By Fatteh Hamid
Occupational health nurse, Abdulsalam Abdulmalik, talks to FATTEH HAMID about gonorrhoea, a sexually transmitted infection, and the risk it poses if left untreated
What is gonorrhoea?
This is a common sexually transmitted infection caused by a bacteria called neisseria gonorrhoeae. Gonorrhoea is spread through sexual fluids, including vagina fluids and semen. It is an infection that can be caught through oral sex, anal sex or sharing steroids with an infected person. Most times, it doesn’t cause any infection which makes it easy to infect others.
It is majorly caused when an individual has unprotected sexual intercourse with an infected person. This is the same for males and females and it involves vagina intercourse or anal sex, oral or sharing of maybe a sex toy of an infected person in a case where the sex toy is not protected or clean. By protection, I mean probably the sex toy is protected with the use of a condom. But if it is exposed, such toys can still hold the bacteria and will still infect another individual that is reusing the sex toy. Likewise, close genital contact even without penetration can be a cause for gonorrhoea in both men and women.
Are there early signs of gonorrhoea?
Individuals that have gonorrhoea may not have any early signs. They only notice that there’s a problem when they start having some symptoms, and they are likely to impact individuals differently based on the reproductive part affected and the gender of the individual.
Research shows that Nigeria has more than 1.5 million cases of gonorrhoea per year. Do you think it shows how common the infection is?
Absolutely. Gonorrhoea is the second most common STI caused by bacteria just behind chlamydia. These infections almost happen most times, together. If researchers are saying we have about 1.5 million cases per year, we can conveniently term gonorrhoea as one of the most common cases in Nigeria because these days, we have much more cases of patients coming into the hospital with cases of gonorrhoea because people are now very exposed to unprotected sexual intercourse. With this data, we can actually say that it is one of the most common diseases in Nigeria.
What are the symptoms of this disease?
They can be classified into two or three. However, I’ll first address the classification based on gender. In most cases for females, the notable symptom they do have is an unusual vagina discharge. It can either be a whitish discharge or a yellowish discharge. Asides that, there can be pain in the pelvic area or probably in the hole of the abdominopelvic region. Asides that, there can be pain during sexual intercourse. Also, there can be a burning sensation during urination when the individual is urinating, there can be very serious pain. There can also be bleeding between periods, which means that even after the menstruation has finished or probably the individual has finished the menstrual cycle for that month, there’s continued bleeding or even bleeding in between periods. These are a few of the symptoms in females.
In men, the men can start having what we can call abnormal discharge which can either be whitish, yellowish or sometimes, even a greenish discharge from the penis. Men can also have a burning sensation just like women and likewise in men, there can be what we call testicular pains and swollen testicles. So, the testicles can get swollen or probably start having unbearable pain around them. Part of the symptoms of gonorrhoea can also occur outside the genitalia. It can occur in the throat where the individual will have an itching feeling in the throat and there can be soreness and dysphagia which is known as difficulty in swallowing. If it happens in the anus, there can be serious itching, abnormal discharges from the anus and there can be pains when the individual is trying to defecate as well.
What are the risk factors of the infection?
Sexually active persons of any age or sex can get gonorrhoea as well as their partners. It must be noted that a newborn can get gonorrhoea from the mother during childbirth. People who are at greater risk for this infection are people under the age of 25 and they are at a higher risk of having gonorrhoea because they are the ones more active sexually and they are the ones that engage in unprotected sexual intercourse with several partners. They are at a higher risk of having this infection. Likewise, an individual that has had a history of STIs, any one of them, is at a higher risk of having gonorrhoea if they have contact with someone that is infected.
Individuals that do not use condoms or protective measures before sexual intercourse are at a high risk of having this infection. Also, people with multiple sexual partners are prone to or have a greater risk of getting this infection. More importantly, people who have sexual intercourse with the same gender have a higher risk of being infected. Men, because they go through the anal orifice, are at a very high risk of having this infection because if they are unfortunate to meet with an infected person, they are at higher risk of being infected.
Is it true that the disease can cause infertility in men, repeated miscarriages and blindness in a newborn when the mother has it?
