Gonococcal urethritis is an inflammation of the urethra, the tube that carries urine out of the body. It is caused by the bacterium Neisseria gonorrhoeae, which also causes the sexually transmitted infection (STI) known as gonorrhea. This infection is a common global concern.
Recognizing the Symptoms
Symptoms of gonococcal urethritis typically appear within 3 to 5 days after exposure in men. Common indicators include painful urination, frequent urination, and a pus-like discharge from the penis. This discharge is often yellow or green, sometimes accompanied by itching or burning at the urethral opening.
While men usually experience clear symptoms, women may have milder symptoms or be entirely asymptomatic. When symptoms occur in women, they can include painful urination, increased vaginal discharge, and abdominal or pelvic pain. Vaginal bleeding between periods, such as after intercourse, can also occur.
How it Spreads
Gonococcal urethritis is primarily transmitted through sexual contact, including vaginal, anal, and oral sex. Ejaculation is not necessary for the bacteria to spread from one person to another.
The bacteria can infect various sites beyond the urethra, including the rectum, throat, and eyes. In rare instances, an infected mother can transmit the infection to her newborn during childbirth, which can lead to gonococcal conjunctivitis in the baby’s eyes.
Diagnosis, Treatment, and Potential Outcomes
Diagnosis typically involves laboratory tests to identify the Neisseria gonorrhoeae bacterium. A healthcare provider may collect a urine sample or a swab from the urethra or other affected areas like the throat, rectum, or vagina. For men with urethral discharge, a Gram-stained smear can be effective. Nucleic acid amplification tests (NAATs), such as PCR, are also a preferred method for diagnosis.
Gonococcal urethritis is treated with antibiotics. Current recommendations for uncomplicated cases often involve an injectable antibiotic like ceftriaxone, sometimes combined with oral azithromycin or doxycycline, especially if chlamydial infection has not been ruled out. Completing the entire course of prescribed medication is important to ensure the infection is fully cleared. Abstaining from sexual activity until treatment is finished and symptoms have resolved is advised.
Complications in Men
Untreated gonococcal urethritis can lead to serious complications. In men, the infection can spread to the epididymis, the coiled tube at the back of the testicle, causing painful inflammation called epididymitis. This can lead to scrotal swelling and potentially infertility.
Complications in Women and Systemic
For women, untreated gonorrhea may ascend to the upper reproductive tract, leading to pelvic inflammatory disease (PID). PID can cause chronic pelvic pain, increase the risk of ectopic pregnancy, and result in infertility due to scarring of the fallopian tubes. In rare cases, the infection can spread throughout the body, causing disseminated gonococcal infection, which may affect the joints, skin, or other organs, leading to symptoms like fever, joint pain, and skin sores.
Preventing Future Infections
Preventing gonococcal urethritis involves practicing safer sexual behaviors. Consistent and correct use of condoms during all types of sexual activity, including vaginal, anal, and oral sex, significantly reduces the risk of transmission. Abstaining from sexual intercourse or maintaining a long-term, mutually monogamous relationship with an uninfected partner are the most reliable ways to avoid STIs.
Regular STI testing is also a significant preventative measure, especially for individuals with new or multiple partners. Open communication with sexual partners about STI status and recent test results can help prevent the spread of infections. If an infection is diagnosed, ensuring that all recent sexual partners are notified and treated is important to prevent reinfection and further transmission.