How can chlamydia and gonorrhea be transmitted

The failure of these campaigns and interventions to reduce STIs could be due to several reasons including that they are not reaching the core group, or because they are based on an incomplete understating of how infections are transmitted.

In this context, it is time to revisit our understanding of how infections are transmitted with the aim of designing new effective interventions to improve STI control. However, in the context of rising STI rates and ineffective interventions, it is important to review the transmission of both infections particularly at extragenital sites in MSM which are largely asymptomatic 24 , 25 , 26 , Other anal sexual activities such as fingering, fisting and rimming are commonly practiced among MSM and may play an important role in transmission 28 , 29 , Several epidemiological studies have found these activities are associated with the acquisition of any STIs that is, gonorrhoea, chlamydia or syphilis in MSM; 28 , 31 , 32 however, there are limited studies examining the role of these practices in the transmission of gonorrhoea and chlamydia independently.

The aim of this narrative review was to revisit the transmission of gonorrhoea and chlamydia to the oropharynx and anorectum in MSM. Several reviews have already described the prevalence and epidemiology of gonorrhoea and chlamydia, behavioural and social risk factors, and possible interventions; 1 , 4 , 17 , 33 , 34 , 35 and thus these areas will not be covered in this review. Many epidemiological studies have reported on the point prevalence of extragenital gonorrhoea and chlamydia in MSM.

Chan and colleagues published a review in summarising the prevalence of extragenital gonorrhoea and chlamydia from 53 studies Table 1 ; 17 however, these estimates vary substantially across geographical regions and study settings. Overall, the authors reported that the median prevalence of gonorrhoea at the oropharynx 4. In contrast, the median prevalence of chlamydia in the anorectum 8. Data were obtained from a review of 53 studies published by Chan et al. Oropharyngeal gonorrhoea is relatively short lived and commonly asymptomatic 7 , 25 , 37 , 38 , A natural history study of 18 individuals 12 men and six women with untreated oropharyngeal gonorrhoea has suggested that the majority of oropharyngeal gonorrhoea infections clear by six weeks and all by 12 weeks Other epidemiological studies also support the short duration of oropharyngeal gonorrhoea 24 , 38 , However, length time bias may have occurred due to the detection of prevalent infection in these studies.

Fellatio is commonly practiced among MSM that is, Summary of studies examining the route of gonorrhoea and chlamydia transmission to the oropharynx in MSM. Studies of symptoms associated with urethral gonorrhoea have been contradictory. In countries with good access to healthcare, men with symptomatic urethral gonorrhoea usually receive treatment within a few days of the onset of symptoms In this context, the point prevalence of urethral gonorrhoea is estimated to be relatively low in the MSM population approximately 0.

Indeed some investigators have hypothesized that the oropharynx may be a more important anatomical site for gonorrhoea transmission in MSM than the urethra 50 , These same investigators have undertaken a series of studies related to their hypothesis.

They undertook a study of 33 MSM with untreated culture positive oropharyngeal gonorrhoea and obtained saliva samples from these men up to 14 days after screening Furthermore, these findings raise the question of whether oropharyngeal gonorrhoea could potentially be transmitted between the oropharynges through kissing, and also between the oropharynx and the anorectum through rimming Table 2 21 , 22 , 41 , Several case reports purposed kissing could be a risk factor for oropharyngeal gonorrhoea in the s 37 , 54 , In these early studies, cases were diagnosed using culture, which has poor sensitivity and specificity for Neisseria gonorrhoeae in the oropharynx.

Rather surprisingly, there have been only three epidemiological studies conducted since using NAAT, which is a more sensitive test than culture. In the multivariable analysis, men who often engaged in insertive rimming were 1.

The second study by Cornelisse et al. Similarly, the study found that men who kissed their casual partners in the last three months were 2. However, the authors were not able to perform multivariable analysis due to high collinearity with other sexual practices.

Consistent with Templeton et al. Both Templeton et al. The third study by Chow et al. Chow et al. This was the first study identified to show kissing in the absence of sex may be an important and neglected risk factor for oropharyngeal gonorrhoea; however, this study did not measure oral sex as a separate sexual act and so could not adjust for it separately.

Although studies have shown that kissing may be a risk factor for oropharyngeal gonorrhoea in MSM, the role of saliva in gonorrhoea transmission is still poorly understood. If saliva can carry infectious gonorrhoea, it is hypothesized that men could acquire oropharyngeal gonorrhoea through kissing by contacting infectious saliva, but it is unclear how much saliva is adequate for gonorrhoea transmission.

Moreover, the salivary flow and its production vary between individuals. It is estimated that the salivary flow rate is about 0. The majority of the oropharyngeal chlamydia infections are asymptomatic in men and therefore their diagnosis primarily depends on asymptomatic screening 61 , Unlike oropharyngeal gonorrhoea, age does not seem to be a significant predictor for oropharyngeal chlamydia 62 , A number of laboratory studies have been undertaken to examine the role of saliva in oropharyngeal chlamydia transmission.