Yes, gonorrhoea can cause infertility and miscarriage. Firstly, let’s quickly look at infertility. When an individual is infected or has untreated gonorrhoea, it can spread to other reproductive organs including the uterus, and the fallopian tube, and it can even cause what we call pelvic inflammatory disease. So, gonorrhoea, if untreated, can cause infertility and miscarriage. Likewise, it can cause eye problems in infants when the infection is untreated. During the development of the foetus, it can cause blindness or an eye problem. In men, it can also cause infertility and cause some scars in the urethra, and inflammation in the testes, and it can even cause what we call prostate pain and inflammation. Another problem is that if it spreads throughout the body including the swollen and painful joints, it can actually cause what we call liver inflammation and even cause what we call heart defects in the heart valves and once it gets to the bloodstream, it can cause a lot of things and even brain damage. It is proven scientifically that when left untreated, gonorrhoea can cause infertility, among many others.
The World Health Organisation warned that gonorrhoea could also cause blood infection called septicaemia in rare cases. Do we have issues such as this in Nigeria?
Sure, in rare cases when it is left untreated, it can spread through the bloodstream and cause what we call a life-threatening infection. When it also spread to the blood, it can cause what we call disseminated gonococcal infection. This DGI is usually characterised by arthritis, tenosynovitis, and sometimes, dermatitis., and these conditions are very much life-threatening. So, there is a tendency for this infection to get into the bloodstream and cause what we call septicaemia and once there’s septicaemia, the individual would be prone to lots of other complications and many other life-threatening diseases.
The individual is also at risk of contracting other diseases as I earlier stated because when there is septicaemia or once it gets into the bloodstream, it lowers the body’s immunity and when the body’s immunity is altered and affected, it makes the individual prone to other infections and more diseases. Once it is left untreated, it can lead to a lot more complications and this can be a greater risk factor for the individual to contract more infections due to the fact that the immune system is down and the body is unable to fight against any infection and this will continue to make the individual more prone to other infections.
What misconceptions do Nigerians have about gonorrhoea?
Yes, there are a lot of misconceptions about this infection, especially in Nigeria. Most Nigerians do believe that the infection is not curable, which is not right. It has a cure and it can be cured effectively. Part of the misconception we have is that we stigmatise people that have this infection. We should as well know that kissing, hugging or holding hands cannot cause gonorrhoea. Those activities do not allow the transmission of the infection. Likewise, sharing food, drinks, and some other things do not cause gonorrhoea but people just stigmatise people that have gonorrhoea or try as much as possible to avoid them. Also, using the same toilet with someone that is infected does not make one prone to gonorrhoea; it doesn’t. If an infected person uses a toilet and the toilet is flushed and okay, the individual that uses it the next time cannot have gonorrhoea because it is a sexually transmitted infection. Many misconceptions need to be changed.
Many native healers on the streets of Nigeria claim to sell natural herbs that cure gonorrhoea. Have you seen a case where such herbs cure the disease?
I’ve not seen anyone out of the numerous native healers that have successfully treated gonorrhoea because it is a bacterial infection. Part of the disadvantages of using such herbs to treat infection is that there’s no dosage and there’s no way to prove if what they are using is antibiotics or not. I’ve not seen anyone that has used herbs to cure it. It is an infection that can be cured medically and there’s no need for us to give ourselves the stress of finding other alternatives in curing it. I’ve not seen anyone that has this infection and has been cured with herbs.
I’ll not recommend herbs. It is not the best way to cure. It doesn’t have a dosage, it doesn’t have a prescription, and there are a lot of things in many herbs these days that can cause a lot of harm to the body. I will not in any way advise that an individual opt for the usage of herbs.
What are the processes for managing gonorrhoea?
This is through assessment, early diagnosis and prompt treatment of gonorrhoea. There would be an examination where we need to examine the individual before we can confirm them to have the infection. We can perform a pelvic examination or a pelvic scan to know what is going on with the organs in the pelvis. Likewise, we can take a sample of fluid from the penis for testing. We can take a urine sample for testing in the laboratory to know the extent of damage and afterwards, treat it with various antibiotics that are best for the diagnosed individual.
How can the disease be treated?
The treatment of the infection after the diagnosis is majorly the use of antibiotics. Both partners are always treated. Irrespective of being infected or not. Since they are sexually active with each other, they both need to be treated. Because if you treat one and not the other, there is a likelihood that the other person can have the infection and still reinfect the individual. In most cases, we treat both partners together. The extent of the damage will guide one in the treatment of gonorrhoea. There are some in their early stages that can just be wiped off with certain prescriptions. It all depends on the severity and the extent of the damage.