What’s all this buzz about gonorrhea? I mean like is it taking over the world? Will our children and our children’s children have the misfortune of chronically dripping genitalia? I mean, how can we enjoy driverless cars and space travel if the act of urinating causes lightning to pass from our urethras? These and many other questions come to mind as I peruse the recent press about this frightening topic. So of course, I had to find out all the D’s. Grab a cup of coffee, and pull up a chair cause we are about to get an eduMcation!
What is Gonorrhea (It sounds really gross!)
Anyhoo…gonorrhea is a sexually transmitted infection by a bacteria called Neisseria gonorrhoeae. This particular bacteria was actually discovered by a microbiologist named Albert Neisser in 1879. (How glamorous it must be to share the name of the drippy penis bacteria!!) Although symptoms of the disease can be traced back to the 1500s. As a matter of fact, gonorrhea was often called “the clap.” This slang term likely comes from the French word “les clapiers,” which refers to the brothels from which the many men who visited developed penile discharge. It is thought that sailors in the British Navy in the 1500’s had mercury injected into their urethra’s to help stop “the clap.” (Which sounds really horrible, or perhaps slightly titillating depending upon your sexual practices.)
Gonorrhea can infect the mouth, genitals or anus, (or really any other orifice in which you could place your penis.) It typically causes a milky, white, yellow or green discharge, which is often seen as a stain on the underwear. In addition, it usually causes pain with urination or discomfort in your urethra that can be felt before, during or right after urination. If gonorrhea infects your throat, it can also cause a mild to a moderate sore throat. It is often misdiagnosed as strep throat. In the rectum, gonorrhea can cause rectal discharge, painful pooping, or no symptoms at all. As a matter of fact, gonorrhea in any orifice can be completely asymptomatic.
Gonorrhea that is untreated can get into your bloodstream and travel to your joints, tendons or skin. It can cause a multitude of problems including fever, chills, fatigue, swollen joints, skins lesions and tendon pain and swelling.
Antibiotic Resistant Gonorrhea
Unfortunately, as the CDC points out in the above video, Neisseria gonorrhoeae continues to change over time to outsmart our best antibiotics. In 2012, for example, the CDCs guidance to the medical community was to use a low dose of a single antibiotic called ceftriaxone to treat gonorrhea. In 2016, the guidance changed to dual therapy with two different antibiotics, a larger dose of ceftriaxone as well as a second antibiotic called azithromycin. To date, in the United States, there has been no resistance to this cocktail of antibiotics. But the CDC recently published data showing increased resistance patterns to azithromycin. In other countries, pockets of resistance to ceftriaxone and azithromycin have emerged.
Gonorrhea in Men who have Sex with Men
Believe it or not, the CDC has been so concerned with the resistance patterns of gonorrhea, that in 1986, they created the Gonococcal Isolate Sensitivity Project which collects data from samples of gonorrhea collected and grown in labs. They have found that samples collected from men who have sex with men (MSM) were significantly more likely to demonstrate resistance to commonly used antibiotics than samples collected from men who have sex with women (MSW). One study leads to the conclusion that gay men are more likely to be asymptomatic carriers of the infection in their throats or rectums; whereas heterosexuals are more likely to have the infection in their penis or vagina. In the genitalia, the disease causes discomfort and discharge, which usually results earlier treatment with antibiotics.
Gonorrhea in the Throat
Although not completely understood, there are several theories why gonorrhea in the throat can be more resistant to treatment. If you want to know more, (or possibly need a light sedative to put you to sleep tonight), click here. But, I like to think of it like this…. If a bacteria has time to set up shop, maybe build a condo, infrastructure, malls, etc; it might require a bigger gun (AK 47 semi-automatic assault rifle rather than a bb gun) to take it out. Interestingly enough, there is some research that suggests simply using an over the counter antiseptic mouthwash not only stopped the growth of N. gonorrhoeae in lab Petri dishes but also in the throats of men with culture positive throat gonorrhea. However, more research needs to be done, so, for now, don’t count on Listerine to treat your STDs.
Wrapping “It” Up
Unfortunately, with the use of Truvada for PrEP becoming more common, increasing numbers of gay men are foregoing condoms, so other sexually transmitted infections are on the rise. Gonorrhea, chlamydia and syphilis are thought of as “easily treatable.” Unfortunately, this is the same thought process that led to the spread of HIV and AIDS in the 1980s. We, as a gay community, must take responsibility for our health and the health of our partners. Gonorrhea is increasingly showing resistance to currently available antibiotics. Consistent use of condoms has been shown to decrease your risk of gonorrhea as well as other STDs. In addition, it is important to get screened early and get screened often. Make sure to ask your health care provider to check your mouth and rectum for sexually transmitted infections. Genital warts, syphilis, herpes, gonorrhea, and chlamydia can all be present without causing any symptoms. The presence of any single, untreated STD can put you at higher risk for more serious sexually transmitted infections like HIV.
We all know there is some risk inherent in life, right? But we can do our best to minimize our risk by making good decisions. Have a discussion with your prospective partner about sexually transmitted infections. Stay in control. Strongly consider whether you want to mix alcohol or drugs with sex, which has been shown to increase risky behavior. Lastly, never let anyone convince you to compromise your health by not using a condom.