Gonorea

Gejala Penyakit

Organ wanita yang boleh dijangkiti gonorea ialah seperti saluran kencing, serviks, rahim, tiub fallopia, kelenjar kemaluan seperti kelenjar Bartholin (yang terdapat di bibir kemaluan), kelenjar Skene's (yang terdapat di bahagian bawah lubang saluran kencing). Bagi lelaki pula, saluran kencing, epididimis (sebahagian daripada testis) dan kelenjar Cowper's mungkin dijangkiti. Selain membabitkan permukaan mukosa yang wujud pada saluran kemaluan dan organ reproduktif, jangkitan juga boleh membabitkan permukaan mukosa yang ada pada dubur, rektum, mulut, tekak dan mata.
Penyakit gonorea ini dijangkiti melalui hubungan kelamin dan risiko jangkitan daripada satu hubungan kelamin dengan seorang yang dijangkiti gonorea ialah antara 30 dan 70 peratus. Bayi juga boleh dijangkiti apabila dilahirkan oleh seorang ibu yang berpenyakit gonorea. Kira-kira 30 peratus daripada bayi ini akan mendapat permasalahan sakit mata (bertahi mata) pada minggu pertama selepas dilahirkan.

Simptom bagi lelaki

Keluar cairan (discharge) daripada saluran kencing lelaki. Lazimnya keadaan ini berlaku 3 hingga 10 hari selepas bersetubuh dengan wanita yang berpenyakit gonorea. Kadangkala pesakit berasa kesakitan sewaktu membuang air kecil. Sebahagian kecil (15 peratus) daripada lelaki tidak mempunyai sebarang tanda jangkitan. Perlu diingatkan bahawa lelaki dan wanita berpenyakit gonorea yang belum dirawat boleh merebakkan penyakit ini kepada wanita yang disetubuhi termasuklah isterinya sendiri.

Simptom bagi wanita

Tidak ada sebarang tanda yang khusus menandakan penyakit gonorea ini. Cairan yang keluar daripada faraj perlu dipastikan mengandungi organisma N gonorrhoeae sebelum membuat diagnosa dan memberikan rawatannya.
Sejarah hubungan kelamin yang dilakukan oleh seseorang yang dijangkiti penyakit gonorea perlu dijejaki supaya penyakit dapat dirawat dan dihalang daripada merebak. Apa yang lebih penting ialah untuk mengamalkan gaya hidup sihat, iaitu tidak mengadakan hubungan seks secara haram dan rambang.

Pandangan Agama

Langkah dianjurkan oleh Islam ialah langkah mencegah kerana ia jauh lebih baik daripada usaha memperbaiki atau mengatasi masalah yang timbul akibat gejala sosial ini. Marilah kita renungkan dan ambil pengajaran daripada hadis dikemukakan.
Hadis diriwayatkan oleh Ibnu Majah yang bermaksud:
Sabda Rasullulah saw: "Hai golongan Muhajirin! Ada lima perkara jika kamu ditimpa atau ia berlaku di lingkungan kamu - saya berlindung kepada Allah apabila hal itu wujud di antara kamu. Apabila pada satu kaum bercabul perzinaan sampai mereka melakukannya secara terang- terangan, maka mereka akan diserang oleh penyakit yang belum pernah dialami nenek moyang mereka."
(Catatan penulis: Contoh penyakit yang ada akibat gejala ini ialah wabak sifilis ketika "medieval ages" dan sekarang pula timbul penyakit HIV/ AIDS yang masih tidak mempunyai ubat pencegah atau rawatan untuk pulih.)
"Apabila mereka mengurangi timbangan dan takaran, mereka akan dihukum dengan kepapaan dan kemiskinan serta kezaliman daripada pihak berkuasa.
"Setiap mereka enggan membayar zakat harta mereka, mereka akan terhalang beroleh hujan dari langit dan jika tidaklah kerana haiwan ternak, tidaklah mereka akan pernah diberi hujan.
"Sekiranya setiap mereka melanggar janji Allah dan janji Rasul-Nya, mereka akan dijajah oleh musuh daripada bangsa lain yang akan merampas sebahagian kekayaan mereka dan selama pemimpin mereka tidak menjalankan hukum yang ada dalam Kitabullah, maka saling sengketa akan berkobar di antara mereka."
Gonorrhea (gonorrhoea in British English)
 is among the most common  sexually-transmitted diseases in the world and is caused by Gram-negative bacterium Neisseria gonorrheae. The term comes from Greek γονόρροια (gonórrhoia), literally "flow of seed"; in ancient times it was thought that the pus discharge associated with the disease contained semen.
Infection with gonorrhea increases the risk of passing on or becoming infected with HIV (the virus that causes AIDS). This is likely due to weakening of the mucosal surface secondary to the gonorrhea infection.  Gonorrhea might also increase the amount of HIV present in semen and other genital secretions. Note, however, that this effect is by no means limited to gonorrhea and there is increased risk of HIV transmission with co-infection of most sexually-transmitted infections.
The first place this bacterium infects is usually the columnar epithelium of the urethra and endocervix. Non-genital sites in which it thrives are in the rectum, the oropharynx and the conjunctivae of the eyes. The vulva and vagina in women are usually spared because they are lined by stratified epithelial cells — in women the cervix is the usual first site of infection.  
Gonorrhea spreads during sexual intercourse, whereby the infective partner does not need to be human. Infected women also can pass gonorrhea to their newborn infants during delivery, causing eye infections (conjunctivitis) in their babies (which if left untreated, can cause blindness).  Gonorrhea among females can also be transmitted from one individual to another via contact to surfaces that may still be damp from prior contact.

