Introduction of Gonorrhea: Greek word "gonos" meaning "seed" and "rhoia"

meaning "flow". This name reflects the belief that

gonorrhea was caused by the discharge of "bad humors"
or "corrupted fluids". It wasn't until the late 19th century
that Neisseria gonorrhoeae was identified as the
bacterium responsible for the infection by the German
physician Albert Neisser.

Etiology

• The etiology of gonorrhea begins with the transmission

of Neisseria gonorrhoeae through sexual contact. The
bacteria are primarily found in the mucous membranes
of the reproductive and urinary tracts, as well as the
(FEMALE PART) mouth and throat. When an infected individual engages
in sexual activity with a partner, the bacteria can be
transmitted through the exchange of bodily fluids, such
as semen, vaginal fluid, or saliva. This transmission can
occur through vaginal, anal, or oral sex, making
gonorrhea a highly infectious STI. Additionally,
gonorrhea can also be transmitted from an infected
mother to her newborn during childbirth.

Mode of Transmission

• Sexual transmission is the primary mode of spread for

gonorrhea. The bacterium N. gonorrhoeae can infect the
(MALE PART) genitals, rectum, and throat, and it is spread through
unprotected vaginal, anal, and oral sex. When an
individual comes into contact with the infected bodily
fluids of an infected person, such as semen or vaginal
fluid, the bacteria can enter the body and cause infection.
This mode of transmission makes sexually active
individuals who engage in unprotected sex particularly
vulnerable to gonorrhea. In addition to sexual
transmission, gonorrhea can also be transmitted from an
infected mother to her newborn during childbirth. This
can lead to a potentially serious condition known as
neonatal gonococcal conjunctivitis, which is an infection
of the eyes that can cause blindness if left untreated. It is
crucial for pregnant women to get tested for gonorrhea
(EXTRA-GENITAL GONORRHEA) and receive treatment if necessary to prevent
transmission to the newborn. Thus, it can also be
Definition and its History transmitted through uncleaned sex toys used by an
infected person.
• Gonorrhea, also known as "the clap", is a sexually
transmitted infection (STI) caused by the bacterium Incubation Period
Neisseria gonorrhoeae. It is one of the most common
STIs worldwide, and can affect both men and women. • The incubation period of gonorrhea is typically short,
Gonorrhea is primarily spread through unprotected ranging from 2 to 14 days after exposure. However, it is
vaginal, oral, or anal sex with an infected person. important to note that some individuals may be
asymptomatic carriers of the bacteria for a longer period
The history of gonorrhea dates back to ancient times, of time, and others may never develop symptoms at all.
with descriptions of symptoms resembling gonorrhea This makes it difficult to accurately determine the exact
found in the writings of Hippocrates in the 5th century length of the incubation period for each individual case.
B.C. The term "gonorrhea" itself is derived from the
Several studies have been conducted to determine the
average incubation period of gonorrhea. One study Risk Factors
published in the Journal of Infectious Diseases found
that the median incubation period for gonorrhea was 3 • One of the primary risk factors for gonorrhea is having
days, with a range of 1 to 15 days. Another study multiple sexual partners. People who have multiple
published in the Journal of Clinical Microbiology found sexual partners are at a higher risk of being exposed to
that the median incubation period was 5 days, with a the infection, as they have a higher likelihood of coming
range of 2 to 14 days. These studies highlight the into contact with an infected individual. Multiple sexual
variability in the incubation period of gonorrhea and the partners also increase the potential for the infection to
need for individualized care and monitoring. spread within a community (CDC, 2021).

