Gonorrhoea (also gonorrhea) is caused by a loverly little bug — pairs of little round bacteria known as cocci. It has been around for a very, very long time and remedies are mentioned in Egyptian papyrii dated from 3500 BCE. In the Old Testament (Leviticus 15), rituals of atonement are detailed for ‘him who has a discharge and for him who has an emission of semen, becoming unclean thereby; also for her who is sick with her impurity; that is, for any one, male or female, who has a discharge, and for the man who lies with a woman who is unclean’. These rituals had to do with cleanliness, and avoidance of contaminating others for prescribed periods of time, as well as making sacrificial offerings to God.

Hippocrates, around 400 BCE, recognised that this was an affliction associated with sexual acts, but it was Galen, a Greek physician around 200 CE, who called it gonorrhoea, for ‘flow of seed’.

This disease has been called by many names — clap, drip, Jack, a dose, gleet, morning drop, running range and, most descriptively by the French from the fourteenth century, chaude pisse, or hot piss. Hot piss is very much how it feels to the poor man who attempts to empty his bladder through a urethra inflamed with gonorrhoea. Characteristically, a man will have symptoms within three to nine days of his exposure to the disease — by having sex with someone who has the clap. Only 10–15 per cent of men will not have symptoms. An affected man will first experience a burning sensation whenever he tries to take a leak and then notice a creamy drip from his penis. How much drip there is can vary from person to person.

Left untreated, the disease will invade farther up into the urethra and into the neck of the bladder and the prostate. He will feel that he has to pee all the time and urgently — no delay or he may wet himself. As the disease progresses, the urine may be blood-tinged. By contrast, a woman may have few symptoms other than an increase in her vaginal discharge, with or without a little burning, which she may think is a variation on normal. If the illness spreads upward through the uterus into the Fallopian tubes, the woman is usually quite ill with pelvic inflammatory disease (PID) and sterility may result.

Emma was a young mother in her thirties. She used the family planning clinic for her women’s health needs and had had a routine STD screen done with her annual Pap smear. To her doctor’s consternation, Emma’s culture came back positive for gonorrhoea. She was notified to come in for treatment and the clinic nurse told her that her husband should also come for testing and treatment. Emma denied any other sexual partners. The day of her appointment came and so did Joseph, Emma’s husband. Joseph was more than irate; he was dangerously angry — with the clinic staff ! ‘How dare you say that I gave this to my wife. Your tests must be wrong. Or else she got it from a toilet seat. It couldn’t be me, I’m perfectly OK.’ Now, you know, that old toilet seat possibility just isn’t on — the organism doesn’t survive outside a warm human body.

Emma had always struck the nurse as a very meek soul, but the following week she brought a muchchastened Joseph back to the clinic. Seems that Joseph goes out of town every week to sell hairdressing products and a few weeks back he was stuck overnight with a broken-down vehicle and, well . . . his hotrod had been where it shouldn’t have gone. As it happened, he had some dental work a few days after he returned from that trip and a dose of penicillin to cover it must have also treated the disease for him — but not before he had infected his wife. It was just lucky for Emma that her checkup was scheduled at this time.

Does gonorrhoea go other places in the body? You bet. Keith was a young bartender who came into Emergency once where Michele was working, complaining of a hugely swollen and hot knee and generally not feeling well. All of the causes of an acute arthritis were thought of and tested for but the payoff was the fluid drawn off Keith’s knee. When it was stained in the lab and looked at under the microscope, there were all those cute little red bacteria, two by two, in the white cells. This wasn’t too surprising — gonococcal arthritis is the commonest manifestation of gonorrhoea outside the sexual organs. Less commonly, and much more seriously, gonococcal meningitis or pericarditis or hepatitis can occur, or a bloodborne septicemia (blood poisoning). These are very serious illnesses, but are fortunately much less common than garden variety gonorrhoea.

More common, and often overlooked, are infections in the mouth or anus. These are also nice moist mucous membranes and the little gonococci love warm, moist environments. In fact, they can’t live in environments that aren’t warm and moist — hence, no toilet seats.

Some rash young men may find that they have a rash, as well as the other symptoms we’ve mentioned. In fact, Keith had a rash and this helped alert Michele to tap his knee and stain the fluid to look for Neisseria gonorrhoea — the proper name for this bacterium.

Since 1937, when sulfonamides were first introduced, we have had effective treatment for gonorrhoea. Before that, many things were tried in centuries past and some seemed to have low-level efficacy, while others were harmless at best and dangerous at worst. Washing with gin was one measure thought to prevent infection and may have been mildly effective. In the 1950s, we found that penicillin was incredibly successful in treating gonorrhoea, with one test subject being infected and cured three times in one week. (We hope he had the fun as well as the infection.) However, in the 1960s and 1970s, there were world pandemics of gonorrhoea and resistance to penicillin and sulfonamides resulted. Penicillin is still the drug of choice for non-resistant gonorrhoea, but other antibiotics may need to be used.

It is very important that any discharge from the penis be investigated; this usually involves a swab being taken for staining and culture, but there is also a simple urine test available now. In most Western countries, gonorrhoea is a reportable illness by law, so any positive test results are automatically sent to your local Department of Health. A public health worker will contact you to find out who may have infected you and to whom you may have passed this little goodie. No one will be penalised, but attempts will be made to ensure that everyone receives treatment. Also, sexually transmitted diseases are good bed fellows with one another, so testing for syphilis, chlamydia and HIV is a good idea. Transmission of gonorrhoea following a single sex act is 50 per cent male to female, and 20 per cent female to male.

Condoms — male or female — can prevent the spread of gonorrhoea. It is also necessary for us to overcome shyness about these issues and talk frankly with our partners . . . and of course, it helps to know your partner for a while, although that is not always adequate insurance, as Emma’s story demonstrates.