Epidemiology

In 2000, 358,995 cases of gonorrhea were reported to the U.S. Centers for Disease Control and Prevention(CDC). In the United States, approximately 75 percent of all reported cases of gonorrhea are found in younger persons aged 15 to 29 years. The highest rates of infection are usually found in 15- to 19-year old women and 20- to 24-year-old men. Health economists estimate that the annual cost of gonorrhea and its complications is close to $1.1 billion. The disease can spread into the uterus and Fallopian tubes, resulting in pelvic inflammatory disease (PID).  PID affects more than 1 million women in the United States (US) every year and can cause infertility in as many as 10 percent of infected women.

Vertical transmission

Pregnant mothers infected with gonorrhea, can transmit the disease to their babies during childbirth. Gonococcal conjunctivitis is a major preventable cause of blindness in newborns, so if there is a known risk of transmitting gonorrhea, prophylactic silver nitrate or other medications may be applied to the baby's eyes immediately after birth. Because of the risks of vertical transmission, doctors recommend that pregnant women have at least one test for gonorrhea during pregnancy.

Women

Between 30-60% of women with gonorrhea are asymptomatic or have subclinical disease. The woman may complain of vaginal discharge, difficulty urinating (dysuria), off-cycle menstrual bleeding, or bleeding after sexual intercourse. The cervix may appear anywhere from normal to the extreme of marked cervical inflammation (cervicitis) with pus.  Infection of the urethra (urethritis) causes little dysuria or pus. The combination of urethritis and cervicitis on examination strongly supports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients.
More advanced symptoms, which may indicate development of pelvic inflammatory disease (PID), include cramps and pain, bleeding between menstrual periods, vomiting, or fever.

Men

It is not unusual for men to have asymptomatic gonorrhea.  Men may complain of pain on urinating and thick, copious, urethral pus discharge (also known as gleet) is the most common presentation. Examination may show a reddened external urethral meatus.  Ascending infection may involve the epididymis, testicles or prostate gland causing symptoms such as scrotal pain or swelling.
The fact sheet from the Centers for Disease Control (CDC) states, "Many men with gonorrhea may have no symptoms at all, some men have some signs or symptoms that appear two to five days after infection; symptoms can take as long as 30 days to appear. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles."

Rectal gonorrhea

Rectal gonorrhea (gonococcal proctitis) may affect both men and women and is often asymptomatic.  It may present with anal discharge, pain on defecating and rectal bleeding.  Proctoscopy may show an inflamed mucous membrane with little mucus.  Rectal infection also may cause no symptoms.  It is transmitted by penetrative anal sex and is diagnosed on rectal swab.  It cannot be treated with penicillin because rectal commensal bacteria in the rectum produce β-lactamase that protects the gonococcus from penicillin.

Gonococcal pharyngitis

Infections of the throat are usually asymptomatic, but in some cases may cause a sore throat. This condition is diagnosed by a throat culture, utilizing a cotton swab; most cases of gonoccal pharyngitis are caused by oral sex with a partner infected with gonorrhea.

