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The disease called gonorrhoea

Written by Sylvester Ikhisemojie - The Punch, Nigeria.

Sylvester Ikhisemojie
Gonorrhoea is a sexually transmitted disease and it is probably as old as man. The most common way to get the infection is through a sexual act. It thus affects both men and women. No age is exempt from the newborn to the elderly. Newborns will usually get the infection from the birth canal of their infected mothers during delivery. However, the disease is most often seen in people between the ages of 15 and 30, the age in which people are most sexually active and also tend to engage in risky sexual behaviour. It is a bacterial infection caused by an organism known as Neisseria gonorrhoea. It is contagious but may actually cause no symptoms at all especially in women.

It passes from one person to another, outside of the newborn period, in those people engaging in unprotected vaginal, oral and anal sexual relations. It has a tendency to infect the mucous lining of the warm, moist areas of the body where the bacteria reproduce and multiply rapidly and thus includes the following parts of the body;

1) The vagina

2) The anus

3) The throat

4) The eyes

5) The urethra, which is the tube that allows urine to pass out of our bodies from the urinary bladder

6) The female reproductive tract made up of the fallopian tubes, uterus and cervix, the neck of the womb.

The people who have multiple sexual partners and those who do not use the condom are the ones at the greatest risk of contracting the infection. It is reasonable to deduce, therefore, that the best way to avoid this troublesome infection is to abstain from sex if one is unmarried or if one is married, to have only the civil partner as the exclusive sexual partner.
Certain forms of conduct that make persons more prone to exposure to this infection include alcohol abuse and illegal drug use.

It is because this disease has been associated with man for a long time that it was given strange names in a variety of countries. In the United States, it is commonly called the "clap" whereas in the United Kingdom, it is known as the "drip."

In different parts of Nigeria, it is known as "woman's disease" which is strange because more men experience the symptoms than women. In other parts, especially among younger people who catch the disease, it is called "gono."

From the mid 1930s, when the discovery of first, Penicillin, and later other antibiotics began to be widely used, this disease appeared to have its days numbered. There was a sharp decline in new cases and there was a cure for the ones which were already diagnosed. In many parts of West Africa, however, native healers and sorcerers made various concoctions for people to drink in the attempt to treat the disease. In some places, metal tubes were placed in open fires and the hot implements were forced into the male urethra with often sorry consequences.

That disease which seemed to be in retreat, has now staged a comeback due mainly to the emergence of resistant strains and the indiscriminate use of antibiotics often in the wrong dosage or for inadequate periods of time. In England and Wales, there has been a 15 per cent jump in the appearance of new cases in the period between 2012 and 2013 alone. Here at home, there are no figures available other than estimates, but it is clear to many clinicians that there is an upswing in the number of new cases being recorded across the country and they are becoming increasingly difficult to treat.

The symptoms of this disease are seen within two to 14 days after exposure to it. And although many people who have the disease may never even exhibit any symptoms that may be noticeable, such persons remain contagious and able to spread the bacteria when they engage in unprotected sex. The likelihood of developing these symptoms is dependent partially on one's gender. Men who have got the infection are more likely than women to have the symptoms that are specific for the sexes. Whereas about 90 per cent of men with gonorrhoea will have symptoms which make it easier to identify the infection, only about 30 per cent of women will exhibit any symptoms. In women, it can thus be very difficult to recognise because some of its symptoms are so similar to those of many other sexually transmitted infections.

The features of gonorrhoea in men may include the following which may not appear for several weeks. Some men may never even develop symptoms. The common symptoms are;

1) There is a greater frequency and urgency of passing urine.

2) There is a pus-like discharge, called the drip, from the penis and it may be white, yellow or somewhat greenish.

3) There may be a swelling around the the opening of the penis, the urethral meatus, or it may become reddish.

4) There could be pain or swelling within the testes.

5) There may be a persistent sore throat which should prompt your doctor to examine the throat and take swabs for laboratory analysis.

6) There may also be chills.

7) Sometimes, there may be pain within the anus if the infection has spread to the rectum, the part of the large intestine just sitting above the anus.
The rare symptoms of this disease, which may not appear for several months or even years, include the following features;
1) The disease may get into the joints causing severe inflammation there and making movement difficult and painful because arthritis has developed in the affected joint or the tendons around the joint have become inflamed causing tendinitis.
2) It can cause a skin rash on the chest, palms and limbs.
3) It can cause flu-like symptoms with chills and fevers becoming an almost constant companion.

The common features of this disease in women are somewhat different than what men experience. Sometimes, it may be mistaken for fungal infections caused by yeasts or by other bacterial infections. These include the following:
1) Pain or a burning sensation while urinating.
2) The need to urinate more frequently.
3) Discharge from the vagina which may be similar to the discharge seen in males.
4) A persistent sore throat
5) Fever
6) Pain once intercourse is started

Although many women may have no symptoms at all and others may manifest some of the features itemised above, the symptoms are in general, of a mild nature. In some women, however, there is an associated dull pain in the lower part of the abdomen that constantly worsens over time. After a while, it becomes so severe that such women may become almost demented with pain, suffering often with no inhibitions, and almost as though they were drunk.
It gets pretty worse as most of the complications are also borne by women. These include problems like:
1) Progressive damage especially to the fallopian tubes
2) Infertility
3) The risk of suffering from an ectopic pregnancy and the further danger in such an unusual pregnancy getting ruptured and the attendant hazard of the threat to life which such an event poses.
4) Pelvic inflammatory disease which can be so severe, so merciless, that it leaves the entire pelvis frozen with most of the structures in that region being unable to undertake natural movements.

