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Gonococcal Urethritis - Clinical Manifestations, Diagnosis, and Treatment

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Gonococcal urethritis is a lower urinary tract infection in which inflammation of the urethra is observed. Read below for more.

Published At November 16, 2023
Reviewed AtNovember 16, 2023

Introduction:

The urethra is an opening that is the muscular, elastic tube-like structure of the urinary bladder from which the urine and other fluid excreta exit. In males, semen also exits from the urethra. It is located in the pelvic region of the body. It is the lowermost part of the urinary tract. When an inflammation occurs in the urethra, that condition is known as urethritis. Urethritis comes under lower urinary infections. The etiology of urethritis may be from infectious or noninfectious origin. Generally, the term urethritis is used to state the urethral inflammation of sexually transmitted origin. It is strongly linked to sexually transmitted infections (STI). Urethritis can also happen due to noninfectious sources, but sexually transmitted infections through infectious sources are the most common. Urethritis that is sexually transmitted is classified into gonococcal urethritis (GCU) and nongonococcal urethritis (NGU). The microorganism known as Neisseria gonorrhoeae is the most prevalent cause of urethritis. It is a gram-negative diplococci bacteria that is usually transmitted through sexual intercourse. The most common nongonococcal cause of urethritis is a microorganism named Chlamydia trachomatis. Chlamydia trachomatis is also a gram-negative bacteria.

What Is Gonococcal Urethritis?

Gonococcal urethritis (GCU) is an infection caused by bacteria named Neisseria gonorrhoeae. It is a sexually transmitted infection (STI). In many cases, it can be asymptomatic. Even if the patient has gonococcal urethritis and is asymptomatic, he can still transmit the disease. The patient can be an asymptomatic carrier. The females are mostly asymptomatic, or their symptoms could be very mild.

In males, the symptoms are as follows:

  • Increased frequency and urgency of the urine.
  • A purulent discharge from the penis.
  • Swelling at the opening of the penis.
  • Discolored opening of the penis.
  • Swelling and pain of the penis.

In females, the symptoms are as follows:

  • Greenish, creamy, watery discharge from the vagina.
  • Dysuria. It is known as a painful urination.
  • Urgency.
  • Bleeding is heavy in periods or sightings of blood in between the periods.
  • Painful copulation (sex).
  • Pain in the lower abdomen.

What Is Gonorrhea?

Gonorrhea is a disease caused by sexual transmission. The bacteria that causes gonorrhea is called Neisseria gonorrhoeae. It can be seen in both males and females. The bacteria grow in the moist areas of the body, such as the eyes, throat, vagina, cervix, urethra, and anal area. All age groups can get infected by gonorrhea, but mostly sexually active people; the age range could be from late teenage years to old age. The most common age groups are teenagers and adults. An infant can get gonorrhea during parturition, and the infection can get transmitted to the infant from the birthing mother. Gonorrhea affects both male and female genital tracts. It also affects other parts of the human body. Other sites that affect the human body other than the genital tracts include the throat, eyes, joints, and rectum. It may also cause fever.

The diagnosis is based on urinalysis and the swab of the affected area. It is treated with antibiotic therapy. There are certain complications of this infection. Females can have a longer time to get better due to the reproductive organs and can be affected by pelvic inflammatory disease (PID) that can damage the reproductive organs. The child could get the infection from the mother while giving birth, etc. Occasionally, arthritis or heart valve damage can also happen if the untreated infection gets into the bloodstream. Gonorrhea can be prevented by not engaging in sexual activities or following monogamy.

What Are the Clinical Manifestations of Gonococcal Urethritis?

The clinical manifestations of gonorrhea are white purulent discharge, dysuria, and irritated and inflamed urethra. The clinical manifestations help make the confirmed diagnosis. Sometimes, if the discharge cannot be seen, pressure on the urethra is given to get a clear vision. The incubation period could be from an initial 24 hours to 14 days. Generally, the females are mostly asymptomatic compared to the men. In females, blood spots or little bleeding can be seen after the periods or in between periods. Heavy menstruation can be seen in females. Pruritus occurs in the genitals, the vaginal orifice in females, or the penis in males. The genitals look swollen. The infection can spread in the system if gonococcal urethritis is not treated, and many systemic illnesses can occur, like fever, petechiae, arthritis, or corneal scarring in the eyes. Endocarditis and meningitis can also be caused.

What Is the Diagnosis of Gonococcal Urethritis?

Diagnosing gonococcal urethritis is difficult because the symptoms look similar to other sexually transmitted infections (STIs). Due to the widespread point-of-care diagnosis, gonococcal urethritis can be detected. Gram stains can be surely detected. Skilled personnel is needed to make a sure diagnosis. In males, the patient's underwear is inspected for any purulent discharge. The foreskin should be retracted to observe the lesions and exudates. Also, the urethral meatus should be checked for lesions and any strictures. The pelvic region should be palpated for areas of tenderness or firmness, and the cervix area in females. Inguinal adenopathy can also be observed. Endourethral or endo-cervical cultures should be done to detect the bacteria. Catheterization, cystoscopy, dilation of strictures of the urethra, etc.

What Is the Treatment of Gonococcal Urethritis?

The prescribed treatment is a dose of Ceftriaxone 500 mg injection intramuscularly. If chlamydia infection is present, treatment with Doxycycline 100 mg twice a week is added. Treatment with antibiotics is the primary way to cure the infection. The infection also needs to be managed.

What Is the Management of Gonococcal Urethritis?

Gonococcal urethritis management should be done despite the treatment. The partners should not get engaged in sexual relations until the infection is cured. Sexual relations should be avoided as the lesions get irritated, and infection can spread or increase. Every patient should go through the tests for the infection after three months. Pregnant ladies should not be given certain antibiotics. The physician should be vigilant enough while treating pregnant ladies.

What Is the Prognosis of Gonococcal Urethritis?

The prognosis rate showed an excellent rate of cured patients when the infection was treated in time. When the correct and proper line of treatment is given to the patients, the body of the patient responds to the treatment, and eventually, the patient gets cured. Re-infection should be avoided by maintaining abstinence or practicing monogamy. Sexual relationships should be continued only with treated and cured patients. A prompt diagnosis is needed to avoid the spread of the infection and also further serious stages of the infection.

Conclusion:

Gonococcal urethritis is a curable infection. It can be avoided by following monogamy or avoiding multiple sexual partners. Having multiple sexual partners may lead to such infections. If someone is having sex with multiple partners, then they should make sure they use protection while having sex or ask the partner if they have been recently involved in a sexual activity or if they are suffering from any infection. Being vigilant and preventing such sexually transmitted infections is important to have good overall health.

Dr. Tuljapure Samit Prabhakarrao
Dr. Tuljapure Samit Prabhakarrao

Urology

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sexually transmitted diseases
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