

Your doctor may recommend tests for other sexually transmitted infections.

Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea.

Testing for HIV also is recommend for anyone diagnose with a sexually transmitted infection.

Depending on your risk factors, tests for additional sexually transmitted infections could beneficial as well. [2]

Complications of Gonorrhea

Untreated gonorrhea can lead to significant complications of Gonorrhoea, such as:

Infertility in women:

• Untreated gonorrhea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), which may result in scarring of the tubes, greater risk of pregnancy complications and infertility.
• PID is a serious infection that requires immediate treatment.

Infertility in men:

• Men with untreated gonorrhoea can experience epididymitis inflammation of a small, coiled tube in the rear portion of the testicles where the sperm ducts are locate (epididymis).
• Epididymitis is treatable, but if left untreat, it may lead to infertility.

Infection that spreads to the joints and other areas of your body:

• The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body, including your joints.
• Fever, rash, skin sores, joint pain, swelling and stiffness are possible results.

Increased risk of HIV / AIDS:

• Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS.

• People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners.

Complications in babies:

• Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. [2]

Treatment of Gonorrhea

Gonorrhea treatment in adults:

• Adults with gonorrhea are treat with antibiotics.
• Due to emerging strains of drug-resistant neisseria gonorrhoeae, the centers for disease control and prevention recommends that uncomplicate gonorrhea treat only with the antibiotic ceftriaxone give as an injection in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) two antibiotics that are taken orally.
• Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combine with oral azithromycin, is highly successful in treating gonorrhea.
• This treatment may helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone.

Gonorrhea treatment for partners:

• Your partner also should undergo testing and treatment for gonorrhea, even if they have no signs or symptoms.
• Even if you’ve treat for gonorrhea, you can be reinfected if your partner isn’t treated.

Treatment of Gonorrhea for babies:

• Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection.
• If an eye infection develops, babies can be treated with antibiotics. [2]

Prevention of Gonorrhea

Take steps to reduce your risk of gonorrhea:

Use a condom if you choose to have sex:

• Abstaining from sex is the surest way to prevent gonorrhea.
• But if you choose to have sex, use a condom during any type of sexual contact, including anal sex, oral sex or vaginal sex.

Ask your partner to be tested for sexually transmitted infections:

• Find out whether your partner has tested for sexually transmitted infections, including gonorrhea.
• If not, ask whether they would be willing to be tested.

Don’t have sex with someone who has any unusual symptoms:

• If your partner has signs or symptoms of a sexually transmitted infection, such as burning during urination or a genital rash or sore, don’t have sex with that person.

Consider regular gonorrhea screening:

• Annual screening is recommended for all sexually active women less than 25 years of age and for older women at increased risk of infection, such as those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection.
• Regular screening is also recommended for men who have sex with men, as well as their partners.
• To avoid reinfection with gonorrhea, abstain from unprotected sex for seven days after you and your sex partner have completed treatment and after resolution of symptoms, if present. [2]

Homeopathic Treatment of Gonorrhoea

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis. 

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions. 

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Homeopathic treatment for  Gonorrhea is  natural, safe and without any side-effects, and one can enjoy immense relief from these frustrating symptoms.

It is a patient-oriented science and medicines are prescribe on the characteristics of the individual rather than just the symptoms of the disease.

Medorrhinum – for treating gonorrhea:

• Medorrhinum tops the list of medicines to treat gonorrhea.
• In cases needing Medorrhinum, urethral inflammation is mark with burning pain in urethra while urinating.
• Urine also has an offensive smell.
• In males, thin fluid mixed either whitish mucus or yellow purulent discharge appears from the urethra.
• There is soreness in urethra along with this.
• Lastly; In females, thick, acrid vaginal discharge with fishy odor is prominent.

Cannabis Sativa – for watery mucus/purulent discharge from urethra in males:

• Cannabis Sativa is useful for gonorrhea with both watery mucus or purulent discharge from the urethra in males.
• Burning, smarting pain in urethra are mark on urinating.
• A desire to urinate is almost constant.
• The glans is red, swollen, inflamed along with the above symptoms.

Nitric Acid – for yellow green discharge from urethra in males:

• Nitric Acid is helpful for gonorrhea with yellow-green discharge from the urethra in males.
• Sometimes the discharge may blood stained.
• Intense pain may felt while urination.
• Itching in the urethra is also marked.
• Besides this, Prepuce may swollen, red with burning pain.
• The testicles may also painful, swollen also tender.

Rhododendron – for swollen, painful testicles in males:

• It is prepare from fresh leaves of plant rhododendron chrysanthum commonly known by the name of yellow snow-rose of the natural order ericaceae.
• Moreover, Rhododendron is wonderful medicine for gonorrhea in males with swollen, painful testicles.
• Tearing, pressing, sticking pain is there in the testicle.
• Pain is worse on sitting also better by motion. Additionally, the testicle may also feel hard.
• It is painful to touch.
• Thin discharge from urethra may present.
• Rhododendron is also high-grade homeopathic medicine to treat epididymitis.

Cantharis – for painful / burning urination:

• Cantharis is an excellent medicine for managing painful/burning urination in gonorrhea.
• The burning and pain in the urethra is worse while urinating.
• It may also present before urination also continue after urination.
• Pain in the urethra is very severe, cutting and sharp in nature.
• Furthermore; The desire to pass urine is also frequent.
• Urging to urinate is most mark while standing or while walking.
• Urine may also scanty or sometimes passes in drops.
• The pain during urination and its frequency are most worse at night time.

