Gonorrhea is one of the most common STD (sexually transmitted disease) or STI (sexually transmitted infection) seen in HIV STD clinics in Singapore. It is a disease caused by Neisseria gonorrhoeae, a Gram-negative diplococcus that mainly infects the mucosal surfaces of the urethra and endocervix. This bacterium is also capable of living quite well within the mucosal surfaces of the mouth (pharynx) and rectum.
Neisseria gonorrhoeae can also infect the conjunctiva of the eyes, sometimes acquired via contact with the genital secretions of an infected person. In women, gonorrhea can travel further upwards and cause pelvic inflammatory disease (PID), a common but serious complication that can lead to female infertility.
A serious concern with controlling gonorrhea worldwide is the evolution of antibiotic resistance in Neisseria gonorrhoeae. This bacterium has acquired immunity to many large groups of antibiotics, including sulfonamides, tetracyclines, penicillins, and fluoroquinolones. The current therapeutic regimen includes the cephalosporin antibiotic ceftriaxone, but even as we speak, antibiotic resistance to various other cephalosporins are emerging in Asia. It has also been reported recently that the rare ceftriaxone-resistant strains have been reported in parts of East Asia. Hence, ceftriaxone might very well become ineffective against gonorrhea in the near future.
Today’s case study involves a white-collar worker, or more specifically, a banker fresh from an Ivy League college. He was young, successful, and extremely hardworking and ambitious. He was engaged to a young, smart and beautiful lady from sunny Singapore, and was planning to get married within the next year or so. But, according to the banker, he was still “gallivanting around in search of greener pastures.”
He seemed to be exceedingly baffled as to why he had symptoms in his “weiner.” He insisted that he never had any penetrative vaginal or anal sex in the recent weeks.
This was what he did. 4 days ago, he found some “exclusive” massage service online, and decided to give it a try, knowing full well that it is exclusive for some obvious reason. He made the necessary arrangements, and after a “full service” – whatever that meant in his lingo – given by a Mandarin-speaking foreign woman, he succumbed to fellatio without protective measures.
“I never had any sex whatsoever, Doc! It was a hand-job, then a blowjob. Period.”
“I’m sure you didn’t clap after the service was over.”
“Huh, what do you mean, Doc?”
“What you have is also known as the clap.”
The Clap (or Gonorrhea)
The banker had classical symptoms of gonorrhea (“the clap”). In HIV STD clinics in Singapore, gonorrhea is a common occurrence.
He presented with painful urination, and a urethral discharge that was frankly purulent. Physical examination revealed nothing else except mild meatal erythema (redness at the tip of his penis). So it was a rather straightforward diagnosis.
Nevertheless, I ordered the standard gonorrhea and Chlamydia NAAT (nucleic acid amplification tests), VDRL and HIV serology. Only gonorrhea returned positive. I also advised repeat STD and HIV testing and screening in 3 months time in view of his sexual habits.
Although most cases of gonorrhea are acquired via vaginal and anal intercourse, transmission by fellatio, especially from the mouth (pharynx) to the genitals, can occur with oral-genital sexual practices. In certain rare cases, gonorrhea can also be transmitted via cunnilingus. But the banker was adamant that according to his friends, fellatio was perfectly safe without any protection (or condom).
I explained to him he was fortunate that he didn’t live a century earlier. Gonorrhea was called “the clap” for certain, rather unpleasant, reasons. It was rumored that gonorrhea was once treated with “clapping,” or the slamming of a heavy and flat object (like a book or the palm of the hand) onto the shaft of the penis. It was thought that by bringing both hands together and clapping strongly, or slamming a large Webster’s Dictionary onto the shaft of the gonorrhea-stricken penis, urethral discharge would thus be expelled. Thereafter, gonorrhea would leave the body.
We agreed upon one thing on that fateful day. “Clapping” didn’t sound like a good treatment as it involved mechanical and violent impact against a vulnerable organ. He was glad that the only mechanical impact felt was my needle and syringe containing antibiotics against his left buttock, vulnerable as it may be.
He also consented to contact tracing, and all his sexual partners were contacted for treatment, as well as for HIV and STD screening.
The moral of the story here is that you can catch an STD be it vaginal, anal, or oral intercourse. So, if there is some unexplained burning sensation whenever you need to relieve yourself, call our clinic and speak to our doctor. Or visit a HIV STD clinic in Singapore for testing, screening, and treatment.
