Introduction

Chlamydia and gonorrhea are the two most common bacterial sexually transmitted infections (STIs). This means that both these infections are most commonly transmitted from one person to another through unprotected sex acts -vaginal, oral, or anal.

They can also be transmitted through nonsexual ways such as from an infected mother to the baby or through transfusion of infected blood.

Both these common STDs have symptoms that are similar and many a time it may be difficult to differentiate one from another.

Secondly, both these diseases often coexist. A study found 20% of men and 42% of women with gonorrhea were also infected with chlamydia.

If STDs are left untreated, these infections can lead to short-term and long-term complications with serious ramifications.

If you’re sexually active, you must screen yourself for STDs once every six months. Even people in monogamous relationships should screen themselves once every year.

Regular screening for STDs helps in early diagnosis and prompt treatment. Fortunately, there are antibiotics that completely cure both gonorrhea and chlamydia.

This article compares the causes, symptoms, complications, screening guidelines, and treatment criteria for gonorrhea and chlamydia. It points out the similarities and differences between these STDs.

The United States has the highest prevalence of sexually transmitted diseases among developed countries.

According to a study estimate, 45 and 77% of all cases of gonorrhea and chlamydia, respectively, never exhibited symptoms.

As a result, 86 and 95% of cases of gonorrhea and chlamydial infection, respectively, remained untreated because they were asymptomatic.

Causes and risk factors

Both gonorrhea and chlamydia, are bacterial infections. Gonorrhea is caused by the Neisseria gonorrhoeae bacterium while chlamydia is caused by the Chlamydia trachomatis bacterium.

Any sexually active person can become infected, but there are some risk factors that make you more prone to catch the STD infection.

The risk factors that make you prone to get gonorrhea and chlamydia include:

  • Unprotected sex
  • Being in the young age group below the age of 25 years
  • A habit of multiple partners
  • Visiting prostitutes
  • Homosexual men
  • A high STD-risk lifestyle
  • Drug users
  • Ethnicity.  STD infections like gonorrhea are seen more in African Americans than the general population.
  • Decreased immunity
  • Please note that pregnancy does not increase your risk.

Risk of catching gonorrhea by single unprotected sexual intercourse

  • A man who has vaginal intercourse with an infected woman has a 20% risk of catching gonorrhea through a single intercourse.
  • In homosexual men, the risk is higher.
  • A woman has a 60% to 80% risk of getting this disease with a single act of vaginal intercourse with an infected man.

Risk of chlamydia infection from one unprotected sexual encounter

The quantum of risk varies in men and women. It is:

  • In men: 20%
  • In women: 40%

Symptoms

Symptoms of gonorrhea in women

Gonorrhea symptoms include:

  • Burning sensation while passing urine
  • Increased frequency of urination
  • Purulent (greenish-yellow or whitish) discharge from the vagina.
  • Lower abdominal (pelvic) pain
  • Vulvitis (swelling of the labia)
  • Irregular vaginal bleeding
  • Burning in the throat and swollen glands in the neck from oral sex with an infected person with gonorrhea
  • Painful bowel movements, anal discharge, and itching due to anal sex with an infected person
  • Dyspareunia is painful sexual intercourse

Symptoms of gonorrhea in men

  • Burning urination
  • Increased frequency of passing urine
  • Purulent discharge from the penis
  • Sore throat and swollen glands in the neck due to oral sex
  • Testicular pain and swelling

Symptoms of chlamydia in women

Due to a vaginal infection

  • Low-grade fever
  • Abnormal vaginal discharge
  • Yellowish discharge from the cervix that has a strong odor
  • Burning urination
  • Painful menstruation with more bleeding
  • Irregular bleeding in between periods
  • Sex is painful and causes bleeding
  • Burning around the vagina
  • Increased frequency of urine
  • Lower abdominal pain

Symptoms of rectal infection from anal sex

  • Rectal pain
  • Anal discharge
  • Swelling around the anus
  • Bleeding from the anus

Symptoms of chlamydial infection of the throat due to oral sex are rare

  • Soreness of throat
  • Pain while swallowing
  • Cough
  • Fever

Chlamydia symptoms in men

  • Discharge from the penis can be clear or cloudy. It is less cloudy and less in quantity when compared to the gonorrhea discharge.
  • Burning urination
  • Burning and itching around the urethral opening on the penis
  • Swelling and pain around the testicles
  • Low-grade fever
  •  Swelling around the anus due to receptive anal sex

 Complications

Complications of gonorrhea in men

  • Scarring in the urethra
  • Epididymitis is a painful condition in which the epididymis, situated on the rear side of the testicles, gets inflamed. It can lead to sterility.
  • Prostatitis is inflammation of the prostate. It can lead to abnormalities in semen and sterility.
  • Untreated gonorrhea greatly increases your risk of developing cancer of the urinary bladder.

Complications in women

  • Irregularity in the menstrual cycle with bleeding in-between periods
  • Untreated gonorrhea can give rise to pelvic inflammatory disease (PID) causing chronic pain in the lower abdomen. PID is a major cause of infertility in women.
  • Endometritis is inflammation of the inner lining of the uterus.
  • Infection in the fallopian tubes and the ovaries can give rise to a tube-ovarian abscess.
  • An untreated vaginal infection can cause inflammation of the Bartholin glands, which can cause a cyst. These are glands near the vaginal opening, which help to lubricate the vagina. Their blockage can cause vaginal dryness.

