Gonorrhoea (the clap)

Gonorrhoea (known as “the clap”) is a common sexually transmitted bacterial infection caused by the bacterium Neisseria gonorrhoeae, which can only be caught by having sex with a person who already has the disease. It has an incubation period of three to seven days after contact. Some degree of protection can be obtained by using a condom.

The symptoms vary significantly between men and women.

In women there may be minimal symptoms with a mild attack, but when symptoms do occur they include a foul discharge from the vagina, pain on passing urine, pain in the lower abdomen, passing urine frequently, tender lymph nodes in the groin, and fever. If left untreated the infection can involve the uterus and Fallopian tubes to cause salpingitis and pelvic inflammatory disease, which can result in infertility and persistent pelvic pain. Babies born to mothers with the infection can develop gonococcal conjunctivitis (eye infection).

In men symptoms are usually obvious with a yellowy milky discharge from the penis, pain on passing urine and, in advanced cases, inflamed lymph nodes in the groin “tender lumps in the groin”. If left untreated the prostate can become infected, which can cause scarring of the urine tube (urethra), permanent difficulty in passing urine and reduced fertility.

With anal intercourse, a rectal infection with gonorrhoea can develop and cause an anal discharge, mild diarrhoea, rectal discomfort and pain on passing faeces.

Oral sex can lead to the development of a gonococcal throat infection.

Gonorrhoea may also enter the bloodstream and cause septicaemia. An unusual complication is gonococcal arthritis, which causes pain in the knees, ankles and wrists. Other rarer complications include infections of the heart, brain and tendons.

The diagnosis is confirmed by examining a swab from the urethra, vagina or anus under a microscope, and culturing the bacteria on a nutrient substance. There are no blood tests available to diagnose gonorrhoea. Other sexually transmitted diseases should also be tested for when gonorrhoea is diagnosed, as they may be contracted at the same time. For this reason, blood tests are often ordered when treating anyone with any form of venereal disease.

Gonorrhoea has been readily treated with a course of penicillin until recently, but many strains are now resistant to penicillin and more potent antibiotics (eg. spectinomycin) are required. All sexual contacts of the infected person need to be notified as they may be carriers of the disease and unaware of the presence of the infection. After treatment, a follow-up swab is important to ensure that the infection has been adequately treated. The appropriate antibiotics can cure more than 95% of gonorrhoea cases.

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