By Dr. A.H. Serdar
There is a large reservoir of asymptomatic and untreated gonorrhea infection in the world, which sets up question about their clinical signification and possibly their complication. This disease is caused by the bacteria Neisseria gonorrhea and spread through sexual contact. In first step the bacteria can infect the soft integument covering the openings of the body like the urethra, anus, vagina, throat, cervix, and also can pass from mother to infant during delivery. Males infected with gonorrhea will have burning and sometimes searing while urinating, besides will appear a yellowish white discharge from the penis. Women who have gonorrhea may have no symptoms or their symptoms possibly so mild. In some cases, women will perceive a burning sensation when they urinate, or they will observe a yellow-green vaginal discharge. In men symptoms usually emerge two days to one week after contamination, otherwise it can take as long as one month for signs to commence .Often, there are no symptoms for individuals infected with gonorrhea. Diseased with no symptoms are at possibility for progressing complications to illness of gonorrhea. Past infection does not make a individual resistant and immune to Neisseria gonorrhea. Gonorrhea can be cured with a single dose of antibiotics. If the infection has extended, patients will have to take medication for a longer period or hospitalized on condition that the infection is critical. The entire species of gonorrhea are treatable. However, some strains are evolving into more resistant to some antibiotics. This paper will discuss untreated gonorrhea and it will explain some complication of this disease.
Overview of Untreated Gonorrhea
The most common symptom of a gonorrheal infection in a male is discharge from the penis. Sometimes the penis becomes a little swollen; also the urethral opening can become inflamed. If, gonorrhea is not cured, the urethral symptoms may ultimately pass from sight, but epididymitis can appear as a complication. In epididymitis, the scrotum becomes inflamed and sensitive, usually on just one part. This infection can cause scarring that may consequences with a man’s fertility. Gonorrhea can also infect the prostate and cause urethral scarring that makes urination difficult.
The germ transports from the cervix up into the uterus, fallopian tubes, and ovaries. There can be pain with intercourse.The most prevalent aftermath of untreated gonorrhea is PID, a grave infection of the female reproductive organs. Gonococcal PID on many occasions appears immediately after the menstrual period. PID can damage cells lining the fallopian tubes, causing in infertility in as many as ten percent of women infected. Provided the tube is just somewhat scarred, appropriate movement of the fertilized egg into the uterus is blocked. On condition that this occurs, the egg may implant in the tube; this is called an ectopic or tubal pregnancy.Local infection of glands near to the vulva can gives rise to a bartholinitis or skenitis, a analogous circumstance nearst to the urethra. Extend of infection internally can give rise to endometritis, followed by involvement of the fallopian tubes, salpingitis and into the pelvis to give pelvic peritonitis. Spread of infection inwards can give rise to Fitzhugh-Curtis syndrome, a state in which the lining exrerior the liver becomes inflamed.
Gonorrhoea can develop via the blood stream to almost all human systems. Germs can spread to the integument, where little pustules appear which may have slightly bleeding in them, and the joints which are inflamed but seldom severely damaged. The urethra and bladder can as well become infected by bacteria, causing painful urination. Patients with gonorrheal infection can also experience it in the rectum, even though they have not received anal sexual intercourse. For both genuses, gonorrheal infection in the anal part obtained through receptive anal intercourse can cause rectal discharge, bleeding, pain, itching or no symptoms at all. Gonorrhea in the throat can be acquired if a individual does oral sex on a partner who has gonorrhea. Rarely gonorrhea may immigrate to the heart, causing endocarditis, or in the lining of the spinal cord and brain, causing meningitis. One important fact is that having gonorrhea gives a person a high risk of contracting HIV. Furthermore, a patient who has HIV and gonorrhea is more likely to remove HIV to another individual than is a person who has only HIV.
A woman who is infected with gonorrhea can transfer the infection to her child within its passage through the birth canal at the period of delivery. This can result in blindness, joint infection, or a serious blood infection in the infant. Immediately later then a infant is born to a mother who has gonorrhea, the midwife or doctor can prevent eye infection by putting special kind of medication into the child’s eyes.