Merc Sol – for increased frequency and urgency to urinate:

• In general; Merc sol is beneficial to treat increase frequency and urgency to urinate in gonorrhea.
• The person needing merc sol has to hurry to pass urine.
• The frequency to urinate is very high and the person has to go to urinate almost every hour.
• While urinating burning and biting pains are felt.
• In males thick, green or yellow discharge from the urethra, may be present along with above symptoms.
• All in all; In females requiring merc sol, greenish vaginal discharges with burning and itching may there with high frequency and urgency of urination.

Pulsatilla Nigricans– for gonorrhea in females with white, milk-like vaginal discharge:

• Pulsatilla is prepared from plant pulsatilla nigricans commonly known by the name of wind flower of the natural order ranunculaceae.
• In detail, It is prominent to treat gonorrhea in females with white colored vaginal discharge like milk.
• The discharge is acrid, thin with marked burning in the vagina.
• And the discharge may also cause biting, stinging pains.
• The discharge is most worse on lying down where pulsatilla is indicate.

Sepia – for greenish vaginal discharges:

• Sepia is a very effective medicine for gonorrhea in females with greenish vaginal discharges.
• The discharge is profuse mainly after urinating.
• The discharges cause itching of vulva and vagina along with burning pain.
• Pain and bearing down sensation in the pelvic region is mark.
• Sepia is also indicate to treat a complaint of painful coition in females.
• Bleeding from the vagina after coition is also treated well with Sepia.

Kreosote – for yellow vaginal discharges:

• Kreosote is indicate for gonorrhea in females with yellow vaginal discharges.
• The discharges are acrid and corrosive in nature causing much itching.
• The odour is also offensive.
• The vaginal discharge is attend with fatigue and weakness especially in the legs.
• Frequent desire to urinate is also present.

Natrum Muriaticum – for painful coition in women:

• Natrum Mur is indicate for gonorrhea in females to manage complaint of painful coition.
• Along with pain, burning and smarting are also felt in the vagina during intercourse.
• Profuse vaginal discharge along with weakness may be present.
• The discharges are acrid and either may greenish or transparent, watery.
• They cause itching especially at night time.

Sabina – for treating gonorrhea with heavy periods:

• Basically; Sabina is prepare from a plant named as sabina officinalis or juniperus sabina of the natural order Coniferae.
• It is very suitable to treat gonorrhea in females with heavy periods.
• The bleeding is profuse, bright red colored also is mix with dark clots.
• Furthermore, Least motion increases the flow of blood.
• Lastly, Pain from sacrum to pubes is a characteristic attending feature.

Do’s And Dont’s 

Do’s:

• Seek medical attention: Consult a healthcare professional for diagnosis and appropriate treatment of gonorrhoea.
• Get tested: Undergo testing for gonorrheoa and other sexually transmitted infections (STIs).
• Inform your partners: Notify all sexual partners so they can also get tested and treated.
• Follow treatment instructions: Take all prescribed medications as directed and complete the full course.
• Abstain from sexual activity: Avoid sexual contact until you and your partner(s) have completed treatment of gonorrhoea and been cleared by a healthcare professional.
• Practice safe sex: Use condoms consistently and correctly to reduce the risk of STIs.
• Get retested: Follow up with your healthcare provider for a test of cure, usually 1-2 weeks after treatment. [10]

Don’ts:

• Ignore symptoms: Don’t dismiss any unusual symptoms, even if they seem mild.
• Delay treatment: Prompt treatment is crucial to prevent complications and further spread of gonorrhea.
• Self-medicate: Avoid using over-the-counter medications or home remedies without consulting a healthcare professional.
• Have unprotected sex: Refrain from sexual activity until you and your partner(s) have completed treatment and been cleared.
• Share personal items: Avoid sharing towels, undergarments, or other personal items that could transmit the infection of gonorrhea.
• Engage in high-risk behaviors: Limit sexual partners and avoid risky sexual practices. [10]

References:

1. Davidson’s Principles and Practice of Medicine (22nd edition) Ch. 15 [443]
2. https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774
3. https://www.healthline.com/health/gonorrhea
4. https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/stis/gonorrhoea
5. https://www.drhomeo.com/homeopathic-treatment/11-remedies-homeopathic-treatment-of-gonorrhea/
6. Prevalence of Neisseria gonorrhoeae in India: A systematic literature review. STI 2021;97(Suppl 1):A170.2
7. Sexually Transmitted Infections among Key Populations in India: A Protocol for Systematic Review. medRxiv 2022.12.04.22282962v1.
8. Book: Sexually Transmitted Diseases (4th Edition) Writer: King K. Holmes, P. Frederick Sparling, Walter E. Stamm, Peter Piot, Judith Wasserheit, Lawrence Corey, Myron S. Cohen, Thomas C. Quinn Year of Publication: 2008 Publication: McGraw Hill Professional

9. Book: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (9th Edition)
   Writers: John E. Bennett, Raphael Dolin, Martin J. Blaser, Year of Publication: 2020, Publication: Elsevier

10. Book Title: Sexually Transmitted Diseases (4th Edition), Authors: Kinghorn, G. R., Year of Publication: 2008, Publisher: Informa Healthcare

11. Book Title: Integrative Medicine (4th Edition), Editors: David Rakel
    Year of Publication: 2018, Publisher: Elsevier