Can You Get Gonorrhea Without Symptoms? Key Facts and Insights - 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, along with genital warts (commonly referred to as "cauliflower") and syphilis.
According to the World Health Organization's global surveillance data on infectious diseases, there were approximately 78.3 million new cases of gonorrhea reported in 2015.
In Taiwan, the situation is concerning; the Centers for Disease Control reported 3,587 cases in 2015 and 4,469 cases in 2016, indicating 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 co-infection 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 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 individuals with multiple partners are naturally at higher risk.
Substance abusers often engage in more complex sexual behaviors and risky practices, increasing their risk for gonorrhea and other STIs, including syphilis and HIV.
According to the CDC data, the most common age range 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 has a strong association with HIV.
Individuals with gonorrhea often exhibit higher rates of risky sexual behavior, which is a 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 the mucous membranes of an infected person.
Infants can contract gonorrhea during childbirth, leading to conjunctivitis.
Gonorrhea can infect mucosal tissues in the urethra, vagina, anus, and even the oral cavity and throat.
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 discharge)
- Pain or burning sensation during urination
- Itching or discharge from the anus (in those who have engaged in anal intercourse)
The aforementioned urethral discharge and painful urination are classic symptoms of gonococcal urethritis.
Some patients describe the discharge as resembling nasal mucus.
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 are not obvious, which can lead to the disease being overlooked.
Severe infections may 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, leading to endometritis, salpingitis, or severe pelvic inflammatory disease.
In the worst cases, this can result in infertility, ectopic pregnancy, or chronic pelvic inflammatory disease.
Additionally, women with gonorrhea can transmit the infection to their infants during childbirth, 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, causing septic arthritis, endocarditis, or even meningitis.
Therefore, if you suspect a gonorrhea infection, it is a mistake to think it only causes painful urination.
If you experience any symptoms of infection, you should seek medical assistance rather than relying on faith for healing.
During diagnosis, a physician may assess the possibility of gonorrhea infection through medical history and physical examination, followed by collecting samples for bacterial culture and microscopic examination.
If there is a risk of gonorrhea infection, the physician will typically recommend screening for other STIs as well.
How is gonorrhea treated and prevented? The standard treatment for gonorrhea involves antibiotics.
Historically, penicillin was the treatment of choice, but due to the emergence of antibiotic-resistant strains of Neisseria gonorrhoeae, the choice of antibiotics now requires careful evaluation and experience from the physician.
Treatment options range from oral antibiotics to injectable forms.
It is crucial to adhere to the physician's treatment plan; once antibiotic therapy begins, it should not be discontinued prematurely, as this can lead to treatment failure and the development of resistant strains, complicating future treatment.
Currently, there are cases of "super gonorrhea," where strains of gonorrhea exhibit extensive antibiotic resistance, making it challenging to find effective treatments.
Therefore, it is essential to follow the physician's instructions and not stop medication on your own.
Another key point in treating gonorrhea is to ensure that both partners receive treatment.
Gonorrhea is transmissible between partners, and after treatment, individuals are not immune and can be reinfected.
It is vital that both partners are treated simultaneously to prevent a cycle of reinfection.
During treatment, gonorrhea remains contagious, so sexual activity should be avoided.
How can gonorrhea be prevented? Here are several recommendations for preventing gonorrhea in daily life:
- Avoid sexual contact with partners of unknown sexual history.
- Do not participate in sex parties or have multiple sexual partners.
- Avoid substance abuse to prevent engaging in risky sexual behaviors.
- Always use condoms during sexual activity, preferably with water-based lubricants.
- Avoid sharing sex toys.
- Clean the genital area 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 infection." By adhering to these two principles, you can minimize your risk of infection.
The use of sex toys is becoming increasingly common; it is best to use these personal items individually rather than sharing them with others.

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Reply Date: 2023/07/25