By Sola Ogundipe
The world’s most commonly reported Sexually Transmitted Infection (STI), Gonorrhoea, a.k.a the “gentleman’s disease” is gradually becoming untreatable and as incurable as it was in the 1920s, before the first drugs to treat it were discovered.
Misuse of antibiotics and unsafe sexual activities are causing the spread of the dangerous gonorrhoea superbug. Dr. Olusola Olabisi Ayolowo, Consultant Physician and Health Dermatology, Genitourinary Medicine & Rheumatology, Lagos University Teaching Hospital, LUTH speaks about preventing the infection and what to do if you get infected. Excerpts.
Gonorrhoea is a very common sexually transmitted infection (STI). It is caused by bacteria, which are passed on during sex. Anyone can get infected with these bacteria during sexual activity ranging from vaginal sex, anal sex, oral sex, sharing sex toys and genital contact with an infected partner. But it is possible to become infected without engaging in sexual activity.
There are short term and long term problems. An instance of the long term problem in males is problem with passing urine. Gonorrhoea causes an obstruction as well as infection of the genitals and the prostate. Another complication is male factor infertility. We do know that in 50 per cent of infertility cases will have male factor.
In women, gonorrhea infection could spread to the blood and cause pelvic inflammatory disease (PID) in addition to other infections that ascend the vaginal tract to the cervix, womb and other reproductive organs. Women with gonorrhea could have difficulty conceiving and could pass the infection to their unborn children if they are pregnant.
This is why there are cases of congenital gonorrhoea that could affect the eyes of the baby. It’s a common cause of a baby being born blind. In order to prevent this, pregnant women should get tested for the gonorrhoea.
How it is transmitted
The disease is almost always transmitted during sex but, it is possible to contract gonorrhoea without engaging in penetrative sex, for instance if your genitals touch the genitals of an infected partner.
Gonorrhoea can also be contracted through sharing share sex toys. You can’t contract gonorrhoea from kissing, hugging or sharing a drink, but you can get it from oral sex. Gonorrhoea cannot be contracted from the toilet. The bacteria do not survive outside the human body and you cannot be infected from sitting on a toilet.
In women, the symptoms are similar to those in men. A common symptom is persistent lower abdominal pain, so if a woman has persistent lower abdominal pain she should not just assume it’s her menstrual pain. It could be gonorrhoea.
Having rashes on the private part may or may not be a feature of gonorrhoea. For women who may have gonorrhoea rashes all over the body and the palms may be a symptom and she would need to visit the dermatologist who would have to differentiate between rashes in gonorrhoea and other rashes.
To confirm, we would conduct a high vaginal swab and can also perform the PCR test. It is also important to test for syphilis and HIV which is a viral infection that reduces the body immunity and makes us more susceptible to bacterial infection.
If you are a woman, when you are coming in for your gonorrhoea/chlamydia testing, it is advisable to also do a panel of tests for STIs. For men with multiple sex partners and women who know that their spouses have multiple sexual partners, their risk factor is high so they should go and get themselves tested.
The diagnosis involves taking samples. The sample commonly taken is urine. For males we also take the discharge and send it to the lab for microscopy. Previously testing was through culture and sensitive test, but there is now an advanced test —the Polymerase Chain Reaction (PCR) recommended by the World Health Organisation (WHO).
The gonorrhoea/chlamydia PCR is very sensitive and is the universally recommended testing for gonorrhoea. Gonorrhea and chlamydia go hand-in-hand and only a specialist can really differentiate them. In many cases if you are not a specialist there could be misdiagnosis, and so people end up treating for chlamydia instead of treating for gonorrhoea, yet the treatment for the two infections are different.
Now, there is a recommendation yearly testing for sexually active women and yearly testing for men who engage in alternate kinds of sexual activity. There must also be diagnosis and monitoring for follow up. The people who indulge in alternative sexual practices are more at risk.
Generally we know that for STIs, people don’t always come to the clinic so that is the reason there is collaboration between the LUTH STI Clinic and other clinics, and now there is increasing number of people coming in. But we also know that so many people quacks. Some even place signboards for the treatment of gonorrhoea and people patronize them, but those are not the best places to go. The recommendation is that three months after completing treatment, you should repeat the gonorrhoea PCR test.
Come to the clinic if you have urinary discomfort as a male; it may or may not be gonorrhoea. So just don’t go and buy antibiotics because that is the origin of the resistant gonorrhoea we are talking about. Taking antibiotics, self-medication, buying over-the-counter and so on and not reporting are common problems with gonorrhoea.
Complete the treatment if you have been diagnosed. It is wrong to take drugs home and share your prescription. Initially when treatment begins, you may have symptomatic relief, but you do need to take your antibiotics for the prescribed number of days and usually not less than 10 days. That is our advice. There is need for advocacy to encourage people to come in for treatment and stop spreading the infection.
On the one-on-one level, we need to tell people to come in and get tested and treated,then we talk about condom use and abstinence. On the long-term and we need to talk about public education and stop the stigmatization of patients particularly by medical practitioners and everybody working in the hospital. When people come in for treatment we give condoms and also educate them about safer sex.
Condoms prevent STIs including gonorrhoea. But one thing is to have condoms available and it’s another thing for culture to actually accept their use. In some communities, condoms are taboo, yet on paper and in practice, we do know that such communities rank high in STIs especially HIV. The background problem is the taboo. We need to convince men and about the need to embrace condom use even within a matrimonial relationship.
We need to give all STIs the same or similar attention we give HIV so that we can have a fuller picture and global view. We don’t always have data for gonorrhoea because not all patients come to the hospital, therefore we cannot presently determine the burden in Nigeria as a whole. What we have are individual reports.
We should be very careful in our sexual practices. Abstain or keep to a single partner and/or embrace condom use. Report suspected symptoms of STIs to the hospital and get investigated and get treated. Avoid buying antibiotics by the roadside or in the market and using them anyhow.