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Gonorrhoea: Symptoms, Causes, & Treatment

Written by Dr. Salim Olabi | Medically reviewed by Editorial Team
Last updated on: June 18, 2024

What is Gonorrhoea?

Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It can infect both men and women and commonly affects the urethra, rectum, throat, and in women, the cervix. Gonorrhea is spread through sexual contact with an infected person, including vaginal, anal, and oral sex.

This infection is particularly common among young people aged 15-24 years. Gonorrhea can lead to serious health problems if left untreated, including pelvic inflammatory disease (PID) in women, which can cause infertility, and epididymitis in men, which can also lead to infertility. In addition, gonorrhea can increase the risk of contracting or transmitting HIV.

Gonorrhoea Symptoms

Gonorrhea can affect multiple parts of the body, and its symptoms can vary depending on the site of infection. Many people with gonorrhea, especially women, may not experience any symptoms, which can lead to delays in seeking std gonorrhoea treatment. When symptoms do occur, they typically appear within 2 to 14 days after exposure.

Gonorrhoea Symptoms in Men

- Painful Urination: A burning sensation during urination is one of the most common symptoms.

- Discharge: A white, yellow, or green discharge from the penis.

- Testicular Pain: Pain or swelling in one or both testicles, though this is less common.

- Rectal Symptoms: If the rectum is infected, symptoms can include discharge, itching, soreness, bleeding, or painful bowel movements.

Gonorrhoea Symptoms in Women

- Vaginal Discharge: An increased amount of vaginal discharge, which may be watery, creamy, or slightly green.

- Painful Urination: A burning or painful sensation when urinating.

- Vaginal Bleeding: Bleeding between menstrual periods or heavier periods.

- Abdominal or Pelvic Pain: Discomfort or pain in the lower abdomen or pelvis.

- Rectal Symptoms: Similar to men, if the rectum is infected, symptoms can include discharge, itching, soreness, bleeding, or painful bowel movements.

Throat Infection Symptoms

- Sore Throat: If gonorrhea infects the throat (pharyngeal gonorrhea), it can cause a sore throat.

- Swollen Lymph Nodes: Swelling of the lymph nodes in the neck.

Eye Infection Symptoms

- Eye Pain: Pain in the eyes or sensitivity to light.

- Discharge: Pus-like discharge from one or both eyes (conjunctivitis).

Rectal Infection Symptoms

- Discharge: Pus-like discharge from the rectum.

- Itching and Soreness: Itching, soreness, or inflammation around the anus.

- Bleeding: Bleeding during bowel movements.

- Painful Bowel Movements: Pain during defecation.

Asymptomatic Cases

A significant number of gonorrhea cases are asymptomatic, especially in women. Asymptomatic individuals can still transmit the infection to others and are at risk of developing complications if the infection is not treated.

Early detection and treatment are crucial to prevent the spread of gonorrhea and to avoid serious health complications. Regular screening and practicing safe sex are essential preventive measures.

Diagnosis and Tests for Gonorrhoea

Diagnosing gonorrhea involves a combination of medical history, physical examination, and laboratory tests. Since gonorrhea can be asymptomatic, especially in women, regular screening is important for sexually active individuals.

Medical History and Physical Examination

During the initial consultation, a healthcare provider will take a detailed medical history, including sexual activity and symptoms. They will also perform a physical examination to check for signs of infection, such as discharge, sores, or inflammation.

Laboratory Tests

Several laboratory tests are used to diagnose gonorrhea:

Nucleic Acid Amplification Tests (NAATs)

NAATs are the most commonly used tests for diagnosing gonorrhea due to their high sensitivity and specificity. These tests detect the genetic material of Neisseria gonorrhoeae and can be performed on various samples, including:

- Urine Samples: For men and women, urine samples are often used to detect gonorrhea in the urethra.

- Swabs: Swabs from the affected area, such as the cervix (women), urethra (men), rectum, or throat, are used to detect the presence of the bacteria.

Culture Tests

Culture tests involve growing Neisseria gonorrhoeae from a sample in a laboratory setting. While culture tests are not as commonly used as NAATs, they are important for antibiotic susceptibility testing, especially in cases of gonorrhea treatment failure or suspected antibiotic resistance. Samples for culture tests are obtained through swabs from the cervix, urethra, rectum, or throat.

Gram Stain

A Gram stain can provide a rapid preliminary diagnosis, especially in symptomatic men with urethral discharge. In this test, a sample of the discharge is stained and examined under a microscope. The presence of Gram-negative diplococci within white blood cells is indicative of gonorrhea. However, this test is less sensitive in women and asymptomatic individuals.

