Written by Ada’s Medical Knowledge Team
What is gonorrhea?
Gonorrhea, sometimes known as the clap, is a common sexually transmitted infection (STI) caused by a bacterium named Neisseria gonorrhoeae. It most commonly affects the mucous membrane in the reproductive and genital area. However, all the following can be infected with gonorrhea:.
- The rectum
- The eyes
- The throat
A small minority of men and around half of women with gonorrhea infection have no symptoms. For those that do, symptoms of the condition vary depending on what part of the body is affected. Gonorrhea in the genital area generally causes an unusually coloured discharge from the penis or vagina, as well as pain during urination.
New cases of gonorrhea almost always occur after sexual contact with someone else that has the condition. The infection can also be spread from mother to baby during delivery.
The condition can generally be treated effectively with antibiotics. If diagnosed and treated early, it is unlikely any long-term problems will be caused. Ongoing sexual partners should be treated at the same time as well.
If left untreated, several complications can arise, including pelvic inflammatory disease in women and epididymitis in men. As gonorrhea can sometimes present with no symptoms, regular testing for sexually transmitted infections is recommended for groups at risk, such as people who have intercourse with multiple partners.
The best way to avoid becoming infected with gonorrhea is to practice safe sex. For example, male partners should wear a condom during intercourse.
Gonorrhea typically infects the genital area in both men and women. The symptoms 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.
Worried you may have this condition? Start a symptom assessment on the Ada app.
Symptoms of genitourinary gonorrhea in men
Gonorrhea will usually affect men in the urethra, which is the tube that connects the bladder to the opening at the tip of the penis. Other parts of the genital area that can be affected include the prostate and the epididymis, which is a duct behind the testes that sperm passes through. The condition can cause the following symptoms:
- Pain and/or a burning sensation when urinating
- A white, green or yellow discharge from the penis, which can sometimes be bloody
- Swelling and inflammation in the foreskin.
Gonorrhea infection in the epididymis can sometimes cause a condition called epididymitis, which causes pain and swelling in the testicles.
Symptoms usually begin within two weeks after men are infected with Neisseria gonorrhoeae, the bacteria that cause gonorrhea.
Symptoms of genitourinary gonorrhea in women
- The cervix
- The uterus
- The fallopian tubes
- The ovaries
- Glands near the labia
Around half of women with the condition will not report any symptoms. Sometimes, the symptoms are so mild that they may not be noticeable or may be confused with a bladder or vaginal infection. This is why complications such as pelvic inflammatory disease arise relatively frequently, as the gonorrhea often remains untreated.
As a result, regular testing for sexually transmitted infection is recommended for those who are sexually active and either under the age of 25 or at particular risk of catching an STI. The latter group includes older women with a new partner or those who sleep with multiple partners.
- An increased and unusual discharge from the vagina
- Pain and/or a burning sensation when urinating
- Pain during sexual intercourse
Rarer symptoms of the condition include vaginal bleeding between periods and mild abdominal pain.
Symptoms of rectal gonorrhea infection
- A discharge from the anus
- Itchiness in the rectal area
- Bleeding from the anus
- Painful bowel movements
- A frequent need to evacuate the bowels
Symptoms of gonorrhea of the throat
Gonorrhea can infect the pharynx, a membrane-lined part of the throat behind the nose and mouth that connects to the esophagus. This type of gonorrhea infection usually causes no symptoms, but can sometimes lead to a sore throat and swelling in the neck.
Symptoms of gonorrhea of the eye
- Swelling of the eyelids
- A discharge containing pus and mucus
- Tenderness of the eyeball
- Swelling just in front of the ears
This form of gonorrhea is rare in adults, but can cause lasting damage to the eye and a person’s vision if left untreated.
Gonorrhea occurs after the body becomes infected with Neisseria gonorrhoeae bacteria. Usually, this occurs after unprotected sexual contact with an infectected partner. However, Neisseria gonorrhoeae can also spread from mother to child during pregnancy and childbirth.
Teenages and young adults are at particular risk of catching gonorrhea. Of the 820,000 people in the U.S. estimated to be newly affected by gonorrhea each year, more than two thirds are believed to be aged under 25.
Gonorrhea infection after sexual contact
- The penis
- The vagina
- The anus
- The mouth, e.g. through oral sex
- Sharing sex toys
Ejaculation does not have to occur during sexual contact for gonorrhea to pass from one partner to another. Gonorrhea can be passed on through mutual masturbation and the sharing of sex toys.[^10]
Non-sexual transmission of gonorrhea
Gonorrhea can be transmitted through autoinoculation. This is when a person touches an infected body part, e.g. with their finger and then touches a part of the body through which transmission can occur. This is one way in which gonorrhea can infect a person’s eye, for example.
