Gonorrhea: Treatment, Procedure, Cost and Side Effects

In both males and females, Gonorrhea takes a few weeks to show its symptoms. In the case of males, some may never develop symptoms on the other hand women tend to develop mild or almost similar symptoms to other diagnoses which make it difficult to diagnose in both cases.

Even though the symptoms show a little late, certainly after a week after transmission. Some of the first symptoms in men may include:

• Frequent, painful, or burning urination.
• Pus-like discharge can be yellow, beige, white, or greenish in color.
• Persistent sore throat.
• Swelling or pain in the testicles and rectum.

Some of the first symptoms of Gonorrhea in women are:

• Viginal discharge is watery, creamy, or slightly green.
• Heavier periods or spotting.
• Fever and sore throat.
• Sharp pain in the lower abdomen especially during sexual intercourse.
• Frequent, painful, or burning urination.

They may appear as common vaginal yeast or bacterial infection, so it will need a medical diagnosis to confirm the case.

Treatment for gonorrhoea can be done by using oral and injectable antibiotics prescribed by your doctor. It is also important for your sexual partners to be tested and treated too even if there are no symptoms evident in him/them. This is because if the partner is also infected but not treated along with you, you might get re-infected. After the patient has been diagnosed with gonorrhoea, a decision has to make for whether the patient has to be hospitalised to be treated as an outpatient. Males are always treated as outpatient for their genital infection.

But if they come with complications like gonococcal arthritis or gonococcal infection (DGI), hospitalisation would be required. This decision making is q little difficult in females because of the high risk of complications. Female with pelvic inflammatory disease (PID) or similar complications are normally avoided by doctors for treatment because of the high rate of reinfection, poor follow-up and noncompliance. Gonorrhoea can also be treated by surgical procedures.

The patient must not share their medication with another patient with gonorrhoea because the treatments are individual and damage type-specific. Re-evaluation might be required if even after the commencement of the treatment, symptoms continue to prevail. Infants may also require medication for conjunctivitis or any other eye disease which may be caused due to the mother’s gonorrhoeal infection.

Gonorrhoea is usually treated with dual therapy of antibiotics- azithromycin (Zmax , Zithromax) or doxycycline(Vibramycin, Monodox) and ceftriaxone. Also, the combination of either injectable gentamicin or oral gemifloxacin (Factive) and oral azithromycin has been proved very effective in the treatment of gonorrhoea.

People who are allergic to ceftriaxone (cephalosporin antibiotics) find this combination of treatment beneficial. In the treatment of gonorrhea, antimicrobial resistance is of growing concern thereby rendering successful treatment difficult. In case of complications like gonococcal arthritis, 1g of ceftriaxone as IV/IM daily coupled with a single dose of 1g azithromycin treatment should be given for a day or two after there has been improvement in the symptoms.

The gonococcal conjunctivitis complication in adults can be treated by a single dose of azithromycin 1g PO and ceftriaxone 1g IM along with saline drip. Pelvic inflammatory disease due to gonorrhoea is effectively treated by a single dose of doxycycline 100mg PO BID and ceftriaxone 2g IM for a fortnight in combination with metronidazole 500mg PO BID. Therapy recommended for treating gonococcal epididymitis is a single dose of ceftriaxone 250mg with doxycycline 100mg twice orally every day for 10 consecutive days. For the treatment of gonococcal meningitis and endocarditis, it is advised to use azithromycin 1mg PO as a single dose with ceftriaxone 1-2g IV for every 12 to 24 hours.

An alteration in the therapy and its duration must be consulted with your physician, the patient’s medical response to the therapy, and his/her antimicrobial susceptibility testing must be evaluated with utmost importance. Gonococcal meningitis and endocarditis have been recommended for a specific number of days of parenteral therapy, that is, 10-14 days for meningitis and 4 weeks for endocarditis.

People who get infected with Neisseria gonorrhoeae bacterium and have symptoms like burning with urination, testicular pain, penile discharge in men and vaginal discharge and bleeding other than in periods with pelvic pain in women are eligible for treatment. Also, the partners of the patients who may not show evident symptoms but might be infected with the bacteria must also go for a diagnostic test and thereafter for its treatment. A child born from a gonorrhoea infected woman may also get infected affecting its eyes developing a condition called ophthalmia neonatorum.

Diagnostic test for gonorrhoea must be accompanied by a pregnancy test in women and must be taken care that the treatments and medications are not given to the pregnant women.

Side effects of medication by IV/IM include headache, nausea, pain and reddening of the injection spot and itching. Side effects of oral medications are usually mild abdominal pain, diarrhoea and nausea too. To be more specific, injection of ceftriaxone can cause several side effects like diarrhoea, weakness, pale skin, shortness of breath while exercising, tenderness, pain, warmth or hardness at the injection site. Some serious side effects can also be experienced like stomach ache and tenderness, heartburn, nausea, vomiting, rashes on the body stomach cramps, watery stools with blood, fever, chest pain, painful and decreased urination, pain below the ribs, red, pink, brown or cloudy urine which can also be foul smelling, peeling and blistering of the skin, swelling of the legs, throat, tongue, seizures and difficulty in breathing and swallowing. The gonorrhoea bacterium has grown resistance towards certain drugs like penicillin and tetracyclines.

After the treatment is complete you must abstain from sexual contact for at least a week. This will surely reduce the risk of transmission of the disease to your partner. You should also advise your partner(s) to go for gonorrhoea diagnostic test and treatment at the same time. Condoms must be used while having sex or even during oral sex because the bacteria can infect the throat too. If symptoms persist after the treatment, doctor must be consulted soon to prevent the condition to get aggravated. A follow-up treatment done every 2-4 weeks is always good with ‘test of cure’ to be sure that you are completely clear of the bacteria or any sexually transmitted infection.

It normally takes a week to get rid of the infection completely meanwhile abstaining from sexual activity with your partner. In some cases where the patient suffer from bleeding between the periods, it takes almost another menstrual cycle to get completely rid of the bacteria and improve the bleeding issue.

Garlic is one of the most effective antibacterial home remedies for bacterial infections. It can protect your body from pathogens and inhibit the growth of infectious agents. There are no specific studies conducted to see the effectiveness of garlic on Gonorrhea, but it is somewhat promising as it builds immunity against bacterial infection in our body.

The cost of treatment for gonorrhoea can range from Rs.300 to Rs.2000 including consultation fees for the doctor. The STD test can be done for about Rs. 2050.

The treatment cannot be termed permanent because re-infection can occur as the transmission of the virus does not just depend upon one person’s hygiene. So, use of protection barriers like condoms must always be used during sexual intercourse to keep infection at bay.

Alternative treatment options for gonorrhoea are single dose of cephalosporin injection, cefoxitin or cefotaxime for urogenital and anorectal infections. Cephalosporin allergic patients can get different therapy with a single dose of gemifloxacin PO 320 mg with azithromycin 2g PO. Gentamicin 240 mhg IM with azithromycin 2g PO is also recommended for ones who are allergic to cephalosporin. In case of azithromycin allergy, doxycycline 100 mg PO BID can be prescribed for a week coupled with ceftriaxone.

Summary: Developed by the bacterium Neisseria gonorrhoeae, it is a unisexual STI that affects both males and female genitals. It can be cured but cannot be eliminated permanently from the body.