Men may develop mainly a certain kind of scarring of the urethra, the structure which passes urine from the bladder and out of the body. Men and women can also suffer some rather rare but varied serious complications such as damage to the heart valves; inflammation of the lining of the brain or spinal cord leading to meningitis in addition to the earlier mentioned complication of arthritis.

The diagnosis of this miserable disease is possible in a variety of ways. It is commonly done here at home by obtaining swabs from the affected part of the body such as the eyes, the urethra, the vagina, the anus or the throat and sending such swabs to the laboratory for culture. This means growing the bacteria in a culture medium. However, there are errors to which this is prone because the sampled area may not have any of the bacteria being sought even when the person evidently has the infection. Other methods include the use of DNA probes to identify the genetic material of the bacteria. This is a lot more accurate and they also yield more rapid results than cultures but are very expensive and so generally beyond the reach of the average Nigerian.

Ask the doctor

Dear doctor, I am a man and I will be 45 in April. I used to feel waist pain when I bend down or when I want to stand up from the bed. Also sometimes when I bend down, I used to feel pain in my left knee. A doctor I visited asked if I used to play football to which I answered in the affirmative. He then prescribed calcium for me which I have been taking. Recently, I felt the pain again. It was difficult for me to rise up from the bed. What is happening to me? 

There is the possibility that you are suffering from a kind of arthritis seen usually in the back, within the bones of the spine and caused by a degenerative disease of the spine. That in turn may be brought about either by disease, previous injury of simply by wear and tear. Certainly, the use of calcium will not provide you with the cure and may even worsen the condition. You must see an Orthopaedic surgeon without further delay for an exhaustive examination and appropriate treatment. In the meantime, and before you see him, please stop using the Calcium supplements.

Dear doctor, thanks for your concern on public health. May God bless you. Please, I am 63 years old and diagnosed with benign prostatic enlargement. The doctor prescribed Atorvastatin and Tamsulosin for me. Please, when will my situation normalise or is the medication for life? Thank you very much. 

Thank you very much for your words of appreciation. Atorvastatin is a cholesterol lowering drug used to treat people with high levels of cholesterol in their blood and people who have diabetes, heart disease or other risk factors to reduce their risk of suffering a stroke. So you may have any of these conditions which is why you are on it. With regular checkups at your doctor's office, he will determine when to reduce the dose of the drug or to stop it depending on what your results show. It is not likely for you to use it for life. Tamsulosin on the other hand is a drug which should help you urinate with some more ease. You will have to take that one for as long as you live. However, the dosage may often be reduced or otherwise varied depending on the judgment of your doctor.

Dear doctor, I have always taken to your advice. I suffered (offensive breath) and I have never smoked. I was diagnosed with chronic halithosis and rhinitis at Eko Hospital and treated. But I think it is not totally cured. Please advise me on what to do. 

That is very humbling to know. I believe what you must now do is return to Eko Hospital for a thorough re-evaluation. It is not usual to absolutely cure a chronic infection with the first combination of therapeutic measures. Very often, such treatment is administered, then followed up and treated with some more treatments, until it is certified to be gone.

Dear doctor, you are doing a marvellous job. Please keep it up. May the good Lord continue to strengthen and enlarge you in Jesus' name. I am avid reader of your column which is a must read every Sunday. I went through a left-sided hernia operation about 20 months ago and it healed well and quickly too. But surprisingly, there is another one on the way. Otherwise, I am fairly healthy, not diabetic or hypertensive. What are the implications of a second operation in two years? Can I continue to keep it? It hardly gives any pain. I am 76. Thank you and remain lifted in Jesus' name. 

Thank you very much sir. It is a pleasure to read from you too. There are no implications of having this operation done for the second time in two years. It is safer to do so than having to deal with any complications which might occur without prior warning. On that basis, I will advise that you have the hernia operated to remove the risk. When a hernia begins to cause pain, trouble is on the way.

Dear doctor, I want to ask if it is possible for a lady to be pregnant and still be menstruating. 

Yes, it is possible for that to happen. The conventional wisdom is that when a woman gets pregnant, her menstrual period should stop but nothing surrounding a pregnancy is cast in stone. What is more frequent though is that a pregnant woman may have some spotting during pregnancy which eventually stops but there are women who have regular periods all through their pregnancies.

Dear doctor, thank you for your articles in the last three Sundays in SUNDAY PUNCH. From the test I did, it was revealed that I have fatty tissues in my liver. Please is that a liver disease? I was placed on Livolin capsules which I have been taking over the last three months. I am 68 years old. Expecting your response. Thank you.

Thank you also for thanking me sir. Yes, having fat in your liver is a disease which is why you are being placed on medications. A rather quicker way to deal with that particular problem provided there is no other major disease which may be accelerating it is to cut down on the volume of fat, carbohydrates and sugar you consume in your food and conduct more physical exercises.

Dear doctor, thank you for your article titled, "More facts about liver disease." I am a hepatitis patient at the Lagos University Teaching Hospital, LUTH. Next time in your write-up, please dwell on the treatment and the food one should avoid. I was asked to avoid beans, groundnuts, oil, alcohol, meat, eggs, fried foods etc. but some medical journals encourage one to eat some of these foods for protein which the body needs. Or what is do you advise me to do? Thank you. 

A number of factors may be responsible for that. In those journals you are reading the people are mostly hepatitis patients who never become as sick as many of our patients are here. They report early to the hospital and get prompt treatment. At that time when there has not occurred any significant liver damage, such is the advice you would get. In contrast, many of the patients we see here report late to the hospital, are very ill at the time the diagnosis is made with severe jaundice and some of the other features mentioned in that article so that very drastic measures usually have to be taken if the person is to have a chance of overcoming the disease. That is the key factor.

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