Early symptoms of gonorrhea infection are more likely to be evident in men than in women (Centers for Disease Control, 2009c). Most men who experience gonococcal urethritis have some symptoms, ranging from mild to pronounced. However, it is not uncommon for men with this type of infection to have no symptoms and yet be potentially infectious.

Sexually Transmitted Infections

Early Symptoms in the Male In men early symptoms typically appear 2-5 days after sexual contact with an infected person. However, symptoms can show up as late as 30 days after contact or, in a small number of cases, may not appear at all. The two most common signs of infection are a bad-smelling, cloudy discharge from the penis (see I Figure 15.1) and a burning sensation during urination. Some infected men also have swollen and tender lymph glands in the groin. These early symptoms sometimes clear up on their own without treatment. However, this is no guarantee that the infection has been eradicated by the body’s immune system. The bacteria may still be present, and a man may still be able to infect a partner.

Complications in the Male If the infection continues without treatment for 2 to 3 weeks, it can spread up the genitourinary tract. Here, it can involve the prostate, bladder, kidneys, and testes. Most men who continue to harbor gonococcus have only periodic flare-ups of the minor symptoms of discharge and a burning sensation during urination. In a small number of men, however, abscesses form in the prostate. These can result in fever, painful bowel movements, difficulty urinating, and general discomfort. In approximately 1 out of 5 men who remain untreated for longer than a month, the bacteria move down the vas deferens to infect one or both of the epididymal structures that lie along the back of each testis. In gen­eral, only one side is infected initially, usually the left. Even after successful treatment, gono­coccal epididymitis leaves scar tissue, which can block the flow of sperm from the affected testis. Sterility does not usually result, because this complication typically affects only one testis. However, if treatment is still not carried out after epididymitis has occurred on one side, the infection can spread to the other testis, causing permanent sterility.

Early Symptoms in the Female Most women infected with gonorrhea are unaware of the early symptoms of this infection. The primary site of infection, the cervix, can become inflamed without producing any observable symptoms. Symptoms that may occur include a painful or burning sensation when urinating and/or increased vaginal discharge. However, because this discharge is rarely heavy, it com­monly goes unnoticed. A woman who is aware of her vaginal secretions is more likely to note the infection during these early stages. Sometimes the discharge is irritating to the vulval tissues. However, when a woman seeks medical attention for an irritating discharge, her physician may fail to consider gonorrhea because many other infectious organisms produce this symptom. Also, many women who have gonorrhea also have trichomoniasis (discussed later in this chapter), and this condition can mask the presence of gonorrhea. Consequently, it is essential for any woman who thinks she may have gonorrhea to make certain that she is tested for the infection when she is examined. (A Pap smear is not a test for gonorrhea.)

Complications in the Female Serious complications result from the spread of this infec­tion to the upper reproductive tract, where it often causes PID (Centers for Disease Con­trol, 2009c). The symptoms of PID, discussed in the section on chlamydia infection, are often more severe when the infecting organism is gonococcus rather than Chlamydia tracho­matis. Sterility and ectopic pregnancy are serious consequences occasionally associated with gonococcal PID. Another serious complication that can result from PID is the development of tough bands of scar tissue adhesions that may link several pelvic cavity structures (fal­lopian tubes, ovaries, uterus, etc.) to each other, to the abdominal walls, or to both. These adhesions can cause severe pain during coitus or when a woman is standing or walking.

Other Complications in Both Sexes In about 2% of adult men and women with gonor­rhea, the bacteria enter the bloodstream and spread throughout the body to produce a variety of symptoms, including chills, fever, loss of appetite, skin lesions, and arthritic

pain in the joints (Centers for Disease Control, 2009c; Martin et al., 2008). If arthritic symptoms develop, quick treatment is essential to avoid permanent joint damage. In rare cases the gonococcus organism can invade the heart, liver, spinal cord, and brain.

An infant can develop a gonococcal eye infection after passing through the birth canal of an infected woman (Workowski et al., 2010). In a few rare cases, adults have transmitted the bacteria to their own eyes by touching this region immediately after handling their genitals—one reason why it is important to wash with soap and water immediately after self-examination.

Oral contact with infected genitals can result in infection of the throat. Although this form of gonorrhea can cause a sore throat, most people experience no symptoms. Rectal gonorrhea can be caused by anal intercourse or, in a woman, by transmission of the bacteria from the vagina to the anal opening by means of menstrual blood or vaginal discharge. Rectal gonorrhea is often asymptomatic, particularly in females, but it might be accompanied by itching, bleeding, rectal discharge, and painful bowel movements.