Screening Recommendations

Regular screening for gonorrhea is recommended for certain groups, including:

- Sexually Active Women Under 25: Annual screening is advised for all sexually active women under the age of 25.

- Older Women with Risk Factors: Women over 25 with risk factors such as new or multiple sex partners, or a sex partner with an STI, should also be screened annually.

- Men Who Have Sex with Men (MSM): Annual screening, or more frequently if at high risk, is recommended for MSM.

- Pregnant Women: Screening during the first prenatal visit and in the third trimester if at high risk.

Partner Notification and Testing

If someone is diagnosed with gonorrhea, it is important to inform all recent sexual partners so they can be tested and treated if necessary. This helps prevent the spread of the infection and reduces the risk of re-infection.

Importance of Follow-Up

Follow-up testing is crucial to ensure the infection has been fully treated, especially in cases of persistent gonorrhoea symptoms or if a less common antibiotic was used. Retesting is typically done a few weeks after completing treatment to confirm the infection is cleared.

Accurate diagnosis and timely treatment are essential to manage gonorrhea effectively, prevent complications, and reduce the spread of the infection. Regular screening and safe sexual practices are key preventive measures.

Treatment of Gonorrhoea

Treating gonorrhea promptly and effectively is crucial to prevent complications and stop the spread of the infection. Gonorrhea is typically treated with antibiotics, and the recommended treatment regimens are designed to address potential antibiotic resistance.

Recommended Antibiotic  Gonorrhoea Treatment

The Centers for Disease Control and Prevention (CDC) recommends a dual therapy approach for treating gonorrhea:

- Ceftriaxone: A single intramuscular dose of 500 mg.

- Doxycycline: A 100 mg oral dose taken twice daily for 7 days. This is recommended if there is a co-infection with Chlamydia trachomatis, which is common in people diagnosed with gonorrhea.

This dual therapy is effective in treating the infection and helps to slow the development of antibiotic-resistant strains of Neisseria gonorrhoeae.

Alternative  Gonorrhoea Treatments

If the patient is allergic to ceftriaxone or if ceftriaxone is not available, alternative regimens may be considered, such as:

- Gentamicin: A single intramuscular dose of 240 mg.

- Azithromycin: A single oral dose of 2 grams.

These alternatives should only be used when ceftriaxone cannot be administered, and healthcare providers should monitor patients closely to ensure the infection is fully resolved.

Follow-Up Testing

Follow-up testing is essential to ensure the infection has been completely eradicated. The CDC recommends retesting three months after gonorrhoea treatment to check for reinfection, especially in sexually active individuals who might have been re-exposed to the infection.

Partner Notification and Treatment

Individuals diagnosed with gonorrhea should inform all recent sexual partners so they can also be tested and treated if necessary. This process, known as partner notification, helps to prevent the spread of the infection and reduces the risk of reinfection.

Managing Complications

In cases where gonorrhea has led to complications, additional treatments may be required:

- Pelvic Inflammatory Disease (PID): Women with PID may need more extensive antibiotic treatment and possibly hospitalization if the infection is severe.

- Epididymitis: Men with epididymitis will require additional antibiotics and possibly pain relief medications.

- Disseminated Gonococcal Infection (DGI): This severe condition, which occurs when gonorrhea spreads to the bloodstream, requires immediate hospitalization and intravenous antibiotics.

Preventing Reinfection

Preventing reinfection involves several strategies:

- Abstaining from Sexual Activity: Avoiding sexual activity until the treatment is completed and all partners have been treated.

- Condom Use: Using condoms consistently and correctly can significantly reduce the risk of gonorrhea and other STIs.

- Regular Screening: Regular STI screening for sexually active individuals, especially those with multiple partners or those in high-risk groups.

Importance of Adherence

Adhering to the prescribed antibiotic regimen is crucial for the successful treatment of gonorrhea. Patients should complete the entire course of medication even if symptoms resolve before finishing the treatment. Failure to do so can lead to incomplete eradication of the infection and contribute to antibiotic resistance.

Effective treatment of gonorrhea not only cures the infection but also helps prevent serious health complications and reduces the risk of transmission to others. Regular screening, safe sex practices, and prompt treatment are key components of managing and controlling gonorrhea.

