Dear Doctor,

My nanny was recently found to be with gonorrhoea. I noticed a bad smell coming from her and knew that something was wrong. She was given medication and an injection but I worry about other people in the house, especially the kids. She has her own bathroom but what else should I be cautious about? I have talked to her about sanitation but I need to know if there is something else we should worry about?

Barbara

Dear Barbara,

Gonorrhoea is a sexually transmitted disease caused by the microbe neisseria gonorrhoea. It is acquired and transmitted by sexual activity.  The incubation period (time from entry of germs in body to manifestation of disease) is usually two to fourteen days, with maximum cases occurring by four to six days of infection. In both men and women, it causes painful urination, genital discharge, with or without swelling of tubes. In men, it can cause inflammation of the testes. Throat infection can occur due to oral sex. Anal sex can cause proctitis.  However, it does affect other body parts as well. Untreated, the microbes can spread via blood stream and affect a major joint, causing pain and swelling (gonococcal arthritis). Skin rashes may occur.  It may reach heart causing infection and inflammation of inner layer of heart (endocarditis) or even affect coverings of the brain (gonococcal meningitis).  The eyes can be infected by being touched with a finger contaminated by genital discharge.

Diagnosis is by microscopic examination of the discharge, which shows the presence of infection. Gram’s stain and culture, help in identifying the specific microbe causing infection. Polymerase chain reaction is also used for diagnosis. Treatment is by antibiotics. Currently, commonly a single dose of a broad-spectrum antibiotic is used as injection, with tablets of another antibiotic. However, treatment does not prevent against future infection/ infections. A person indulging in unprotected sex with an infected partner or multiple unknown partners, is at risk of acquiring gonorrhoea again and becoming sick, despite having completed treatment for one episode of infection.

A child may be infected, during delivery, if the mother is infected. He may become blind due to eyes being infected during delivery.  A child’s eyes can also be infected, if touched by a finger contaminated with genital discharge of a person suffering from gonorrhoea.   A child can also be infected by using objects contaminated by Neisseria gonorrhoea, like bath towels or toys.  However, this is uncommon, because the microbe does not survive outside human body for more than a few minutes to hours.  A paedophile can infect a child by direct sexual activity.

Make sure that your nanny is free from gonorrhoea. She should be symptom free, vaginal discharge if any should  be germ free on microscopic examination and sterile on culture. You also must ensure that she washes her hands thoroughly, before handling the children and does not use any of her used towels, napkins, etcetera, for the children. If possible, keep her away from handling the children, till she is cured. Also, counsel her on "safe sex” which would safeguard her own health.

Dr Rachna is a specialist in internal medicine  at Ruhengeri Hospital

rachna212002@yahoo.co.uk