Gonorrhoea is one of the most common forms of sexually transmitted diseases (STDs). It’s caused by a bacterial pathogen known as gonococcus or neisseria ghonorrhoeae, which infects the urogenital tract after having sex with a person who already suffers from this condition.
The disease most commonly infects the cervix, vagina, urethra or rectum in a woman and more rarely the throat and eyes.
In pregnant women, since gonorrhoea can be transferred to the child during birth, it is necessary for women to get tested for STDs during pregnancy.
30% to 40% of women with gonorrhoea do not show any symptoms, however those who develop symptoms, will manifest the following:
1. Lower abdominal pain
The most common site of gonorrhoea in women is endocervix, urethra and rectum and can develop into a pelvic inflammatory disease faster than in men, as the urethra of women is shorter.
Even though the bacteria first infect the areas of sexual contact, after several days the infection may spread to other internal genital organs such as the uterus, fallopian tubes and ovaries. From here it may then spread to the abdominal cavity (peritoneum) and other pelvic organs and structures causing pelvic inflammatory state, which results in lower abdominal pain.
More symptoms on next page…
2. Painful urination
Another frequent complaint with gonorrhoea is painful urination or burning sensation during urination, known as dysuria. Along with this, pus can be discharged from the urethra as well and may present as small yellow patches in underwear.
Visually some women are presented with local complications around urethra and labia, where swelling, reddening of the skin (erythema) and pain might be commonly found. The ducts and the orifices of glands around external genital organs (bartholin’s glands) and urethra can also be infected and local redness and swelling can be present, while the opening of the ducts may have droplets of pus.
3. Increased vaginal discharge
When the bacteria infects the mucosal layers of vagina and cervix, there can be an increased secretion of the mucosal glands, leading to an increase in vaginal discharge.
The volume as well as the frequency of discharge can get affected. It is possible that these discharges do not show any colour changes at the beginning, but after several days the colour might change showing the first signs of urogenital infection.
4. Painful intercourse
Pain during sex (dyspareunia) can disturb the sexual life of people who have gonorrhoea. It can be defined as recurrent, continuous pain in the genital region before, during and after sex.
Some women feel pain only during the penetration while for others the pain can be a burning or aching sensation, and it may worsen during thrusts. Sometimes, a throbbing pain will be felt for about an hour after having sex. Pain can also be present during non-sexual penetrations, such as inserting a tampon.
5. Infected vaginal or urethral discharges
While increased volume and frequency of vaginal discharges can be a symptom, some women may only realize that something is wrong when they see infected vaginal discharges. These discharges can be light to dark yellow in colour, thin and mildly odorous.
Infected vaginal discharge is the most common symptom of gonorrhoea and is the reason why many women first seek medical help.
These infected discharges can also pass in larger volumes than the norm and might cause a mild itch around the vagina. Urethral discharges can also be present along with vaginal discharges, if the urethra of a woman has got infected, accompanied by cervicitis.
6. Pelvic tenderness
While gonorrhoea can transmit to the pelvis through the urogenital tract and cause inflammation of the pelvic organs, the adnexa or the appendages of the uterus can also get infected in the process.
There will be a lower abdominal (pelvic) tenderness in both sides of the abdomen, which is medically termed as ‘bilateral adnexal tenderness’, while the abdominal muscles in this area will show stiffness. In more prolonged diseases, adnexal masses (a lump in tissue of the adnexa of uterus) can be found and is a result of continuous inflammation of the appendages of the uterus. This indicates a chronic and serious state of the disease and medical attention should be sought immediately.
7. Intermenstrual bleeding
If gonorrhea spreads to the mucous membrane that lines the inside of the uterus (endometrium), it is possible that you will find bloody or brown coloured discharges. This type of discharge in gonorrhea indicates an ascending and spreading infection and must be controlled immediately before it affects the fallopian glands, which may result in further infection and possible infertility.
While these blood stained discharges can pass in between menstruations, during menstruation an infected endometrium can be manifested as excessive menstrual flow. These bloody discharges can pass alone, or along with the pus stained vaginal discharges making mixed coloured stains.
8. Fever, chills and nausea (symptoms of general infection)
Fever, chills and nausea are symptoms of a generalized infection and most commonly occur when the infection has spread into the fallopian tubes and ovaries. While this can be mislead by a diagnosis of flu, it is important that you mention any urogenital symptoms that you might have.
Women are more likely to suffer from generalized disseminated form of gonorrhoea than men and this usually develops after the 7th day of menstruation or after an abortion while infected. Women with disseminated gonoccocal infections suffer from episodes of fever, joint pains and arthritis.
9. Rectal pain & itching
Rectal pain and itching is an indication that the rectum is also infected. In women this might occur as a result of spreading infection from the cervix or can be directly infected by having anal sex with a partner who suffers from gonorrhoea.
Even though rectal gonococcal infections are often asymptomatic in women when compared with homosexual men, some women complain about rectal pain, along with itching and cramps.
The skin around the anus is usually normal, but it may occasionally be red and irritated by discharges.
10. Right upper quadrant pain
A right upper quadrant pain during a gonrrheal infection indicates an advanced serious stage of the disease. If gonorrhoea spreads further into the abdomen, an abscess can be formed around the liver causing this upper abdominal pain.
This is a rare situation and is known as “Fitz-Hugh-Curtis syndrome”. Further symptoms can be breathing difficulties and stomach bloating and discomfort due to the involvement of the liver and peritoneum, a layer of tissue that covers most of the abdominal organs.
A rigidity of abdominal muscles during palpation can also be found during Fitz-Hugh-Curtis syndrome.
It is important to get tested and receive the correct treatment as soon as possible if you think you are infected, because in worst cases it may lead to infertility if not treated on time.
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