What is gonorrhea?

Gonorrhea is an infection caused by a sexually transmitted bacterium that can infect both males and females. Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix.
Gonorrhea is a very common infectious disease in the U.S. Each year, according to the CDC, there are as many as 700,000 new cases, with less than half of them reported to the CDC. There were 309,341 reported cases of gonorrhea in the U.S. in 2010.  Sexually active teenagers have one of the highest rates of reported infections.

How is gonorrhea passed on?

Gonorrhea is passed on through penetrative sex, including:
- vaginal sex
- anal sex
- oral sex. Oral sex can either transmit gonorrhea from the genitals to the throat of the person giving the stimulation, or it can pass an infection from the throat to the genitals of the person receiving stimulation.
Less often it can be transmitted by:
- a person using their mouth and tongue to lick or suck another person's anus;
- a person putting fingers into the vagina, anus or mouth of someone infected with gonorrhea, then touching their own mouth, genitals or anus without washing their hands in between.

What are gonorrhea symptoms?

Symptoms of gonorrhea usually appear 2 - 5 days after infection, however, in men, symptoms may take up to a month to appear. Some people do not have symptoms. They may be completely unaware that they have caught the infection, and therefore do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person.
Symptoms in men include:
- Burning and pain while urinating
- Increased urinary frequency or urgency
- Discharge from the penis (white, yellow, or green in color)
- Red or swollen opening of penis (urethra)
- Tender or swollen testicles
- Sore throat (gonococcal pharyngitis)
Symptoms in women can be very mild or nonspecific, and may be mistaken for another type of infection. They include:
- Vaginal discharge
- Burning and pain while urinating
- Increased urination
- Sore throat
- Painful sexual intercourse
- Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area)
- Fever (if the infection spreads to the fallopian tubes and stomach area)
If the infection spreads to the bloodstream, fever, rash, and arthritis-like symptoms may occur.

How is gonorrhea diagnosed?

To determine whether the gonorrhea bacterium is present in your body, your doctor will analyze a sample of cells. Samples can be collected by:
- Urine test. This may help identify bacteria in your urethra.
- Swab of affected area. A swab of your throat, urethra, vagina or rectum may collect bacteria that can be identified in a laboratory.
Testing for other sexually transmitted infections
Your doctor also may recommend tests for other sexually transmitted infections. Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea. Testing for HIV is also recommended for anyone diagnosed with a sexually transmitted infection. Depending on your risk factors, tests for additional sexually transmitted infections could be beneficial as well.

How is gonorrhea treated?

There are two goals in treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first is to cure the infection in the patient. The second is to locate and test all of the other people the person had sexual contact with and treat them to prevent further spread of the disease.
Never treat yourself without being seen by your doctor first. Your health care provider will determine the best and most up-to-date treatment.
About half of the women with gonorrhea are also infected with chlamydia, another very common sexually transmitted infection. Chlamydia is treated at the same time as a gonorrhea infection.
You should receive the hepatitis B vaccine. If you are younger than 26, you also need the HPV vaccine.
A follow-up visit 7 days after treatment is important if joint pain, skin rash, or more severe pelvic or belly pain is present. Tests will be done to make sure the infection is gone.
All sexual contacts of the person with gonorrhea should be contacted and tested. This helps prevent further spread of the disease. In some places you may be able to take counseling information and medicines to your sexual partner yourself. In other places, the health department will contact your partner.

What is azoospermia?

Azoospermia is the medical condition of a man not having any measurable level of sperm in his semen. In some cases (eg blockage or absence of duct) the testes do actually produce sperm but it is not ejaculated and in other cases (hormonal problems, varicocele) there is no sperm production. In humans, azoospermia affects about 1% of the male population[1] and may be seen in up to 20% of male infertility situations.


What are azoospermia types?

There are two types of azoospermia. Non-obstructive azoospermia results from abnormal sperm production. Obstructive azoospermia is caused by an obstruction or blockage that prevents or harms sperm delivery into the ejaculate.


What are azoospermia causes?

Azoospermia can result from a problem with sperm production or sperm delivery, including:
- High fever - causing temporary lack of sperm
- Undescended testicle
- Testicle conditions
- Obstructions of seminal passages
- Testicle infection
- Certain hormonal disorders
- Sperm duct blockage


What are azoospermia symptoms?

Azoospermia doesn't cause any symptom in men. However men with azoospermia may find it difficult to make their wife or girlfriend conceive.


How is azoospermia diagnosed?

Azoospermia is diagnosed initially when no sperm can be detected under a high-powered microscope on two separate occasions.

Subsequent diagnostics will focus on determining the cause of azoospermia, which can help your doctor recommend treatment options. Your initial evaluation will include a complete medical history, physical examination, and tests of selected hormones. Your doctor will ask questions about your prior fertility, childhood illnesses or disorders, such as undescended testicles, genital trauma, infections, exposure to toxins, and family history of reproductive problems and other disorders.

Your doctor will then do a physical examination, taking into account things like testis size, secondary sex characteristics, and presence of varicoceles, which aer varicose veins in the scrotum.

An initial endocrine evaluation will also be done. You may be tested for measurements of serum total testosterone and follicle-stimulating hormone (FSH). Elevated levels of FSH may indicate that your testicles are not adequately producing sperm.

Other tests may include a transrectal ultrasound, urinalysis, or testicular biopsy.


How is azoospermia treated?

Pre- and post-testicular azoospermia are frequently correctible, while testicular azoospermia is usually permanent. In the former the cause of the azoospermia needs to be considered and it opens up possibilities to manage this situation directly. Thus men with azoospermia due to hyperprolactinemia may resume sperm production after treatment of hyperprolactinemia or men whose sperm production is suppressed by exogenous androgens are expected to produce sperm after cessation of androgen intake. In situations where the testes are normal but unstimulated gonadotropin therapy can be expected to induce sperm production.

A major advancement in recent years has been the introduction of IVF with ICSI which allows successful fertilization even with immature sperm or sperm obtained directly from testicular tissue. IVF-ICSI allows for pregnancy in couples where the man has irreversible testicular azoospermia as long as it is possible to recover sperm material from the testes. Thus men with non-mosaic Klinefelter's syndrome have fathered children using IVF-ICSI. Pregnancies have been achieved in situations where azoospermia was associated with cryptorchism and sperm where obtained by testicular sperm extraction (TESE).

In men with posttesticular azoospermia a number of approaches are available. For obstructive azoospermia IVF-ICSI or surgery can be used and individual factors need to be considered for the choice of treatment. Medication may be helpful for retrograde ejaculation.

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