Gonorrhea | cause

Gonorrhea (also spelled gonorrhoea or gonorrhœa; colloquially known as the clap) is a common human sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain. In both men and women, if gonorrhea is left untreated, it may spread locally, causing epididymitis or pelvic inflammatory disease or throughout the body, affecting joints and heart valves.

The common treatment is with ceftriaxone (Rocephin), as antibiotic resistance has developed to many previously used medications. This is typically given in combination with either azithromycin or doxycycline, as gonorrhea infections may occur along with chlamydia, an infection that ceftriaxone does not cover. Some strains of gonorrhea have begun showing resistance to this treatment, which will make infection more difficult to treat

Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in mucus membranes of the body. Gonorrhea bacteria can grow in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (the tube that carries urine from the bladder to outside the body) in women and men. The bacteria can also grow in the mouth, throat, and anus.

History

 

Age-standardised disability-adjusted life year (DALY) rates from Gonorrhoea by country (per 100,000 inhabitants).

   no data

   less than 10

   10-20

   20-30

   30-40

   40-50

   50-75

   75-100

   100-115

   115-130

   130-145

   145-160

   more than 160

It has been suggested that mercury was used as a treatment for gonorrhea. Surgeons' tools on board the recovered English warship the Mary Rose included a syringe that, according to some, was used to inject the mercury via the urinary meatus into any unfortunate crewman suffering from gonorrhea. The name "the clap", in reference to the disease, is recorded as early as the sixteenth century.
Silver nitrate was one of the widely used drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün invented this type of colloidal silver, which was marketed by Bayer from 1897 on. The silver-based treatment was used until the first antibiotics came into use in the 1940s.
 


The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record. One of the first reliable notations occurs in the Acts of the (English) Parliament. In 1161, this body passed a law to reduce the spread of "...the perilous infirmity of burning." The symptoms described are consistent with, but not diagnostic of, gonorrhea. A similar decree was passed by Louis IX in France in 1256, replacing regulation with banishment. Similar symptoms were noted at the siege of Acre by Crusaders.
Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several changes occurred in European medieval society. Cities hired public health doctors to treat afflicted patients without right of refusal. Pope Boniface rescinded the requirement that physicians complete studies for the lower orders of the Catholic priesthood.

Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as lepers and other epidemic victims. After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted disease.
Human experiments were conducted by the United States in Guatemala from 1946 to 1948 to find a cure for syphilis and gonorrhea. The United States formally apologized to Guatemala in 2010. Some scholars translate the biblical terms zav (for a male) and zavah (for a female) as gonorrhea.

An old patent medicine named "Gono" pitches itself as "Man's Friend for gonorrhea and gleet – an unequalled remedy for unnatural discharges."

The WHO estimates that 88 million cases of gonorrhea occur each year, out of the 448 million new cases of all curable STI each year – that also includes syphilis, chlamydia and trichomoniasis. As of 2010, it caused about 900 deaths down from 1,100 in 1990.
In the United Kingdom, 196 per 100,000 males 20 to 24 years old and 133 per 100,000 females 16 to 19 years old were diagnosed in 2005. In 2013, the CDC estimated that more than 820,000 people in the United States get a new gonorrheal infections each year. Fewer than half of these infections are reported to CDC. In 2011, 321,849 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113.5 per 100,000 persons.
In the US, it is the second-most-common bacterial sexually transmitted infections; chlamydia remains first.According to the CDC, "Overall, African Americans are most affected by gonorrhea. Blacks accounted for 69% of all gonorrhea cases in 2010."

 Gonorrhea is a very common infectious disease in the U.S. Each year, according to the CDC, there are as many as 700,000 new cases, with less than half of them reported to the CDC. There were 334,826 reported cases of gonorrhea in the U.S. in 2012. Sexually active teenagers have one of the highest rates of reported infections.

References

1. "Expedited partner therapy in the management of sexually transmitted diseases". February 2006. Centers for Disease Control and Prevention (CDC).
2. CDC (14 July 2014). "Gonorrhea - CDC Fact Sheet". Retrieved 17 October 2014.
3. George William Hunter; J. Clyde Swartzwelder; David F. Clyde; Thomas Turlay Mackie (1976). Tropical medicine. Saunders. p. 234. ISBN 978-0-7216-4847-7.
4. "Prophylaxis for Gonococcal and Chlamydial Ophthalmia Neonatorum in the Canadian Guide to Clinical Preventative Health Care". Public Health Agency of Canada.
5. Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 705–706 ISBN 978-1-4160-2973-1
6. Datta, SD; Sternberg, M; Johnson, RE; Berman, S; Papp, JR; McQuillan, G; Weinstock, H (Jul 17, 2007). "Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002.". Annals of internal medicine 147 (2): 89–96. doi:10.7326/0003-4819-147-2-200707170-00007. PMID 17638719.
7. (pdf) Emergence of multi-drug resistant Neisseria gonorrhoeae (Report). World Health Organisation. 2011. pp. 2. Archived from the original on 2014-09-12.
8. Lozano, R (Dec 15, 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. PMID 23245604.