Ask Dr. Wang : Let's talk about gonorrhea

By Kevin Wang
Before I start my column, I'd like to remind everyone of a survey I'm conducting. I'm starting a research project to increase awareness of the LGBT community in the medical community. These surveys ask you what you wish or would like your primary care physician to know about our community. For a more detailed explanation, please my column on the subject by clicking here. Please e-mail me at the address below and I'll send out the materials. I'd like to thank those of you who have responded. Your help is much appreciated.
Now this month's column is going to be just a bit different. This was a question that a friend of mine asked (of course, I'm not going to name names). He was wondering what the differences were between gonorrhea and Chlamydia as well as what the symptoms were. So I figured I'd do a series of articles discussing the various STDs along with their symptoms, signs and treatment.
Let's start with gonorrhea.
Now believe it or not, men typically have a higher rate of gonococcal disease since gonorrhea typically is asymptomatic (meaning without symptoms) in women. The incidence of gonorrhea has also gone way up in the gay population as gonorrhea can involve any part of the genital tract, throat and rectum. Men, however, typically are more symptomatic than women so the signs are easier to pick up and to get treated earlier.
Men usually have burning on urination and/or a penile discharge. The time from infection to the onset of symptoms can range from two to eight days with 90 percent of men having these symptoms within two weeks. The discharge can be clear or pus-like.
Other symptoms include a condition called epididymitis – a condition where the epididymis (a structure just above the testicle) is inflamed from the bacteria. This causes a person to have one-sided testicular pain and swelling. Another is a condition known as proctitis. This typically occurs with anal sex and may present with a pus-like discharge from the rectum, constipation, pain and feeling a persistent sensation like you need to have a bowel movement.
The last most common symptom may be a sore throat in those who participate in oral sex. Some may not even have a sore throat but may have swollen lymph nodes in the neck as well as pus-covered tonsils.
In women, the most common site of infection is the cervix. However, the majority of women are asymptomatic and may not even know they are infected with gonorrhea. If symptoms do arise, they include vaginal itching and/or a pus-like vaginal discharge. The cervix is often sensitive and pain with sexual intercourse may be present. Other symptoms may also include painful urination, anorectal infection and sore throat as seen with men.
The most dreaded complication of gonorrhea in women is a condition known as pelvic inflammatory disease (PID). This occurs in 10-40 percent of women infected with gonorrhea. PID results in significant scarring and inflammation of the fallopian tubes and may lead to infertility. Symptoms include pelvic/abdominal pain, abnormal vaginal bleeding, fever and painful sexual intercourse. At the doctor's office, the doctor may find uterine tenderness and cervical motion tenderness – this is basically pain on motion of the cervix during a pelvic examination. A patient with cervical motion tenderness is often said to give something we call the "chandelier sign," because the patient reaches for the chandelier when we move the cervix.
Treatment, of course, involves antibiotics as well as treatment of the partner as he/she may be infected as well but is asymptomatic. Of course, the best way to prevent the spread of such disease is the use of condoms during sex but as we all know, it's not 100 percent effective.
As always, if you have any other questions, please feel free to contact your primary health care provider or me. I've run out of room for the month and will discuss another STD next month. I hope this column finds everyone in good health and spirits and I'll see you next month!