Explanation of some gonorrhea Complication
Gonorrheal sepsis is a serious infection of blood which can spread the bacteria through the blood stream into the many organs. Myriad cases of gonorrheal septicemia have been developed in adults. Among children and infants such cases occur but are uncommon. The bacteria can spread throughout the body and it can lead to serious complications that affect every port of body, as a result appear some symptoms such as fever, irritability, lethargy, rash, decreased amount of urine, rapid or difficulty breathing, change in skin color, rapid heart rate. The symptoms quickly develop to shock with hypothermia, decreasing blood pressure, changes in mental status, also it can even cause death. Typically, septicemia is a medical emergency that necessitates quickly medical concentration. In all cases, the infection is treated with broad spectrum of antibiotics.
Between men gonorrhea causes a medical condition called epididymitis in which there is inflammation of the epididymis .This state of health is a painful condition of the testicles and it may be acute or chronic. Epididymitis is caused by extend of neisseria gonorrhea or other infection from the urethra or the bladder. Symptoms of epididymitis may begin with a low-grade fever and include the following: urethral discharge, nausea, scrotal pain and edema, abdominal or flank pain, urinary frequency or dysuria. Signs of infection may follow sexual activity, trauma or physical strain. Therapy is by antibacterial antibiotics, and as an attachment to treatment bed rest, pain relief, and scrotal elevation are recommended.
A patient who becomes infected with gonorrhea but does not take complete therapy can develop arthritis that is a group of conditions involving injury to the joints. Bacteria are carried by the bloodstream from an infectious point to the joint tissue. In this case for gonococcal diagnosis a healthcare provider with a syringe removes liquid from the joint to analyze it. The joint discomfort of arthritis can emerge as knee pain, hip pain, wrist pain or hand pain, as well as symptoms can include fever, chills, skin rash, inflammation of joint, tenderness in the joint and loss of range of motion in the joint. Treatment of gonococcal joint infections ordinary requires intramuscular, intravenous and sometimes oral antibiotics. Physical therapy may also include a consultation for relieving pain or stiffness.
Pelvic Inflammatory Disease
Neisseria gonorrhea moves up from a woman’s vagina, infecting her womb, tubes and ovaries. Pelvic Inflammatory Disease (PID) is a progressive process and infection, which can evolve in significant harm to a woman’s reproductive structure. PID takes place in the ovaries, fallopian tubes, uterus, upper genital tract, and throughout the pelvic area. It can result in abnormal or unusual vaginal discharge or bleeding, fever, chronic pain, sterility, ectopic pregnancy, irregular periods, and pain during urination. Infection-causing Neisseria gonorrhea can slowly and silently overrun the fallopian tubes, reasoning normal tissue to become changed into scar tissue. The scar tissue obstructs the normal transportation of eggs into the uterus. On condition that the fallopian tubes are entirely obstructed by scar tissue, spermatozoid cannot fertilize an egg, and the woman becomes sterile. PID can be cured with antibiotics. A majority of women are cured as out patient; on the other hand, up to 25% of women will be treated in the medical center. Hospitalization may be necessitated for women who are very sick, are pregnant, did not respond to antibiotics, or have an abscess.
Meningitis is an inflammation of the meninges, the membranes that protects the brain and spinal cord. Gonorrheal meningitis is recognized as among the rare complications of gonorrhea. They can break through the body’s immune defenses and immigrate to the liquid encircling the brain and spinal cord. Classic symptoms (very stiff, sore neck, pain in head, high fever) can progress over several hours, or one to two days. Other symptoms may include: cyanosis, vomiting, mental confusion, red or purple skin rash, nausea, vomiting, and photophobia. Individuals with Gonorrheal meningitis are commonly hospitalized and remedied with antibiotics intravenously.
