gleet n : a thin morbid discharge as from a wound or especially chronic gonorrhea
- obsolete except Scots Stomach mucus, especially of a hawk.
- obsolete except Scots Any slimy, viscous substance.
- vulgar slang A
urethral discharge, especially as a
symptom of gonorrhoea.
- 1980, ‘There was this Estella, a real drab, being given syph and gon and gleet by Augustus John, and Tommy has her living with him in that place of his in Earl’s Court and going to a doctor, nothing wrong with her actually but there might well have been, and he never touches her, you know.’ — Anthony Burgess, Earthly Powers
Gonorrhea (also gonorrhoea) is amongst the most common sexually transmitted diseases in the world, caused by Neisseria gonorrhoeae.
Non-genital sites in which it thrives are in the rectum, the throat (oropharynx), and the eyes (conjunctivae). The vulva and vagina in women are usually spared because they are lined by stratified epithelial cells—in women the cervix is the usual first site of infection. Gonorrhea spreads during sexual intercourse. Infected women also can pass gonorrhea to their newborn infants during delivery, causing eye infections (conjunctivitis) in their babies (which if left untreated, can cause blindness). Doctors have often attempted to treat this immediately by applying small amounts of silver nitrate or other antibiotic to the eyes of all newborn babies.
Symptoms of gonorrheaThe incubation period is 1 to 10 days with most symptoms occurring between the second and fifth days after being infected. A small number of people may be asymptomatic for up to a lifetime. Between 30–60% of monkeys with gonorrhea are asymptomatic or have subclinical disease. Women may complain of vaginal discharge, difficulty urinating (dysuria), projectile urination, off-cycle menstrual bleeding, or bleeding after sexual intercourse. The cervix may appear anywhere from normal to the extreme of marked cervical inflammation with puss. Possibility of increased production of male hormones is common in many cases. Infection of the urethra (urethritis) causes little dysuria or pus. The combination of urethritis and cervicitis on examination strongly supports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients. Gonorrhea is caused by the Neisseria gonorrhoeae bacteria. The infection is transmitted from one person to another through vaginal, oral, or anal sexual relations.
Men have a 20% chance of getting the infection by having sexual relations with a woman infected with gonorrhea. Women have a 50% chance of getting the infection by having sexual relations with a man infected with gonorrhea. An infected mother may transmit gonorrhea to her newborn during childbirth.
Less advanced symptoms, which may indicate development of pelvic inflammatory disease (PID), include cramps and pain, bleeding between menstrual periods, vomiting, or fever. It is not unusual for men to have asymptomatic gonorrhea. Men may complain of pain on urinating and thick, copious, urethral pus discharge (also known as gleet) is the most common presentation. Examination may show a reddened external urethral meatus. Ascending infection may involve the epididymis, testicles or prostate gland causing symptoms such as scrotal pain or swelling.
ComplicationsIn men, inflammation of the epididymis (epididymitis), prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea..
In women, the most common result of untreated gonorrhea is pelvic inflammatory disease, a serious infection of and tenosynovitis in fingers, wrists, toes or ankles. This should be evaluated promptly with a culture of the synovial fluid, blood, cervix, urethra, rectum, skin lesion fluid, or pharynx. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.
The mainstay of treatment is the appropriate use of antibiotics. While penicillin was the most common antibiotic used to treat gonorrhea up until the 1970s, an increase in antibiotic resistance has led to a decline in its use. Recommendations for first choice treatment of gonorrhea must depend on local information on resistance patterns and it is not possible to make treatment recommendations that are applicable to all parts of the world.
The Centers for Disease Control and Prevention (CDC) released a report on Thursday, April 12, 2007 officially adding gonorrhea to a list of super bugs that are now resistant to common antibiotics according to CDC.
Antibiotics that may be used to treat gonorrhea include:
- Amoxicillin 2 g plus probenecid 1 g orally
- Ampicillin 2 to 3 g plus probenecid 1 g orally
- Azithromycin 2 g orally
- Cefixime 400 mg orally
- Cefotaxime 500 mg by intramuscular injection
- Cefoxitin 2 g by intramuscular injection, plus probenecid 1 g orally
- Cefpodoxime (Vantin) 400 mg orally
- Ceftriaxone (Rocephin) 125 to 250 mg by intramuscular injection
- Ciprofloxacin 500 mg orally
- Levofloxacin 250 mg orally
- Ofloxacin 400 mg orally
- Spectinomycin 2 g by intramuscular injection
The level of tetracycline resistance in Neisseria gonorrhœae is now so high as to make it completely ineffective in most parts of the world.
The fluoroquinolones (penisciprofloxacin, ofloxacin, levofloxacin) cannot be used in pregnancy. It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected with gonorrhea. Patients should also be offered screening for other sexually transmitted infections. In areas where co-infection with chlamydia is common, doctors may prescribe a combination of antibiotics, such as ceftriaxone with doxycycline or azithromycin, to treat both diseases.
Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria within the rectum produce β-lactamases that destroy penicillin. All current treatments are less effective at treating gonorrhea of the throat, so the patient must be rechecked by throat swab 72 hours or more after being given treatment, and then retreated if the throat swab is still positive.
Although gonorrhea usually does not require follow-up (with the exception of rectal or pharyngeal disease), patients are usually advised to phone for results five to seven days after diagnosis to confirm that the antibiotic they received was likely to be effective. Patients are advised to abstain from sex during this time.
Drug resistant strains are known to exist.