Complications during pregnancy

  • Infection of the amniotic sac causes the sac to rupture or leak.
  • Preterm labor
  • Miscarriage
  • Premature delivery

Complications in the newborn

  • Conjunctivitis is the most common complication in newborns (gonococcal ophthalmia neonatorum).
  • Sepsis – infection of the blood
  • Arthritis due to the transport of gonococcal bacteria to the joints
  • Meningitis is an infection of the protective membranes that cover the brain and the spinal cord.

Long-term complications of gonorrhea

  • DGI. In untreated gonorrhea, the infection spreads through the bloodstream and travels through the body.  This is called disseminated gonococcal infection (DGI).
  • Arthritis. Infection of the joints causes stiffness, pain, and swelling of the joints (arthritis). The joints of the hand and the knee are most commonly affected by gonococcal infection. The proximal tendons too can get inflamed.
  • Blood sepsis. Widespread infection of the blood causes blood sepsis. If not treated, it can result in multi-organ failure and death.
  • Endocarditis. Infection spreading to the heart causes endocarditis. This is an infection of the heart valves and the inner lining of the chambers of the heart. If left untreated, the endocarditis infection can spread to other organs in the body through the blood and can cause organ failure.
  • Cellulitis. Infection spreading to the skin can cause cellulitis wherein the skin becomes swollen; there is the formation of skin rash, sores, pus, fever, and malaise.
  • Meningitis. The membranes that contain the fluid surrounding the brain and the spinal cord become infected.
  • In all the above complications, fever is a common symptom.

Chlamydia complications common in both men and women

  • Having chlamydia increases your risk of acquiring other sexually transmitted diseases like HIV (AIDS virus) and gonorrhea.
  • Reactive arthritis causes inflammation of the joints. Referred to as Reiter’s syndrome, it can comprise a triad of symptoms including urethritis (inflammation of the urethra) and conjunctivitis (inflammation of the eyes).

Complications in women

  • Pelvic inflammatory disease (PID) is a serious infection of the pelvic reproductive organs of a woman. These organs are the ovaries, the fallopian tubes (salpingitis), the uterus (endometritis), and the cervix (cervicitis).
  • Swelling of Bartholin’s glands (Bartholinitis). These are the glands situated on both sides of the vaginal opening. Chlamydia infection causes these glands to become infected leading to their blockage and swelling, leading to cyst formation. If infected, it can result in an abscess.

Complications in men

  • Urethritis is an infection of the urethral canal.
  • Epididymitis is the infection of the epididymis. At times, the testicles may also get infected. This is called epididymo-orchitis.
  • The prostate, another important organ of the male reproductive system, makes the fluid part of the semen. It is situated beneath the urinary bladder. Chlamydia can cause prostatitis
  • Sterility is another effect of chlamydia that can arise as a result of long-standing epididymitis and/or prostatitis. However, if treated early, this complication is reversible.

Complications in pregnancy and newborn

Chlamydia complications in pregnancy include

  • preterm labor
  • miscarriage
  • ectopic pregnancy
  • chronic pelvic pain due to damage to the pelvic organs.
  • After delivery, the uterus of the woman gets infected causing late postpartum endometritis (infection of the inner lining of the uterus).

Complications in newborn

The newborn delivered naturally through the vaginal canal gets exposed to the infection and it can develop complications such as

  • eye infection (conjunctivitis),
  • ear infection (otitis media),
  • infection of the nose and throat and lung infection (pneumonia).

Diagnosis

Both gonorrhea and chlamydia are diagnosed using similar diagnostic tests. One or more of these tests are done to ensure that the diagnosis is accurate and that the right treatment is given:

  • physical examination to look for symptoms
  • urine test to test your urine for the bacteria that cause chlamydia or gonorrhea
  • blood test to test for signs of bacterial infection
  • The culture of the swab sample taken from the urethra, vagina, anus, or throat is tested in the lab to look for the relevant bacteria.

Treatment

Chlamydia and gonorrhea, being bacterial infections require treatment with antibiotics.

Neither can be effectively treated at home. It requires the choice of the right antibiotic, which your health provider will decide.

Your provider will likely recommend retesting after you finish the complete course of antibiotics.

In addition, your health provider may recommend testing for other STIs. He will also recommend abstaining from sex for at least one week after finishing treatment.

  • The best treatment for gonorrhea is an injection of the antibiotic ceftriaxone followed by an oral course of another antibiotic (usually azithromycin or doxycycline).
  • Chlamydia is generally treated with a single dose of oral azithromycin or a prescription of oral doxycycline that is taken twice a day for one week.

Prevention

Both infections are sexually transmitted, which means they can spread through unprotected vaginal, oral, and anal sex.

Abstinence can eliminate your risk of getting either disease, but may not be practical. Practicing safe sex with the use of protection is often a more practical preventive measure.

To prevent getting these infections during sex, use latex condoms. They also reduce the risk of catching other STIs.

In addition, being monogamous with a partner who has been tested for all STIs will ensure prevention.