Time To ‘Clap’ Back? Here’s How To Deal With Gonorrhoea

Gonorrhoea is a widely prevalent but often neglected sexually transmitted disease. This bacterial infection frequently goes undiagnosed, yet its impact is staggering — over 82.4 million new cases were reported worldwide in 2020 alone, marking it a global epidemic. In India, the prevalence of gonorrhoea ranged from 0.2% in Prakasam, Andhra Pradesh, to 9.3% among female sex workers in Mumbai, Maharashtra.

Given its widespread prevalence and serious health implications, understanding gonorrhoea's symptoms and prevention methods has become increasingly crucial in today's sexual health landscape.

So, what is gonorrhoea? Gonorrhoea is a contagious sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It infects the urogenital tract, anorectal region, conjunctiva, and the pharynx. Women especially do not show any symptoms from this infection, which is why regular screening is necessary after one becomes sexually active. If not treated correctly, it may lead to certain health issues and may also increase the chances of HIV infection being transmitted, especially in women. 

As per the National Institutes of Health (NIH), 50% of gonorrhoea cases spread from penile-to-vaginal intercourse, and 20% spread from the vagina to the penis during sex worldwide.  

Gonorrhoea is transmitted mainly through: 

• Vaginal, anal, or oral sex
• Use of sex toys without adequate cleaning
• Mother-child contact during birth
• Physical contact with the infected lesions

Gonorrhoea cannot be transmitted through food, hugs, or swimming pools. Since this condition can only be passed in certain conditions, protection and awareness are key.

Knowing gonorrhoea symptoms is important for detecting it early. Approximately 20% of women and 10% to 15% of men are asymptomatic worldwide, which makes it the world’s biggest ‘silent’ STI. When symptoms do happen (usually 2-14 days after contact), they can be difficult to ignore:

In women:

• More vaginal discharge
• Painful urination
• Unusual bleeding
• Pain in the lower belly
• Discomfort during sex

In men:

• Yellow or green discharge from the penis
• Painful urination
• Swelling in the testicles
• Sore throat (if spread through oral sex)

Remember, the symptoms and causes of gonorrhoea can be different, and waiting for them to show up is not wise — regular check-ups are your best option.

Untreated gonorrhoea may come with many complications. With gonorrhoea being prevalent at a rate of 14.1% in India, we present this picture of the consequences that one may face if the progress of their symptoms is left unchecked:

In women, it may cause:

• Pelvic Inflammatory Disease (PID) 
• Childbearing problems
• Chronic pelvic pain
• Pregnancy complications outside the uterus
• Itching in joints 

In men:

• Epididymitis (inflammation of the scrotal duct)
• Prostatitis 
• Stricture of the urethra

During pregnancy:

• The likelihood of premature delivery is 12.2% in women with infection 
• Eye disease in babies born vaginally 
• May have higher chances of foetal demise in utero

All these effects of gonorrhoea are curable, and no extra costs are incurred with the right treatment at the right time.

Gonorrhoea can be transmitted primarily through sexual intercourse without protection from an infected person. Other commonly infected places are the mucus membrane associated with the oral, vaginal, or rectal regions. Contributing factors include multiple sexual partners, unprotected or no condom usage, and a history of STDs. The burden of gonorrhoea is higher among girls and women between the ages of 15 and 24. Infection may also be from mother to child during the passage through the birth canal. Such trends are mostly seen in urban areas, and factors such as the availability of healthcare services influence the effect of social determinants of health. Awareness is created, and therefore, screening is encouraged by your local healthcare provider.

Estimates reveal that gonorrhoea prevalence in India is 6%, and most cases occur in urban populations; thus, it is important to be aware of one’s risk factors for gonorrhoea to be healthy and safe.

Important risk factors of gonorrhoea in the Indian context are:

• Less than 25 years of age and being sexually active 
• The presence of numerous sexual partners
• Failure to use protection most of the time 
• Being a city dweller
• Prior occurrences of sexually transmitted infections
• Absence of adequate screening practices

Discussions around safe sex are still very much a taboo subject in India, and hence, it is wise to put all efforts into prevention.

Essential prevention strategies include: 

• Using condoms when engaging in sex 
• Getting tested for sexually transmitted infections, particularly if one has intercourse (every 6 months is the preferred duration) 
• Discussing one’s sexual health status with one’s partner 
• Having sex with only one person at a time, whether newly met or known for some time

Gonorrhoea is not an individual-centric health issue alone but a societal health problem that should be dealt with. With regular screening, partner notification, and the use of barriers, we can wind down the funnel of spread. The improvement of medical techniques, accessible treatment methods, and enlightenment of society signal better days ahead. Own your sexual well-being today, learn about the recent advances in the prevention of sexually transmitted infections, and do not forget – your health decisions are not only for you.

A discharge from the genitals is often the most prominent initial symptom — in males, gonorrhoea causes a whitish or yellowish-green purulent discharge from the penis, usually 2-5 days following infection. 

Symptoms that may be experienced include: 

• Discharge from the genital areas is unusual
• A burning feeling in the urethra while passing urine
• Swelling of the male reproductive gland (testes)
• Occurrence of menses (bleeding) in young females (between menstrual periods)
• Pain or inflammation in the neck (for oral cases)
• Pain in the lower section of the belly
• Some patients have elevated body temperature

Gonorrhoea won't just disappear by itself. However, it can be eliminated with appropriate doctor-prescribed treatment.

Possible side effects of gonorrhoea when it occurs during pregnancy may include:

• Rupture of the amniotic membranes
• Preterm birth
• Infection to the child at the time of birth.
• Conjunctivitis in infants

Nevertheless, in pregnancy, these risks may be reduced with the help of medications (treatment of bacterial infections). Adequate regular checking and understanding of prenatal care can help control and eradicate the infection effectively.

Paired with the above, it is imperative to consider the following to prevent gonorrhoea: 

• Sexual activity during gonorrhoea treatment and at least 7 days after completing the prescribed medications should be avoided.
• Wait for all symptoms to disappear
• Confirm testing and treatment of your partner(s)
• Follow up with a test to ensure gonorrhoea has resolved
• Take precautions whenever sexual relations resume