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Sexually Transmitted Disease: Gonorrhea

Gonorrhea is a sexually transmitted infection that has existed for centuries and remains a common infection. In 2018, the United States recorded about 1.6 million new gonorrhea infections (CDC, 2022). More than half of these infections are among individuals aged between 15 and 24.  Gonorrhea ranks second as the most prevalent bacterial sexually transmitted infection in the U.S. Although contemporary antibiotics manage the condition, Gonorrhea has developed resistance to antimicrobials. Increased resistance and limited pipeline for developing new antimicrobial has undermined therapy for the disease, making gonorrhea a public health threat. Thus, the paper focuses on the pathophysiology, etiology, clinical manifestation, and treatment of gonorrhea.

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Pathophysiology of Gonorrhea

Gonorrhea infection commences with gonococci (the agent causing the infection) attaching to the epithelial cells, resulting in the cellular invasion. The infectious agent gonococci (N.gonorrhoeae) use pili (hair-like appendages) to attach to the epithelial cells. The pili cover the bacterial surfaces, and their retracting and expanding ability permits the bacteria to attach to the epithelial cells regardless of the distance (Springer & Salen, 2022). As a result, the pili promotes cellular invasion and provide the bacteria with protection and motility. Surface proteins like LOS (lipooligosaccharide), opacity-associated proteins, and Opa promote cellular attachment. LOS adhesion to the sperm cells contributes to gonorrhea infection in uninfected sexual partners from males. N. gonorrhoeae also invades the cervical epithelium. The bacterial cells interact with host cell CR3 (complement receptors type 3). The invasion is triggered when pili bind to CR3, causing the host cell to rearrange. The outcome is the emergence of ruffles, large projections that permit gonococci to invade the host cells and multiply within the invaded cells (Springer & Salen, 2022). Neisseria gonorrhoeae infects the anus, pharynx, cervix or urethra in adults and affects the newborns’ pharynx or eye conjunctiva. 

The Etiology of Gonorrhea

N. gonorrhoeae pathogen infects humans and manifests in women as cervicitis and urethritis in men. N. gonorrhoeae as an obligate pathogen must manifest illness to enhance transmission from one person to the other. The bacteria’s survival depends on its ability to infect a host because surviving outside a host is impossible. Untreated/undiagnosed gonorrheal urogenital infections cause adverse reproductive complications like infertility, pelvic inflammatory disease, endometritis, ectopic pregnancy, and life-threatening morbidity (Hill, Masters, & Wachter, 2016). Gonorrhea infection undermines a person’s immunity, leading to repeated infection. Therefore, seeking early treatment is recommended to avoid severe complications.

The Clinical Manifestations of Gonorrhea

Gonorrhea remains asymptomatic in men.  However, infected men may present with urethral infection symptoms like green/white/yellow urethral discharge or dysuria one day to a week following the infection.  Some men may also complain of scrotal or testicular pain (CDC, 2022). The presence of infections like urethritis and epididymitis may confirm gonorrhea infection in men. Women infected with gonorrhea may also be asymptomatic. Sometimes, the symptoms are nonspecific and mild and healthcare providers tend to mistake them of vagina or bladder infections. Nonetheless, the initial signs and symptoms of gonorrhea infection in women include vaginal bleeding, increased vaginal discharge, or dysuria (CDC, 2022). Women are vulnerable to developing severe complications regardless of the severity of symptoms.  Other clinical manifestation of gonorrhea in women includes cervicitis, urethritis, pelvic inflammatory disease, and pregnancy complications. Clinical manifestations present in both men and women include rectal infections like painful bowel movements, bleeding, soreness, anal itching, or discharge. 

Gonorrhea Treatment

Gonorrhea is treatable with appropriate therapy. CDC (2022) recommends gonorrhea treatment using a single 500mg intravenous or intramuscular dose of ceftriaxone. The dose can be taken with 100mg of doxycycline twice a day orally for a week. However, these prescriptions stop the infection without repairing any permanent damage caused by gonorrhea.  The healthcare sector worries about unsuccessful gonorrhea treatment due to antimicrobial resistance (Hill, Masters, & Wachter, 2016).  As