Gonorrhoea can be very dangerous if it is left untreated, even in a
person who has mild or no symptoms of the disease. Experts warn on
increasing cases of this sexually transmitted infection, saying it was
better to seek care in a reputable hospital rather than a pharmacy shop
because the germ is gradually developing resistance to common
antibiotics given at these shops, reports Sade Oguntola.
LOOKING at Mrs Kemi Haruna (not real name) as she stepped out of the doctor’s consultation room suggests that all was not well. Going by her swollen face and a dejected look, it was obvious that there was really a problem.
Mrs Haruna, a 32-year-old teacher had been visiting one hospital after the other because of her inability to get pregnant. She had been married for over six years and was passing through intense pressure from her husband’s family to get pregnant. So, the pronouncement that the inner part of her fallopian tube was blocked and that she might not be able to conceive really jolted her.
Most women with blocked fallopian tubes are completely unaware they might have had a prior pelvic infection. About 10 per cent of infertility cases are caused by tubal disease, either complete blockage or pelvic scarring causing tubal malfunction.
One major cause of tubal disease is a prior pelvic infection from a sexually transmitted disease called Chlamydia and gonorrhoea. These infections can give few symptoms that the woman might completely be unaware that her tubes are affected.
Chlamydia and gonorrhoea are crucial preventable causes of infertility. According to Dr Adetona Fayemiwo, a consultant medical microbiologist, University College Hospital (UCH), Ibadan, Oyo State, gonorrhoea is a sexually transmitted disease caused by a bacterium called Neisseria gonorrhoeae.
The bacteria can easily grow in the warm, moist areas of the reproductive tract, including the cervix (womb’s opening), uterus (womb) and fallopian tubes in women and in the urethra (urine canal) in both men and women. It could also grow in a person’s mouth, throat, eyes and anus.
Gonorrhoea is always sexually transmitted, and as such individuals can contract it by having sex anally, vaginally or orally with someone who has the disease. Of course, people having sex without the use of condoms are more likely to acquire this infection as those with multiple sex partners. Sexually active teenagers have the highest rate of reported infections.
Men have a 20 per cent risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for men who have sex with men is higher. Women have a 60 to 80 per cent risk of getting the infection from a single act of vaginal intercourse with an infected man.
Nonetheless, Dr Fayemiwo stated that gonorrhoea is far more likely to give symptoms in men than in women. In men, symptoms typically appear after two to 14 days, but occasionally symptoms appear months after infection. There is a discharge of yellowish or greenish pus from the penis and a frequent need to urinate. Urinating often causes a severe burning pain. The opening of the penis may be red and swollen.
Ironically, most women don’t have symptoms of gonorrhoea unless there are complications. A few may experience pain on urination. while some others have noticeable vaginal discharge, which comes from the opening of the womb (cervix). The discharge is usually yellowish or greenish, but it may also contain blood with an unpleasant odour.
But “when vaginal discharge is noticed, whether accompanied with abdominal pain or not, it is important that such women visit the hospital for examination,” declared Dr Fayemiwo.
Although women feel fewer symptoms, they are more vulnerable to serious complications of gonorrhoea than men when the infection is left untreated, these infections include; infertility, pelvic inflammatory disease (PID) and a life-threatening blood infection (sepsis), stated Dr Fayemiwo.
“By the time the woman starts to feel the effect of the infection, the fallopian tubes (the tubes connecting the ovaries to the womb), womb and other important organs in the body would have been affected. It is about this period that some of them develop pelvic inflammatory disease, ectopic pregnancy (when the fertilised egg implants and develops outside the uterus), fallopian tubal blockage and eventually infertility.
“Many cases of infertility that have today are as a result of untreated past Chlamydia and gonorrhoea infection. Thus people having discharges need to be properly evaluated and treated,” stressed the physician.
According to Dr Fayemiwo, it’s scary, however, that cases of gonorrhoea are on the rise in Nigeria. Still, many people after noticing discharges from their genitals resort to self medication or consultation with chemists rather than visiting the hospital for proper treatment which he stated is making gonorrhoea resistant to antibiotics.
“We have a lot of cases of gonorrhoea that are resistant to the available antibiotics sold in chemist shops. And when gonorrhoea is not treated properly, it would appear as if the infection has disappeared. But the case is not so, especially in females. After some time, the symptoms will resurface, but with greater severity.
“Different complications can ensue afterwards. In men, gonorrhoea can cause epididymitis, (a painful condition of the testicles) that sometimes lead to infertility if left untreated. It can also lead to scarring inside the urethra, (the tube running down the centre of the penis), making urination difficult. Sometimes, because of the obstruction in urination, the urine is passed out like water coming out of a watering can.
“But when the urine passage is blocked as a complication of gonorrhoea, this would require a surgical operation to create a channel for the man to be able to urinate again.”
Strangely enough, the complications of improperly treated gonorrhoea can manifest even 10 years after the infection had been contacted.
“There are some complications that do not manifest immediately. Some might take months, while some others years. For instance, men that suffer from epididymitis (inflammation of the part of the testicles where sperm is stored) might have swollen testicles at about two to three months after contracting gonorrhoea.
“Also, where the infection leads to scarring inside the urethra, the tube running down the centre of the penis, making urination difficult, urine passage may not become fully obstructed until after five years. By then, the man might not even link the previous gonorrhoea case to his urination problem.
In addition, Dr Fayemiwo said this might equally potentiate prostate cancer and enlargement in men.
Unfortunately, gonorrhoea may soon become untreatable due to the development of antibiotic resistance in Neisseria gonorrhoeae. This is because the bacteria that causes gonorrhoea mutates quickly and develop resistance to antibiotics quite rapidly. This is a growing public health concern, in particular because gonorrhoea control strategy relies on effective antibiotic therapy.
Since antibiotics were first used for treatment of gonorrhoea, N. gonorrhoeae has progressively developed resistance to antibiotic drugs prescribed to treat it: sulfonilamides, penicillin, tetracycline, and ciprofloxacin.
However, Dr Fayemiwo, assured that scientists are already working to ascertain the extent of untreatable and treatable cases of gonorrhoea in Nigeria, with the view of using the findings to increase public awareness on this deadly and silent sexually transmitted disease.
Similarly, Dr Akintunde Ayinde, a consultant obstetric and gynaecologist, Ring Road State Hospital, Ibadan, Oyo State while corroborating disease that gonorrhoea can be very dangerous if left untreated, even in a person who has mild or no symptoms of the stated that the infection in women can easily move into the womb, fallopian tubes, and ovaries (causing pelvic inflammatory disease or PID) and can lead to scarring and infertility.
In the process, the lining of the womb could be affected, and endometriosis, might result in the womb unsuitable for a fertilised female egg to be implanted so that it can grow into a mature baby.
Sometimes, the fimbrial ends of the fallopian tubes are also damaged and the tubes become ineffective in picking up the egg at the time of ovulation that no fertilisation takes place.
Dr Adigun counselled that it was important that all cases of abdominal pain and vaginal discharge were better handled by experts rather than resorting to self medication or patronising chemist shops because of wrong diagnosis.
“There were cases where people with abdominal discharges were merely taken as urinary tract infection, meanwhile, this could have been due to a sexually transmitted infection or even uncompleted abortion.”
The gynaecologist warned that gonorrhoea infection during pregnancy can cause problems for the newborn baby, including meningitis (an inflammation of the membranes around the brain and spinal cord) and an eye infection that can result in blindness if left untreated.
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