Gonorrhea

The gonorrhea (from the medieval Latin gonorrhoea, derived from the Greek γονόρροια [gonórrhoia], "flow of semen"),, also Known as gonorrhea, gonorrhea or gonorrhea, it is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae or gonococcus, whose specific host is humans. It mainly affects the mucous membranes of the genital and urinary tracts, but it can also affect the ocular conjunctiva, pharynx, and rectum. Its most common characteristics are purulent discharge from the urethra in men and the consequence of infertility in both sexes.

History

Gonorrhea has been recognized and described since Antiquity, where it is mentioned in Egyptian papyri, and it is known that in the third millennium BC it was already causing havoc in Asia. Hippocrates diagrammed gonococcal infection by dissecting the urethra of men who were infected with this agent and noted changes in epithelial tissue, discharge, and a urethral stenosis (narrowing) that often accompanies untreated disease.

In the year 130 AD. C., Galen established the term gonorrhea, from the ancient Greek γονόρροια, ("gonórrhoia"), a compound form of γόνος ("gonos": seed, genitals) and ῥέω, ("rhêo": flow); that is, "seed flow", or seminal flow, due to the mistaken impression of considering the purulent discharge that comes out through the urethra as spermatorrhea.

Neisseria gonorrhoeae, the organism that causes the disease, was discovered by the German physician Albert Neisser (hence its name) in 1879.

Epidemiology

The World Health Organization (WHO) estimates that there are 106 million new cases in the world every year. In the United States of America, gonorrhea has been one of the most common communicable diseases since 1965. In that country, the incidence of infections caused by N. gonorrhoeae is approximately 375 cases per 100,000 population. In Mexico, the incidence decreased in the second half of the XX century, from 213 cases per 100,000 inhabitants in 1941 to 20 cases on the same denominator in 1989. In the 1990s, the trend in Mexico remained downward, with an incidence in 1995 and 1996 of 8.8 and 13.7 per 100,000 inhabitants, respectively.

Etiology

Gonorrhea is caused by a bacterium called Neisseria gonorrhoeae, or gonococcus. This bacterium is a Gram-negative diplococcus, between 0.6 and 0.8 microns in diameter, not flagellated, without a capsule, whose external surface is composed of fimbriae consisting of long hairs called pili. Under the microscope it appears as two kidney-shaped or coffee-bean structures, joined by the concavity in adjacent pairs. The gonococcus is a microorganism that is labile to heat, refrigeration, and various antiseptics. It is sensitive to drying out and has little resistance to air (one or two hours).

Transmission can occur during sexual intercourse, during childbirth (if the mother is infected), or by contamination by carrying infected secretions from one mucosa to another.

Pathogenesis

Neisseria gonorrhoeae

The first places that the bacteria affect are the columnar epithelium of the urethra and endocervix. The rectum, pharynx, and conjunctiva of the eyes may also be infected. The vulva and vagina of women are usually also affected, since they are bound up with epithelial cells. In women, the cervix is usually the first infected site.

Clinical picture

Although some carriers of gonorrhea may not have any symptoms, they can still transmit the infection to others. The clinical picture varies depending on the gender of the carrier.

In the male

Symptoms in men usually appear between 2 and 21 days after contracting the disease. Among the most common is the urethral discharge of a mucous nature and whitish, clear, purulent, thick and yellowish tone released by the penis. It can also manifest as pain when urinating, experiencing a stinging or burning sensation from the urethra. Testicular pain and inflammation are quite common in gonorrhea.

Neisseria gonorrhoeae can cause other secondary complications such as urethritis and prostatitis. Very rarely, this bacterial infection manifests as asymptomatically in men, with almost all being symptomatic at first, although at first it can be confused with another type of urogenital pathology.

In women

In women, the infection is usually asymptomatic. However, signs and symptoms such as vaginal discharge, increased urination, and urinary discomfort (dysuria) may occur. The spread of the germ into the fallopian tubes can cause pain in the lower abdomen, cramping, fever, nausea, and generalized symptoms of a bacterial infection.

It also causes diseases such as vaginitis and cervicitis, but also endometritis, salpingitis and pelvic inflammatory disease (PID). Characterized by redness in the genital area. The immune system has serious problems killing Neisseria gonorrhoeae, since it has fibers with a high rate of antigenic variation. It can be a cause of sterility and blindness in the newborn.

Consequences

• It can cause damage to reproductive organs.
• Both men and women may be sterile. In women it produces inflammatory pelvic disease (EPI) that causes infertility. In men with epididymitis, the transport of sperm may also be affected.
• A mother who has gonorrhea can contaminate her baby during childbirth by causing blindness.
• It can cause damage to the penis, skin diseases, articulations with arthritis. There is an immune disorder that triggers the bacteria that affects the eyes with conjunctivitis or uveitis, joints (reactive arthritis) and genitourinarias (uretritis or cervicitis).
• Yellow or white thick secretion of the vagina.
• Burn or pain when urinating.
• Abnormal menstruation or loss of vaginal blood between menstruations.
• Skulls and burning in the lower abdomen.
• It produces inflammation and obstruction of the tubes or abscesses (pus clusters) in the ovaries.
• In man infections in the urethra, prostate, seminal vesicles and epididym.

Complications

When gonorrhea is left untreated, it can cause serious and permanent health problems in both men and women, who can be infertile if they have gonorrhea complicated by epididymitis in men, or salpingitis or pelvic disease inflammatory in the case of women.

If gonorrhea is left untreated, it can spread to the blood and joints and can even cause death.

Treatment

Gonorrhea (Neisseria gonorrhoeae) is sensitive to a wide range of antibiotics, but is capable of developing resistance against some of them. Many strains are resistant to penicillin. However, before the appearance of the resistant strains, it was very sensitive to this antibiotic, which is surprising given that they are gram-negative bacteria. Currently, the use of third-generation cephalosporins such as ceftriaxone is effective in the treatment of gonorrhea, which is administered intramuscularly at a dose of 250 mg in a single injection; Azithromycin (Zithromax), 2 g as a single dose, may be used for people who have severe allergic reactions to ceftriaxone, cefixime, or penicillin. There are also strains of N. gonorrhoeae resistant to azithromycin.

The sexual partners of the infected person should receive antibiotic treatment as well. In addition, other STIs should be screened in the patient and in their sexual partners.

Cephalosporin is also usually associated with a macrolide, such as azithromycin, due to the frequent co-infection with Chlamydia trachomatis, which causes a picture similar to gonococcal infection, generally two weeks after initiation the picture, whose urethral excretion does not usually have an unpleasant odor, and with a negative Gram test.

Fluoroquinolones, ciprofloxacin, ofloxacin, norfloxacin and levofloxacin are not recommended in the patient group that includes men who have sex with other men and in case of resistance to these drugs, the Centers for Disease Control and Prevention of the United States recommends the use of cephalosporins in conjunction with tetracyclines. As of 2007, there have been no new treatment options for antibiotic-resistant species beyond cephalosporins.

In 2011, scientists in Japan and Sweden managed to isolate a new strain, called H041, that can cause this disease. The team's analysis of the strain revealed that it is extremely resistant to all cephalosporin-type antibiotics, the last remaining effective drugs for treating gonorrhea.