Types of Gonorrhea • Unprotected sexual intercourse is another major risk

factor for gonorrhea. The use of barrier methods such as
• The three main types of gonorrhea are urogenital condoms can greatly reduce the risk of acquiring the
gonorrhea, extra-genital gonorrhea, and disseminated infection. However, individuals who engage in
gonococcal infection (DGI). unprotected sex are at a higher risk of contracting
gonorrhea, as well as other STIs.
1. Urogenital Gonorrhea is the most common form of
the infection and primarily affects the genital area. This • The age group of 15-24 is considered to be at a higher
includes the urethra in men and the cervix, vagina, and risk of gonorrhea infection. This age group is more
urethra in women. Urogenital gonorrhea is typically likely to engage in risky sexual behaviors, including
transmitted through sexual contact with an infected having multiple partners and engaging in unprotected
partner. The symptoms may include painful urination, an sex. Additionally, young people may be less likely to
increased frequency of urination, abnormal vaginal seek out and utilize available STI prevention and
discharge, and testicular pain in men. However, it is treatment services (CDC, 2021).
essential to note that up to half of women infected with
gonorrhea may not experience any noticeable symptoms, • A past history of gonorrhea infection is also a risk
leading to underdiagnosis and the potential for further factor for acquiring the disease again. Individuals who
complications. have previously been infected with gonorrhea are at a
higher risk of reinfection, as the bacterium can often
2. Extra-genital Gonorrhea refers to infections that become resistant to antibiotics used for treatment.
occur in areas outside of the genital region. This type of Additionally, having a past history of gonorrhea
gonorrhea can affect various parts of the body, including infection can indicate a pattern of risky sexual behavior,
the anus, throat, rectum, and eyes. Extra-genital which increases the likelihood of future infections.
gonorrhea is generally contracted through oral or anal
sexual activities. Symptoms may include rectal pain, • Substance abuse, particularly the use of drugs and
discharge, and itching, as well as a sore throat or red alcohol, has been linked to an increased risk of
eyes if those areas are affected. Like urogenital contracting gonorrhea. Substance abuse can lead to
gonorrhea, individuals with extra-genital gonorrhea may impaired decision-making and judgment, which may
not exhibit any symptoms, making diagnosis result in engaging in risky sexual behaviors such as
challenging. unprotected sex and multiple sexual partners (CDC,
2021).
3. Disseminated Gonococcal Infection (DGI) occurs
when the N. gonorrhoeae bacteria spread from the initial Statistics
infection site(s) to other parts of the body through the
bloodstream. DGI is a severe form of the infection and
• The statistics of gonorrhea are alarming, with millions
can lead to complications if left untreated. Commonly
of cases reported each year. According to the World
affected areas include the skin, joints, and less
Health Organization (WHO), there were an estimated 87
frequently, the heart and brain. Symptoms of DGI may
million global cases of gonorrhea during 2016, making it
include joint pain and swelling, skin lesions, fever, and
one of the most common STIs worldwide (World Health
fatigue. This condition requires immediate medical
Organization, 2016). In the United States alone, the
attention to prevent long-term health consequences.
Centers for Disease Control and Prevention (CDC)
reported 583,405 cases of gonorrhea in 2018,
representing a significant burden on the healthcare
system and impacting the lives of those affected by this
infection (CDC, 2018).
Pathophysiology

Step 1: Transmission:
The primary mode of transmission for N. gonorrhoeae is
via sexual contact with an infected individual.
Unprotected vaginal, anal, or oral intercourse with an
infected person allows the bacterium to enter the body.

Step 2: Colonization:
Upon entering the body, N. gonorrhoeae initially
colonizes and targets the mucosal surfaces of the
urogenital tract. It attaches to and enters the epithelial
cells of the urethra, cervix, rectum, throat, or eyes, where
it establishes infection.

Step 3: Adherence:
N. gonorrhoeae is equipped with various surface
components, including pili and outer membrane proteins,
allowing it to adhere to host cells. These components
interact with specific receptors on the surface of
epithelial cells, facilitating the attachment and
subsequent invasion of the bacterium into the host cells.

Step 4: Invasion:
Once attached, N. gonorrhoeae exploits its arsenal of
virulence factors to invade the host cells. It secretes
enzymes, such as proteinase and outer membrane
proteins, to break down the barriers of the host cell,
enabling the bacterium to enter the intracellular space.
Step 5: Escape from Immune System:
To survive within the host, N. gonorrhoeae has
developed mechanisms to evade the immune system. It
possesses the ability to undergo antigenic variation,
altering the expression of surface proteins to avoid
recognition by the host's immune cells. Additionally, it
can impair phagocytosis or inhibit the activity of
immune cells, thus ensuring its persistence.

Step 6: Local and Systemic Complications:

N. gonorrhoeae's presence within the host can lead to
various local and systemic complications. Locally, it
causes inflammation, leading to symptoms such as pain,
discharge, and swelling. In some cases, it may ascend
the urogenital tract, causing pelvic inflammatory disease
in women. Systemically, if left untreated, the bacterium
can spread through the bloodstream, potentially leading
to serious infections at distant sites, such as joints, skin,
or heart valves.