Prostatitis is a condition that causes inflammation of the prostate that prepares ingredients of semen, the fluid that aids support and translocation of sperm material. Chronic gonococcal prostatitis, occurs when neisseria gonorrhea achieves an area on the prostate where they can exist. The infection can spread to the prostate directly from an adjacent organ or through the blood stream. Twenty-five percent of all males who have urinary difficulties have prostatitis. Symptoms include: soreness with ejaculation, burning on urination, unpleasantness in the pelvic area, and more frequent urination. Patients with acute bacterial prostatitis may have: chills, fever, and shake. Chronic gonococcal prostatitis treatment is with long-term antibiotics. Even with proper therapy, the chronic prostatitis can reappear. Usually treatment for acute gonococcal prostatitis is a prescription for antibiotics by mouth. Home care includes drinking plainly of fluids and medications for pain control.
An ectopic pregnancy is a gestation that occurs out side of a woman’s uterus. This develops when the fertilized egg from the ovary does not implant itself typically in the womb, and it develops in the other location in the abdomen. An inflammation or infection or of the tube may have slightly or completely obstructed it. Pelvic inflammatory disease (see: PID), which can be caused by gonorrhea, is one of the common causes of obstruction of the fallopian tube. In this case the most common symptoms include: feeling faint, vomiting, pain when urinating, one-sided pain in the lower abdomen, vaginal bleeding, and shoulder-tip pain. Provided an ectopic is detected, the surgeon can remove this operating the laparoscope to cut the tube and eliminate the pregnancy, leaving the tube intier. On condition that the tube has ruptured, every so often abdominal surgery is required rather than laparoscopic surgery to remove the pregnancy and tubal injury. In some condition the health providers terminate the pregnancy by some kind of medicine. In all case antibacterial therapy is required.
Ophthalmia neonatorum, also known as neonatal conjunctivitis, is a variety of conjunctivitis. This sort of conjunctivitis is develops in the first 28 days of baby’s life. It is most frequently infective in source neisseria gonorrhea, and the other kind of microorganisms. This disease can lead to some other complications such as superior corneal pannus, keratitis, and conjunctival scarring. The most common symptoms are redness and swelling of the conjunctiva in the newborn. Ophthalmia neonatorum due to gonococci typically appears in the first five days of life and is characterized with marked tow side discharge. It is standard in hospitals to give infants antibiotic eye drops instantly following delivery. This supports prevent the expansion of an eye infection. In some cases where gonococcal conjunctivitis does develop, the treatment due to bacteria are given antibiotics (topical eye drops, orally, or as an injection).
The other Complication of Gonorrhea includes:
• Urethritis- is defined as infection-induced inflammation of the urethra.
• Vaginitis- is described medically as irritation and/or inflammation of the vagina.
• Conjunctivitis- is any inflammatory process that involves the conjunctiva.
• Pharyngitis- is a sore throat caused by inflammation of the back of the throat
• Cervicitis- is an infection in the cervix or the opening of the womb
• Perihepatitis- is inflammation of the peritoneal coat of the liver and the surrounding tissue.
• Bartholinitis- is an inflammatory condition of one or both Bartholin’s glands,
• Dermatitis- is a blanket term meaning any “inflammation of the skin”
• Endocarditis- is an infection of the inner lining of your heart (endocardium).
• Pneumonia- is an infection of one or both lungs
• Ophthalmia (also called Ophthalmitis)- is inflammation of the eye.
• Endometritis- is inflammation of the endometrium, the inner lining of the uterus.
Treatment of chronic Gonerrhea
Treatment of gonorrhea depends on condition of patient, duration of disease and antibacterial resistance of germ; however, a number of antibiotics can positively treat gonorrhea in first stage of disease. On the other hand, drug-resistant strains of gonorrhea are extending in many countries, and successful cure of gonorrhea is becoming more complicated, in view of the fact that majority of patients with gonorrhea also have another kind of sexually transmitted diseases or an untreated chronic infection sickness. People who have had gonorrhea and have been treated can get the infection again if they have sexual contact with infected persons.