A new alarm has been raised from Treviso: a gentleman returning from a trip to Thailand has reported a gonorrhea infection. They write in the local and national press that he went overboard on the subject of "mercenary relationships" in that country, infamous for sex tourism. The souvenir unfortunately proved rather bitter for him. An infection that seems to have given a very troublesome localization: a septic gonococcal arthritis of a leg joint. This case also has the peculiarity that the isolated microorganism is resistant to many antibiotics.
Connorrhea is caused by Neisseria gonorrheae a Gram-negative microorganism that is sexually transmitted. Let's look at the differences in symptoms and related complications between women and men:
- In women, the main clinical manifestation is urethritis, with burning and difficulty urinating, or cervicitis with greenish-yellow discharge, pain during or after sexual intercourse, vaginal itching, and/or difficulty urinating. Complications: Neisseria gonococcus infection can reach the ovaries and abdominal cavity, leading to peritonitis;
- In men, gonorrhea manifests as urethritis with profuse, thick, greenish-yellow discharge, burning and difficulty urinating. Complications: the most common and fearsome of gonorrhea is epididymitis. It is an inflammation that can be painful and, when neglected, can lead to infertility.
In 1% of cases, especially in debilitated and immunocompromised individuals, the bacterium responsible for gonorrhea can enter the bloodstream, causing septicemia, and affect the joints, causing gonococcal arthritis. There is also no shortage of cases of conjunctivitis associated with gonorrhea.
But there is precisely that additional problem that requires general attention. According to the European Centre for Disease Prevention and Control (ECDC), the bacterium Neisseria gonorrhoeae has also begun to show resistance to first-line antibiotic treatments. The first three cases were highlighted in Europe two years ago in the UK (one) and Australia (two), in all cases characterized by a high level of resistance to both azithromycin and ceftriaxone.
"The biggest problem is that the germ is becoming increasingly resistant to antibiotics, consequently antibiotic treatment is also becoming more difficult and complex," warns Pier Giorgio Scotton, who heads the Infectious Diseases Unit at Treviso Hospital.
The emergence of resistance phenomena for the bacterium Neisseria gonorrhoeae could also pose a risk to Europe, where 75,000 cases of the disease, which ranks second among sexually transmitted infections (STIs), were reported in 2016.
We therefore emphasize the risk for travelers to contract this disease, which has this marked resistance to multiple antibiotic therapies. The advice is to do proper counseling in Travel Medicine Clinics before traveling and to always preempt, however, the use of condoms when coinciding with sexual interludes with casual partners of any kind.