Step 7: Transmission to New Hosts:

To perpetuate its life cycle, N. gonorrhoeae creates an
ongoing cycle of transmission. Infected individuals who
remain untreated or enter into risky sexual behaviors can
transmit the bacterium to new hosts, continuing the
spread of the infection within the population.
Clinical Manifestations
Dx Tests
While culture results can provide definitive proof of an
infection, the test can be marred if the swab is not taken
properly. A bacterial culture is temperature-sensitive and
it may be less accurate if there are any mistakes in the
handling, storage, incubation, or processing of a sample.

Gram stain, in which N. gonorrhoeae is seen under a

microscope with the aid of special dyes

is often used for diagnosing a gonorrheal infection in

males. It is typically performed by obtaining a swab
from the urethra (the tube that allows pee to flow from
the bladder outside of the body), as well as a first-catch
urine sample. First catch is a method by which urination
is withheld for at least an hour before collection and only
the first 20 to 30 milliliters of urine are collected.

Special dyes are then added to the samples to tint the

walls of bacteria, if present, so that they can be
differentiated and identified with a microscope. You
should expect to receive your gram stain test results in
two to three days. If the bacterium is present, you will
get a positive result. If it is not, your lab report may say
“negative” or “no organism seen.”
There are three tests used to diagnose gonorrhea:
A gram stain test has a low sensitivity. That means that it
Bacterial culture, which looks for growth of N. is prone to false negatives, or results that indicate
gonorrhoeae gonorrhea is not present when it really is.As such, a
Bacterial Culture negative result cannot be considered definitive. Other
forms of testing would be necessary.
A bacterial culture can be highly effective in diagnosing
gonorrhea of the genitals, rectum, eyes, or throat. Cells
Nucleic acid amplification test (NAAT), which can
collected with a swab of the affected area are sent to a
provide genetic evidence of infection.
lab, where they are added to a substance designed to
promote the growth of N. gonorrhoeae. The NAAT identifies the genes unique to N.
gonorrhoeae. A urine sample or a swab of the vagina,
Generally speaking, it can take from five to seven days
cervix, or urethra is sent to a lab and processed using a
to receive the results of a bacterial culture. If there is
technique that can make roughly a billion copies of the
growth, the test is positive. If there is no growth, the test
genetic material of bacteria, if present. This allows even
is negative. A culture can also be used to determine
small amounts of the bacteria to be detected, making it
whether a bacterium is resistant to any of the antibiotic
highly accurate.
drugs that are used to treat this infection. This is
especially important if treatment doesn’t clear an NAAT results can be delivered within a few hours. You
infection or if disseminated gonococcal infection (DGI) can expect to receive your lab report within two to three
develops. DGI is a severe complication in which N. days. Due to its speed and accuracy, the Centers for
gonorrhoeae spreads through the bloodstream to organs Disease Control and Prevention (CDC) recommends that
in the body. the NAAT be used to diagnose gonorrheal infections of
the rectum and throat.
 plus 2 grams of Azithromycin. You’ll take Azithromycin
Complications by mouth (orally).

Untreated gonorrhea can lead to major complications, Alternative regimens are available when ceftriaxone
such as: cannot be used to treat urogenital or rectal gonorrhea.
Although medication will stop the infection, it will not
Infertility in women. Gonorrhea can spread into the repair any permanent damage done by the disease.
uterus and fallopian tubes, causing pelvic inflammatory
disease (PID). PID can result in scarring of the tubes, It’s important to consider what treatment can and can’t
greater risk of pregnancy complications and infertility. do. Treatment can rid your body of the bacteria.
PID requires immediate treatment. Treatment can’t:

Infertility in men. Gonorrhea can cause a small, coiled  Undo any damage to your body that the
tube at the back of the testicles where the sperm ducts infection may have caused before treatment.
are located, called the epididymis, to become inflamed.  Protect you from future gonorrhea infections.
This inflammation is known as epididymitis. Untreated
epididymitis can lead to infertility.
Nursing Intervemtion for Gonorrhea:
Infection that spreads to the joints and other areas of
the body. The bacterium that causes gonorrhea can Gonorrhea is a sexually transmitted infection caused by
spread through the bloodstream and infect other parts of the Neisseria gonorrhoeae bacterium, primarily affecting
the body, including joints. Fever, rash, skin sores, joint the genital and reproductive tracts. The nursing
pain, swelling and stiffness are possible results. assessment for gonorrhea focuses on gathering
comprehensive data to understand the patient’s sexual
Increased risk of HIV/AIDS. Having gonorrhea makes history, identify potential risk factors, assess symptoms,
you more susceptible to infection with human and determine the need for appropriate testing and
immunodeficiency virus (HIV), the virus that leads to treatment. Below is a plagiarism-free nursing assessment
AIDS. People who have both gonorrhea and HIV can for gonorrhea:
pass both diseases more readily to their partners.
1. Sexual History:
Complications in babies. Babies who get gonorrhea
during birth can develop blindness, sores on the scalp Obtain a detailed sexual history, including the number of
and infections. sexual partners, types of sexual activity, and the use of
barrier protection such as condoms.

Therapeutic Intervention 2. Symptom Assessment:

How is gonorrhea treated? Inquire about any symptoms related to gonorrhea, such
as genital discharge, burning or pain during urination,
You’ll need antibiotics to treat gonorrhea. Your and genital itching.
partner(s) will need treatment, too. The CDC currently
recommends a shot of Ceftriaxone, with dosage based on 3. Risk Factors:
your weight:
Identify potential risk factors for gonorrhea, such as
500 milligrams of Ceftriaxone if you weigh less than having multiple sexual partners, engaging in unprotected
150 kilograms (about 330 pounds). sex, or having a partner with a known STI.

1 gram of Ceftriaxone if you weigh more than 150 4. Physical Examination:

kilograms.
Perform a physical examination, with a focus on the
If you’re allergic to Cetriaxone, your healthcare provider genital and reproductive areas, to check for any signs of
may give you a shot of Gentamicin (240 milligrams) inflammation, discharge, or genital lesions.
  Use a condom if you have sex. Not having sex
and avoiding sexual activity is the surest way to
prevent gonorrhea. But if you choose to have
5. Testing and Diagnosis:
sex, use a condom during any type of sexual
Discuss the importance of gonorrhea testing and contact, including anal sex, oral sex or vaginal
recommend appropriate diagnostic tests, including urine sex.
analysis, swab tests, or nucleic acid amplification tests
(NAATs).
 Limit your number of sex partners. Being in a
monogamous relationship in which neither
6. Contact Tracing: partner has sex with anyone else can lower your
risk.
Inquire about recent sexual contacts and discuss the
importance of notifying partners for testing and
treatment to prevent further transmission.  Be sure you and your partner are tested for
sexually transmitted infections. Before you
7. Pregnancy Screening: have sex, get tested and share the results with
each other.
If applicable, assess the patient’s pregnancy status and
discuss the potential risks of untreated gonorrhea during
pregnancy.  Don't have sex with someone who appears to
have a sexually transmitted infection. If
8. Psychosocial Assessment:
someone has symptoms of a sexually transmitted
Explore the patient’s emotional response to the potential infection, such as burning during urination or a
diagnosis of gonorrhea and provide emotional support genital rash or sore, don't have sex with that
throughout the assessment process. person.

9. Education on Safe Sex Practices:

 Consider regular gonorrhea screening.
Provide comprehensive education on safe sex practices, Annual screening is recommended for sexually
including the use of condoms and regular testing for active women younger than 25 and for older
STIs. women at increased risk of infection. This
includes women who have new sex partners,
10. Treatment Compliance: more than one sex partner, sex partners with
other partners, or sex partners who have sexually
Discuss the importance of completing the full course of
transmitted infections.
prescribed antibiotics if the patient is diagnosed with
gonorrhea. References
11. Education on Partner Notification: Centers for Disease and Prevention (CDC):
https://www.cdc.gov/std/gonorrhea
Encourage the patient to notify recent sexual partners
about the potential exposure to gonorrhea and the World Health Organiation (WHO):
importance of partner testing and treatment. https://www.who.int/news-room/fact-sheets/detail/gonor
rhoea

Prevention https://my.clevelandclinic.org/health/diseases/4217-
gonorrhea
The only way to prevent gonorrhea is not to have sex.
Though therr are still ways to lower the risk of getting https://www.verywellhealth.com/how-gonorrhea-is-
gonorrhea: diagnosed-3132752
https://nursingfile.com/nursing-care-plan/nursing-
interventions/nursing-interventions-for-gonorrhea.html