A newly born baby can catch gonorrhea in their eye if the mother is affected by gonorrhea. This typically occurs during passage through the birth canal, but can sometimes happen while the baby is in the womb. Pregnant women should be tested for gonorrhea infection before the birth of their child.
As gonorrhea can often have no symptoms, diagnosis may happen during a routine sexual health check. If a person suspects that they have gonorrhea, then a physical examination may be performed by a doctor.
To make an accurate diagnosis of gonorrhea infection, there are several tests that can be performed, dependent on the affected person’s gender and the likely location of the infection. Tests will usually be run at the same time for chlamydia infection.
Nucleic acid amplification testing
Nucleic acid amplification testing (NAAT) is generally the test best suited to detecting gonorrhea in the genital area. This is because it is faster, more accurate and less invasive than other forms of testing.
NAAT tests for gonorrhea are designed to seek out specific strands of Neisseria gonorrhoeae DNA in a sample and use chemical reactions to multiply those strands so they are easier to detect.
Doctors will generally take a urine sample from men and a vaginal swab from women. The person being tested is usually able to collect the sample required for testing without the assistance of a doctor.
Bacterial culture testing
A doctor may choose to perform a bacterial culture test for gonorrhea instead of an NAAT test. 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.
Bacterial culture testing is generally cheaper than NAAT and is still very accurate. In U.S. clinics, It will usually be the test of choice for detecting any gonorrhea infections in the throat, rectum or eyes. This is because the Food and Drugs Administration has only approved NAAT tests for infections in the genital area.
Bacterial culture tests also give doctors more information on whether the gonorrhea infection is likely to be resistant to any antibiotics.
Gram stain test
A third method for testing for gonorrhea is a gram stain. 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.
The test is accurate at detecting gonorrhea infection in the urethra of males displaying symptoms. It is also cheaper and faster than other tests. However, women and all other men, i.e. those displaying no symptoms, do not get accurate enough results from a gram stain to rule out gonorrhea infection if a test comes back negative.
Gonorrhea treatment and medication
Most cases of gonorrhea are treatable with medication. The Centers for Disease Control and Prevention (CDC) recommends two antibiotics be used for the majority of uncomplicated gonorrhea infections. This is known as a dual therapy and usually consists of ceftriaxone plus azithromycin.
The ceftriaxone is usually administered via an injection into the veins or the muscles. The azithromycin is generally taken as a tablet. In most cases, one dose is all that is needed to remove a gonorrhea infection.
Symptoms generally clear up in a few days. Sexual activity should be possible seven days after the antibiotics are taken for most infections. However, in some cases a follow-up test will be required. Ask the doctor or medical professional managing the treatment for guidance.
One of the reasons that doctors recommend a dual therapy is because over time gonorrhea has developed resistance to the antibiotics used to treat it. Penicillin was the first drug that was effectively able to treat gonorrhea infection in the 1940s, but strains of the Neisseria gonorrhoeae quickly developed that did not respond to this kind of treatment. Since then, a number of drugs have been used and eventually become ineffective in removing the condition from an infected person.
Ceftriaxone is one of the only drugs currently available that still removes gonorrhea infection. The addition of azithromycin to treatments is designed to reduce the speed at which Neisseria gonorrhoeae becomes resistant to ceftriaxone. In other words, administering the two drugs together makes it harder for the bacteria to build up resistance to one of them. Azithromycin also treats chlamydia, which is important as people are often affected by both gonorrhea and chlamydia at the same time.[^19]
In 2018, a man in the U.K. contracted what media reports described as super gonorrhea. This was the world’s first documented case of gonorrhea that could not be removed by dual therapy. The man was eventually cured with an alternative drug named ertapenem.
Health authorities around the world are now actively engaged in detecting and addressing any potential cases of antibiotic-resistant gonorrhea. Funding is also being directed towards the development of new treatment options.[^19]
- Male partners wearing a condom when having penetrative sex or receiving oral sex
- Using a dental dam, which is a soft latex square, to cover the anus or female genital area during oral sex
- Not having sex if one of the partners is showing any of the signs of gonorrhea infection
- Going for regular sexually transmitted disease (STD) checks
After a diagnosis of gonorrhea, a person should notify any sexual partners from the 60 days before the diagnosis or, if possible, the 60 days before symptoms started showing. Every one of these partners should also get an STD test to prevent the infection spreading to others. A person affected with gonorrhea should not have sex until their treatment has been completed.