Complications

In men, inflammation of the epididymis (epididymitis), prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea. 
In women, untreated gonorrhea can result in cyst and abscess formation in one or more of the greater vestibular glands (bartholinitis), causing trouble walking; PID; and Fitz-Hugh-Curtis syndrome.
The most common result of untreated gonorrhea is PID, a serious infection of the female reproductive tract. PID causes scarring of the fallopian tubes which leads to increased risks of causing an ectopic pregnancy as a fertilized egg may not be able to pass through the narrowed, scarred fallopian tube. Ectopic pregnancies are serious conditions which are potentially life-threatening to the mother.
In both sexes, disseminated gonococcal infection (DGI) can occur, leading to multiple distant sites of infection which can include the brain, heart and joints.
When joints become involved, gonococcal arthritis can develop.  Gonococcal arthritis occurs after primary infection of the genitalia, anus, or throat.  This occurs in about 1% of patients who are infected with gonorrhea and is more common in women than men.  Typical symptoms include a 5-7 day history of fever, shaking, chills, multiple skin lesions, fleeting migratory polyarthralgias and tenosynovitis in fingers, wrists, toes or ankles.  This should be evaluated promptly with a culture of the synovial fluid, blood, cervix, urethra, rectum, skin lesion fluid, or pharynx.  The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.

Diagnosis of gonorrhea

Doctors or other health care workers usually use three laboratory techniques to diagnose gonorrhea: staining samples directly for the bacterium, detection of bacterial genes or DNA in urine, and growing the bacteria in laboratory cultures. Many doctors prefer to use more than one test to increase the chance of an accurate diagnosis.
The staining test involves placing a smear of the discharge from the penis or the cervix on a slide and staining the smear with a dye. Then the doctor uses a microscope to look for bacteria on the slide. One usually can get the test results while in the office or clinic. This test is quite accurate for men but not for women; only one in two women with gonorrhea have a positive stain.
More often, doctors use urine or cervical swabs for a new test that detects the genes of the bacteria. These tests are as accurate or more so than culturing the bacteria, and many doctors use them.
The culture test involves placing a sample of the discharge onto a culture plate and incubating it up to 2 days to allow the bacteria to grow. The sensitivity of this test depends on the site from which the sample is taken. Cultures of cervical samples detect infection approximately 90 percent of the time. The doctor also can take a culture to detect gonorrhea in the throat.  The culture test allows testing for drug-resistant bacteria.

US recommendations

The US does not have a federal system of sexual health clinics, and the 
majority of infections are treated in family practices.
A third-generation cephalosporin antibiotic such as ceftriaxone is 
recommended for use in most areas.  Some areas such as Hawaii and 
California, have very high levels of resistance to fluoroquinolone 
antibiotics (ciprofloxacin, ofloxacin, levofloxacin) they are 
no longer used empirically to treat infections originating in these areas.

UK recommendations

In the UK, the majority of patients with gonorrhea are treated in 
dedicated sexual health clinics.
The current recommendation is for ceftriaxone or 
cefixime as first line therapy; no resistance to either drug has yet 
been reported in the UK.  Levels of spectinomycin resistance in the UK 
are less than 1%, which would make it a good choice in theory, but 
intramuscular spectinomycin injection is very painful.
Azithromycin (given as a single dose of 2 g) is recommended if there is 
concurrent infection with chlamydia.
A single dose of oral ciprofloxacin 500 mg is effective if the organism 
is known to be sensitive, but fluoroquinolones were removed from the UK 
recommendations for empirical therapy in 2003 because of increasing 
resistance rates.  In 2005, resistance rates for ciprofloxacin were 22% for 
the whole of the UK (42% for London, 10% for the rest of the UK).

Prevention

As gonorrhea is a sexually-transmitted infection, proper use of barrier contraceptives such as condoms and dental dams will significantly reduce the risk of getting gonorrhea and its complications. According to the Centers for Disease Control and Prevention, the only ways to completely eliminate the risk are sexual abstinence, or sex with a faithful monogamous partner who has been previously tested.

"The Clap"

Gonorrhea is also commonly known by the slang term "the clap". One suggested etymology is from the old French word "clapier", meaning "brothel". Another suggested source for the term is from a notorious 18th century keeper of a brothel, Margaret Clap (better known as "Mother Clap"), though perhaps her name itself was derived from the slang term. It could also refer to the painful sting in the male urethra, which feels like the sting of a clap (as in clapping hands) when infected with the disease. Yet another suggested source refers to a traditional treatment used to clear the blockage in the urethra from gonorrheal pus, where the penis would be "clapped" on both sides simultaneously.
The term "clap" may be derived from its diplococcoid microscopic morphology, which is suggestive of two cocci "clapping".
This term has, in recent years, come to be used by extension to refer to any unspecified sexually transmitted disease.