Two studies in the s found that saliva has an inhibitory effect against Chlamydia trachomatis 65 , Further studies with better technology and a more sensitive diagnostic test are important to validate whether saliva can carry chlamydia to provide a better understanding of transmission. Most men infected with gonorrhoea in the anorectum are asymptomatic; 27 however, among those with symptoms, anal discharge, pain and itching are common.

Similar to oropharyngeal gonorrhoea, younger MSM are at higher risk of acquiring anorectal gonorrhoea than older MSM 67 , Condomless anal sex is a clear risk factor for anorectal gonorrhoea 67 , 69 , But other modes of transmission may also occur.

Since these diseases can be given to other people when you have sex with them, you should notify everyone you have had sex with during the 60 days before your symptoms appeared or you were diagnosed. One of these people passed the disease on to you without knowing they had the disease. And, you could have passed the disease to others without knowing it. Notify your partner s immediately so that they can see a doctor for testing and treatment, if necessary.

Telling a partner may not be easy, but it is important that you do so. If left untreated, gonorrhea and chlamydia can cause serious permanent damage, including infertility unable to get pregnant and have children. Informing your partners gives them the opportunity to get immediate testing, and if necessary, receive treatment. Just Diagnosed? Women may have pain in the pelvic area. This can cause lower abdominal pain during intercourse, unusual menstrual pain, irregular periods, loss of weight and a general feeling of illness.

If left untreated, both diseases may cause infertility, premature birth or tubal pregnancies where the baby grows in another part of the body outside of the womb. Men may have pain or burning when they urinate.

This can cause mouth and throat symptoms, including sore throat and a cough. With chlamydia, women may experience more severe symptoms if the infection moves upward to the uterus and fallopian tubes.

This can cause pelvic inflammatory disease PID. With gonorrhea, you may also notice rectal symptoms like itching, soreness, and pain when you defecate. Both conditions are caused by an overgrowth of bacteria.

Chlamydia is caused by an overgrowth of the bacteria Chlamydia trachomatis. Gonorrhea is caused by an overgrowth of bacteria called Neisseria gonorrhoeae. Both STIs are caused by bacterial infections that are transmitted through unprotected sexual contact , meaning sex without using a condom, dental dam, or another protective barrier between you and your partner during vaginal, anal, or oral sex.

Both STIs can also be transmitted to a child at birth if the mother has either condition. Both STIs can be diagnosed using similar diagnostic methods. Your doctor may use one or more of these tests to ensure that the diagnosis is accurate and that the right treatment is given:. Chlamydia is usually treated with a dose of azithromycin Zithromax, Z-Pak taken either all at once or over a period of a week or so typically about five days.

Chlamydia can also be treated with doxycycline Oracea, Monodox. This antibiotic is usually given as a twice-daily oral tablet that you need to take for about a week. Not completing the round of antibiotics can cause you to become resistant to that antibiotic.

This can be dangerous if you contract the infection again. Avoid sex until your doctor tells you that the infection has fully been cleared by the antibiotics. Syphilis is treated with antibiotics.

If it is caught and treated early, long-term problems can be prevented. The length of treatment depends on how long you have had the infection. You may have periodic blood tests to see if the treatment is working. Sexual contact should be avoided during treatment. If you are diagnosed with syphilis, you also should be tested for HIV.

Your sex partners should be treated for syphilis. If untreated, syphilis may return in its most serious form years later. Late-stage syphilis is a serious illness. Heart problems, neurological problems, and tumors may occur, leading to brain damage, blindness, paralysis, and even death.

At any stage, syphilis can affect the brain, which can lead to meningitis , problems with hearing and eyesight, and other neurological symptoms. Telling sex partners that you have an STI and are being treated for it is called partner notification. It is an important step in treatment. When partners are treated, it helps reduce the risk of you being reinfected. You can tell your partners yourself, or you may be able to have the health care department in your state do it. If you choose to have the health department tell your partners, your name will not be used when the partner is told.

You can take steps to avoid getting chlamydia, gonorrhea, and syphilis. Know your sex partners. The more partners you or your partners have, the higher your risk of getting an STI.

Avoid contact with any sores on the genitals. Get tested every year for chlamydia and gonorrhea if it is recommended for your age group. If your ob-gyn does not offer you this screening, ask to be tested. Anus: The opening of the digestive tract through which bowel movements leave the body. Chlamydia: A sexually transmitted infection caused by bacteria. This infection can lead to pelvic inflammatory disease and infertility. Complications: Diseases or conditions that happen as a result of another disease or condition.

An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Disseminated Gonococcal Infection : An infection that may result from untreated infection with gonorrhea and can be life-threatening. Symptoms include fever, chills, skin sores, and pain in the wrists, fingers, knees, or toes.

Gonorrhea: A sexually transmitted infection that can lead to pelvic inflammatory disease, infertility, and arthritis.