Good to know: If a person is allergic to latex, condoms made of vinyl should be opted for.
Gonorrhea is unlikely to cause any major complications if treated early. Given that many people with the condition display no symptoms, regularly being tested for sexually transmitted infections is therefore important. Left untreated, gonorrhea may cause the following:
Pelvic inflammatory disease
Women with gonorrhea infection are at risk of the condition spreading to the reproductive organs and causing pelvic inflammatory disease (PID). The most common symptom of PID is pain in the pelvic area, but, like gonorrhea, it may also cause no visible symptoms.
The infection can also be passed on from the mother to the child. This most commonly happens while a baby is being delivered from the womb, with the infection transferring to the eyes and causing gonococcal conjunctivitis. Antibiotic ointment is usually applied to a baby’s eyes after birth to stop the infection developing.
Disseminated gonococcal infection
In rare cases, gonorrhea infection can spread into the bloodstream, causing a condition known as disseminated gonococcal infection (DGI). DGI is treated in the same way as gonorrhea, with a dual therapy aiming to remove the infection from the body.
The most common first sign of DGI is joint pain, especially in the:
- The outermost joints of the fingers
Other early signs of DGI, include:
- Lesions on the skin
- Skin rash, with the rash often found below the neck
Q: How regularly should I have an STD test?
A: The CDC recommends annual gonorrhea and chlamydia screening for all sexually active women under the age of 25, as well as women over that age with:
- A new partner
- More than one sex partner
- A sex partner that has intercourse with other people
- A partner that has a sexually transmitted infection
A test is also recommended for women that fit the above profile as soon as they become pregnant.
The CDC recommends annual testing for men who have sex with men (MSM). For MSM that sleep with multiple partners, the CDC recommends more frequent screening (every three to six months).
Q: What is the relationship between gonorrhea and chlamydia?
A: Chlamydia is another common sexually transmitted infection. Much like gonorrhea infection, chlamydia can often cause no symptoms at first. If it does, typical symptoms include abnormal discharge from the vagina or penis, as well as a burning pain during urination. It is relatively common to be infected with chlamydia and gonorrhea at the same time.
Routine tests for sexually transmitted infections will look for both gonorrhea and chlamydia. Azithromycin, one of the antibiotics currently recommended for the treatment of gonorrhea, is also used to treat chlamydia.
Q: Can gonorrhea be cured?
A: The vast majority of cases of gonorrhea infection can be successfully treated with a dual therapy of ceftriaxone and azithromycin. The infection is generally removed within a few days after treatment.
Q: Is gonorrhea a virus?
A: Gonorrhea is a bacterial rather than viral infection, caused by the bacterium Neisseria gonorrhoeae.
Q: Can I catch gonorrhea from a toilet seat?
A: The likelihood of catching gonorrhea from a toilet seat or by any method not involving some sort of direct genital contact is close to zero.
Other names for gonorrhea
- Gonorrhea infection
- The clap
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“Patient education: Gonorrhea (Beyond the Basics): Causes.” UpToDate. October, 2018. Accessed: 28 November, 2018. [^10: “Gonorrhea.” Sex & U. 2018. Accessed: 28 November, 2018. ↩ ↩
“[Gonorrhea Culture (Discharge)(https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=gonorrhea_culture_discharge).” University of Rochester Medical Center. 2018. Accessed: 28 November, 2018. ↩
“[Gonorrhoea Management]https://patient.info/doctor/gonorrhoea-pro#nav-4).” Patient. 25 September, 2014. Accessed: 28 November, 2018. ↩
“Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea.” Future Microbiology. December, 2012. Accessed: 28 November, 2018. [19:] “Antibiotic-Resistant Gonorrhea Basic Information.” Centers for Disease Control and Prevention. 28 March, 2018. Accessed: 28 November, 2018. ↩
“Antibiotic-resistant gonorrhoea on the rise, new drugs needed.” 07 July, 2017. Accessed: 28 November, 2018. ↩ ↩
“Patient education: Gonorrhea (Beyond the Basics): Prevention.” UpToDate. October, 2018. Accessed: 28 November, 2018. ↩
“Mortality From Sexually Transmitted Diseases in Reproductive-Aged Women: United States, 1999–2010. August, 2014. Accessed: 15 January, 2019. ↩
“Patient education: Gonorrhea (Beyond the Basics): Complications.” UpToDate. October, 2018. Accessed: 28 November, 2018. ↩
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“The Porcelain Terror: Can A Toilet Give You Gonorrhea?.” 13 April, 2011. Accessed: 28 November, 2018. ↩