United States recommendations
The United States does not have a federal system of sexual health clinics, and the majority of infections are treated in family practices. A third-generation cephalosporin antibiotic such as ceftriaxone is recommended for use in most areas. Since some areas such as Hawaii and California have very high levels of resistance to fluoroquinolone antibiotics (ciprofloxacin, ofloxacin, levofloxacin) they are no longer used empirically to treat infections originating in these areas.
Since 1993, fluoroquinolones (i.e., ciprofloxacin, ofloxacin, or levofloxacin) have been used frequently in the treatment of gonorrhea because of their high efficacy, ready availability, and convenience as a single-dose, oral therapy. Beginning in 2000, fluoroquinolones were no longer recommended for gonorrhea treatment in persons who acquired their infections in Asia or the Pacific Islands (including Hawaii); in 2002, this recommendation was extended to California (2). In 2004, CDC recommended that fluoroquinolones not be used in the United States to treat gonorrhea in men who have sex with men (MSM). On the basis of the most recent evidence, CDC no longer recommends the use of fluoroquinolones for the treatment of gonococcal infections and associated conditions such as pelvic inflammatory disease (PID). Consequently, only one class of drugs, the cephalosporins, is still recommended and available for the treatment of gonorrhea.
The Center for Disease Control has recently (April 2007) updated treatment guidelines. http://www.cdc.gov/std/treatment/2006/updated-regimens.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm?s_cid=mm5614a3_e
Antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. Because many people with gonorrhea also have chlamydia, another sexually transmitted disease, antibiotics for both infections are usually given together. Persons with gonorrhea should be tested for other STDs. It is important to take all of the medication prescribed to cure gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea. If a person's symptoms continue even after receiving treatment, he or she should return to a doctor to be reevaluated.
United Kingdom recommendationsIn the United Kingdom, the majority of patients with gonorrhea are treated in dedicated sexual health clinics. The current recommendation is for ceftriaxone or cefixime as first line therapy; no resistance to either drug has yet been reported in the UK. Levels of spectinomycin resistance in the UK are less than 1%, which would make it a good choice in theory, but intramuscular spectinomycin injection is very painful.
Azithromycin (given as a single dose of 2 g) is recommended if there is concurrent infection with chlamydia. A single dose of oral ciprofloxacin 500 mg is effective if the organism is known to be sensitive, but fluoroquinolones were removed from the UK recommendations for empirical therapy in 2003 because of increasing resistance rates. In 2005, resistance rates for ciprofloxacin were 22% for the whole of the UK (42% for London, 10% for the rest of the UK).
HistoricallyHistorically it has been suggested that mercury was used as a treatment for gonorrhea. Surgeons tools on board the recovered English warship the Mary Rose included a syringe that, according to some, was used to inject the mercury via the urinary meatus into any unfortunate crewman suffering from gonorrhea. Silver nitrate was one of the widely used drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün invented this type of colloidal silver which was marketed by Bayer from 1897 on. The silver-based treatment was used until the first antibiotics came in use in the 1940s.
PrevalenceGonorrhea is a very common infectious disease. The CDC estimates that more than 700,000 persons in the United States get new gonorrheal infections each year. Only about half of these infections are reported to CDC. In 2004, 330,132 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113.5 per 100,000 persons.
Slang termsGonorrhea is also commonly known by the slang term the clap.
- Reference to a traditional treatment used to clear the blockage in the urethra from gonorrheal pus, where the penis would be "clapped" on both sides simultaneously.
- Reference to the painful sting in the male urethra, which feels like the sting of a clap (as in clapping hands) when infected with the disease.
- From the old French word "clapier", meaning "brothel".
The term the clap was replaced with the similar sounding the jack in the 1975 AC/DC song The Jack, which used the metaphor of playing cards and poker as sexual innuendo in the original LP version. However, live recordings of the song make direct references to the disease.
gleet in Arabic: سيلان (مرض)
gleet in Bulgarian: Гонорея
gleet in Catalan: Gonocòccia
gleet in Czech: Kapavka
gleet in Danish: Gonoré
gleet in German: Gonorrhoe
gleet in Dhivehi: ކިހުނުވުން
gleet in Estonian: Gonorröa
gleet in Spanish: Gonorrea
gleet in Esperanto: Gonoreo
gleet in Basque: Gonorrea
gleet in Persian: سوزاک
gleet in French: Gonorrhée
gleet in Korean: 임질
gleet in Indonesian: Kencing nanah
gleet in Italian: Gonorrea
gleet in Hebrew: זיבה
gleet in Kazakh: Соз
gleet in Latin: Gonorrhoea
gleet in Lithuanian: Gonorėja
gleet in Hungarian: Kankó
gleet in Malay (macrolanguage): Gonorea
gleet in Dutch: Gonorroe
gleet in Japanese: 淋病
gleet in Norwegian: Gonoré
gleet in Norwegian Nynorsk: Gonorré
gleet in Low German: Drüpper
gleet in Polish: Rzeżączka
gleet in Portuguese: Gonorréia
gleet in Russian: Гонорея
gleet in Simple English: Gonorrhea
gleet in Slovenian: Gonoreja
gleet in Serbian: Гонореја
gleet in Finnish: Tippuri
gleet in Swedish: Gonorré
gleet in Tamil: கொணோறியா
gleet in Vietnamese: Lậu mủ
gleet in Turkish: Belsoğukluğu
gleet in Ukrainian: Гонорея
gleet in Chinese: 淋病