Can You Contract Gonorrhea Without Symptoms? Key Insights and FAQs - Internal Medicine

Dr. Liao Zhongxin reply Internal Medicine

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Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae, which is also known as gonococcus.
It is a common issue among young populations, alongside genital warts (commonly referred to as "cauliflower") and syphilis.
According to the World Health Organization's global infectious disease surveillance data, there were approximately 78.3 million new cases of gonorrhea reported in 2015.
In Taiwan, the severity of gonorrhea is evident from the Taiwan Centers for Disease Control reports, which indicated 3,587 cases in 2015 and 4,469 cases in 2016, showing a rising trend.
However, this does not mean that only a few thousand people are infected each year, as there may be many unreported or undiagnosed cases.
Gonorrhea is a sexually transmitted disease that many patients find difficult to discuss or are embarrassed to seek treatment for.
However, individuals with gonorrhea have a higher likelihood of being co-infected with syphilis or HIV.
Early detection can help identify other hidden sexually transmitted infections.
If left untreated, gonorrhea can lead to infertility, permanently affecting a patient's reproductive capabilities.
What is gonorrhea, and how is it contracted? Gonorrhea is caused by infection with Neisseria gonorrhoeae, a Gram-negative bacterium discovered in 1879 by German physician Albert Neisser.
Certain groups are particularly at risk for gonorrhea, including those who have recently had new sexual partners, multiple partners, are unmarried, are young, abuse substances, or have a history of gonorrhea.
These high-risk groups are understandable, as gonorrhea is a sexually transmitted infection, and sexually active young people or those with multiple partners naturally face higher risks.
Substance abusers often engage in more complex sexual behaviors and risky practices, increasing their susceptibility to gonorrhea, syphilis, HIV, and other STIs.
According to the Taiwan Centers for Disease Control, the most common age group for gonorrhea in Taiwan is 25-39 years, with a male-to-female ratio of approximately 13:1.
However, the actual number of infected women may be underestimated, as many female cases present with mild or no symptoms, often mistaken for normal physiological changes.
Recent statistics indicate a rising trend in new cases among young women, which should not be overlooked.
Epidemiologically, gonorrhea is strongly associated with HIV.
Individuals with gonorrhea often exhibit higher rates of risky sexual behavior, which is a known risk factor for HIV infection.
Additionally, gonorrhea can cause mucosal damage, making it easier for HIV to spread and infect.
Conversely, individuals infected with HIV are also more susceptible to gonorrhea.
What are the symptoms of gonorrhea? Gonorrhea primarily spreads through sexual contact and contact with infected mucosal secretions.
Infants can contract gonorrhea during childbirth, leading to conjunctivitis.
Gonorrhea can infect mucosal tissues in the urethra, vagina, anus, and even the oral and pharyngeal mucosa.
Symptoms typically appear 2-7 days after exposure and can differ between genders.
Common symptoms of gonorrhea in men include:
- Urethral discharge (thick white or yellow pus)
- Pain or burning sensation during urination
- Itching or discharge from the anus (in those who engage in anal intercourse)
The aforementioned urethral discharge and painful urination are classic symptoms of gonococcal urethritis.
Some patients describe the discharge as resembling a runny nose.
In more severe cases, the infection can lead to complications such as seminal vesiculitis, epididymitis, and prostatitis, potentially resulting in infertility or urethral stricture due to recurrent inflammation.
Common symptoms of gonorrhea in women include:
- Increased vaginal discharge
- Changes in the color of vaginal discharge
- Vaginitis
- Urethritis
- Cervicitis
In many women, gonorrhea symptoms may be subtle, leading to the disease being overlooked.
Severe infections can progress from urethritis to cystitis, resulting in frequent urination and burning sensations.
In some cases, the infection can ascend from the vagina and cervix to the uterus, fallopian tubes, and even the entire pelvic cavity, causing endometritis, salpingitis, or severe pelvic inflammatory disease.
In the most severe cases, this can lead to infertility, ectopic pregnancy, or chronic pelvic inflammatory disease.
Additionally, women with gonorrhea can transmit the infection to their newborns during delivery, potentially causing gonococcal conjunctivitis, which can lead to blindness if not treated appropriately.
Gonorrhea infection is not limited to the urinary tract; in severe cases, it can spread to the bloodstream, leading to conditions such as purulent arthritis, endocarditis, or even meningitis.
Therefore, if you suspect a gonorrhea infection, it is a mistake to think it is just painful urination.
Anyone experiencing symptoms should seek medical assistance rather than relying on faith or self-treatment.
During diagnosis, healthcare providers may inquire about medical history and conduct physical examinations to assess the possibility of gonorrhea infection.
They will collect secretions or urine for bacterial culture and microscopic examination.
If there is a risk of gonorrhea infection, healthcare providers typically recommend screening for other STIs as well.
How is gonorrhea treated and prevented? The standard treatment for gonorrhea involves antibiotics.
Initially, penicillin was the treatment of choice; however, due to significant antibiotic resistance in domestic strains of Neisseria gonorrhoeae, treatment options now require careful evaluation and experience from healthcare providers.
Both oral and injectable antibiotics are available as treatment options.
It is crucial to adhere to the prescribed treatment regimen; once antibiotic therapy begins, patients should not discontinue medication on their own, as this can lead to treatment failure and the development of resistant strains, complicating future treatment.
Currently, there are cases of "super gonorrhea," which refers to strains of gonorrhea that exhibit extensive antibiotic resistance, making suitable antibiotic treatment difficult to find.
Therefore, it is essential to follow healthcare providers' instructions and never stop medication prematurely.
Another key aspect of gonorrhea treatment is to ensure that sexual partners are treated simultaneously.
Gonorrhea is transmissible between partners, and after treatment, individuals are not immune and can be reinfected.
It is vital for both partners to undergo treatment together to prevent a cycle of reinfection.
During treatment, gonorrhea remains contagious, so sexual activity should be avoided.
How can gonorrhea be prevented? Here are some preventive measures to consider in daily life:
- Avoid sexual contact with partners of unknown sexual history.
- Do not participate in sex parties or have multiple sexual partners.
- Avoid using addictive substances that may lead to risky sexual behavior.
- Always use condoms during sexual activity, along with water-based lubricants.
- Avoid sharing sex toys.
- Clean the genital and perineal areas after intercourse.
- Drink plenty of water and urinate after intercourse.
The fundamental principles are to "avoid risky sexual behavior" and "reduce the likelihood of exposure to infections." By adhering to these two principles, individuals can minimize their risk of infection.
With the increasing use of sex toys, it is advisable to use them individually rather than sharing them with others.

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Reply Date: 2023/07/23