Gonorrhea Infection

Gonorrhea, sometimes known as ‘the clap’, is a common sexually transmitted infection (STI) caused by a bacterium named Neisseria Gonorrhoeae. 1 It most commonly infects the lower genital tract, including: 1 2

• Urethra
• Cervix
• Rectum

In addition, the eye can also be involved causing conjunctivitis and many other spreading infections. N.gonorrheae can also infect the throat 1 2, and the skin, heart or joints may also be infected; however, this is rare. 2 Gonorrhoea infection is spread by sexual vaginal, oral or anal contact. The bacteria can also affect pregnant women, and the infection can be passed on to their babies. 3

There are certain risk factors which can increase the likelihood of contracting a gonorrhea infection. These can include: 4 5

• Being aged 20-29
• Unprotected sexual vaginal, oral or anal sex with a partner who has gonorrhea
• Unprotected sex with multiple partners
• Current or past history of an STI
• Inconsistent use of condoms

Also, according to the Center for Disease Control and Prevention (CDC), cases of Gonorrhea are estimated to be much higher among men who have sex with men (MSM). 4 5 If left untreated, gonorrhea infection may cause serious problems such as permanent blindness in a newborn baby. 3 The bacteria can also spread to other parts of the body and lead to other complications (Read our article about How to prevent sexually transmitted diseases).

Gonorrhea symptoms can vary by gender. Some people may have no symptoms at all, and sometimes the effects of the condition are so mild that they may not be noticeable. People affected by gonorrhea in the rectum, throat and eyes all have symptoms which are specific to those body parts. 6 7 Symptoms can begin within 2 weeks of being infected with N.gonorrhoeae. 6

• Unusual discharge from the urethra (the tube that allows urine to pass out of the body); this can be white, yellow or green in color
• Pain or burning sensation while urinating
• Inflammation (swelling) of the foreskin
• Pain and tenderness in the testicles – although this is rare
• Symptoms of prostatitis, which is an inflamed prostate, can also be present in men with a Gonorrhea infection. 7 and additionally include lower back pain.

Symptoms can include pain in the lower back and genital area, increased frequency and urge to urinate and pain or burning sensation while urinating. ref6

• Unusual vaginal discharge: can be thin, watery and green or yellow in color
• Pain or burning sensation while urinating
• Pain or tenderness in the lower abdomen – less common
• Bleeding between periods, after sex or heavier periods – less common ref6

• Rectum: itching sensation around the anus, discomfort, pain, discharge, tenesmus (the feeling of the need to pass stools) and bleeding
• Gonorrhea in throat: infection with no symptoms, but can sometimes lead to a sore throat and swelling in the neck
• Eyes: if infected semen or vaginal fluid comes into contact with the eyes, this can cause conjunctivitis. Eye involvement can include irritation of the eye, pain, swelling and discharge. ref6 ref7

A diagnosis of Gonorrhea can be made based on your history, clinical symptoms, a physical examination that is carried out by a doctor and laboratory testing. 7 8 Laboratory investigations can include: 8 9

Nucleic acid amplification testing (NAAT): 8 9

• Nucleic acid amplification testing (NAAT) is generally considered the best-suited test for detecting gonorrhea in the genital area.
• Urine, urethral, vaginal and cervical samples can be collected and analyzed through NAAT – specimens can be collected using a swab.
• Samples can be collected by a doctor or healthcare provider, they can also be collected by the patient themselves (self-collection)
• While conducting a NAAT for gonorrhea, it's also recommended to test for Chlamydia infection. 9

Gonorrhea culture: bacterial culture test for gonorrhea can also be used to diagnose an infection. 8 9 This works by taking a sample from the potentially infected site using a cotton-tipped swab. Laboratory technicians will then place the sample in containers and see if Neisseria gonorrhoeae grows.

Urine analysis: can be used if there's no discharge from the urethra

Gram staining: During a gram stain test, a sample is taken from a person potentially affected with gonorrhea. Several dyes are then applied to the sample, which should show up any Neisseria gonorrhoeae bacteria present. However, if the test comes back negative, this does not rule out a gonorrhea infection.

Gonorrhea treatment can be curative with the use of antibiotics. Currently, the CDC recommends a single-dose 500mg intramuscular Ceftriaxone. 10 11 12 Intramuscular means that the medicine is injected into a muscle, so antibiotic injection therefore can be in the buttocks or thigh. 10 Resistance to antibiotics has been a growing concern, and N.gonorrhoeae bacteria is highly vulnerable to Ceftriaxone.

If you are allergic to penicillin or cephalosporins (such as Ceftriaxone), we advise you to consult an infectious disease specialist for alternative management options. A treatment option that can be considered for those who are allergic can include a combination of: 10

• Single-dose intramuscular Gentamicin
• Oral azithromycin

Once treatment is started, symptoms can improve within a few days, however, it may take up to 2 weeks for the pain to disappear completely. 11 You should avoid having sex until you and your partner have been treated to avoid re-infection or passing the bacteria to others.

It's recommended that you attend a follow-up visit with your doctor after your treatment is complete to make sure you are free of infection. 11

Early diagnosis and treatment of gonorrhea are vital. If left untreated, the infection can spread to different parts of the body and lead to serious complications. These can include: 13

Pelvic inflammatory disease: bacterial infection of the cervix, fallopian tubes, ovaries, and uterus (womb). This can lead to:

• Ectopic pregnancy: a fertilized egg implants itself outside of the womb
• Infertility in women
• Infertility in men
• Blindness
• Chronic pelvic pain
• Fitz-Hugh Curtis syndrome: the gonorrhea bacteria may spread toward to liver and cause perihepatitis (inflammation of the liver capsule) – resolves with antibiotic therapy.

Q: What is gonorrhea?
A: Gonorrhea is a common sexually transmitted infection (STI) caused by a bacterium named Neisseria gonorrhoeae and most commonly affects the lower genital tract, however, the bacteria can also infect the eyes and throat.

Q: Is gonorrhea curable?
A: Yes, gonorrhea can be cured with the appropriate antibiotic therapy. The most commonly used antibiotic used is a single-dose intramuscular Ceftriaxone.

Q: What does gonorrhea look like?
A: Gonorrhea typically presents with a discharge from the tip of the penis or vagina. The discharge can be thick, and green or yellow in color. Other symptoms can include a painful sensation when peeing, pain or tenderness.

Q: Can you get gonorrhea from kissing?
A: No, you can only contract a gonorrhea infection through unprotected sexual vaginal, oral or anal sex with a partner who has gonorrhea. Other risk factors include unprotected sex with multiple partners, current or past history of an STI and inconsistent use of condoms.

Q: How long can you have gonorrhea without knowing?
A: Symptoms usually start 2-7 days after infection, but it can take up to 30 days to experience symptoms.

Q: How to cure gonorrhea without going to the doctor?
A: If you suspect a gonorrhea infection, it's advised that you visit your health practitioner immediately and confirm your diagnosis. Once a diagnosis is confirmed, your physician can prescribe you antibiotics for your curative treatment.