Prevention of Gonorrhoea 

Preventing gonorrhea involves a combination of safe sexual practices, regular screenings, and education. Here are several strategies to help reduce the risk of contracting and spreading gonorrhea:

Safe Sexual Practices

1. Use Condoms: Consistent and correct use of condoms during vaginal, anal, and oral sex significantly reduces the risk of gonorrhea and other sexually transmitted infections (STIs).

2. Limit Sexual Partners: Having fewer sexual partners can reduce the risk of exposure to gonorrhea. Being in a mutually monogamous relationship where both partners are tested and free of STIs further lowers the risk.

3. Communication: Open and honest communication with sexual partners about STI status and sexual history is crucial for mutual protection and understanding.

Regular Screenings

1. Routine Testing: Sexually active individuals, especially those with multiple partners, should undergo regular STI screenings. The CDC recommends annual screening for:

- Sexually active women under 25 years old.

- Older women with risk factors such as new or multiple sex partners, or a partner with an STI.

- Men who have sex with men (MSM), who should be screened at least annually.

2. During Pregnancy: Pregnant women should be screened for gonorrhea during their first prenatal visit and again in the third trimester if they are at high risk. This helps prevent complications during pregnancy and transmission to the newborn.

Education and Awareness

1. Sex Education: Comprehensive sex education that includes information about STIs, safe sex practices, and the importance of regular testing can help prevent gonorrhea. Education should be provided in schools, communities, and healthcare settings.

2. Awareness Campaigns: Public health campaigns can raise awareness about gonorrhea, its symptoms, and the importance of testing and treatment. These campaigns can target high-risk populations and the general public.

Partner Management

1. Partner Notification: If diagnosed with gonorrhea, it is essential to inform all recent sexual partners so they can be tested and treated. This helps prevent reinfection and further spread of the infection.

2. Expedited Partner Therapy (EPT): In some regions, EPT allows healthcare providers to prescribe antibiotics for the sexual partners of individuals diagnosed with gonorrhea without the partners needing a medical examination. This can expedite treatment and reduce transmission.

Behavioral Interventions

1. Avoiding Risky Behaviors: Avoiding risky behaviors such as having sex with multiple partners or engaging in unprotected sex can significantly reduce the risk of gonorrhea.

2. Substance Use: Reducing alcohol and drug use can lower the likelihood of engaging in risky sexual behavior, as substance use can impair judgment and lead to unsafe sex practices.

Vaccination Research

1. Ongoing Research: While there is currently no vaccine for gonorrhea, research is ongoing to develop one. Staying informed about advances in medical research can provide additional future options for prevention.

Healthcare Access

1. Access to Healthcare: Ensuring access to affordable and confidential healthcare services, including STI testing and treatment, is crucial for effective prevention and control of gonorrhea.

Implementing these prevention strategies can significantly reduce the incidence of gonorrhea and its associated health complications. Regular screening, safe sex practices, education, and access to healthcare are key components in preventing the spread of gonorrhea this infection.

FAQs on Gonorrhoea

What kills gonorrhoea fast?

Gonorrhoea can be treated effectively with antibiotics. The Centres for Disease Control and Prevention (CDC) recommends dual therapy with a single intramuscular dose of ceftriaxone and oral azithromycin. It is crucial to follow the prescribed treatment plan and complete the full course of antibiotics to ensure the infection is eradicated quickly and to prevent resistance.

How long can gonorrhoea last?

If untreated, gonorrhoea can persist for months or even years. However, once diagnosed and treated with the appropriate antibiotics, the infection can be cleared up in a matter of days. It is important to seek treatment as soon as symptoms appear or if there is a possibility of exposure.

Is gonorrhoea painful?

Gonorrhoea can cause pain, especially during urination or intercourse. Men may experience a burning sensation when urinating, and women might have pelvic pain or discomfort. In some cases, gonorrhoea can be asymptomatic, meaning it shows no symptoms, which makes regular screening important.

Can you feel gonorrhoea immediately?

Symptoms of gonorrhoea typically appear within 2 to 14 days after exposure, though some people might not notice symptoms for several weeks. It is possible for some individuals, especially women, to have no noticeable symptoms initially, which can delay diagnosis and treatment.

What happens if I get gonorrhoea during pregnancy?

Contracting gonorrhoea during pregnancy can lead to serious complications, including an increased risk of miscarriage, preterm birth, and infection of the amniotic fluid. It can also be transmitted to the baby during childbirth, leading to severe infections in the newborn, such as conjunctivitis (which can cause blindness) or sepsis. Pregnant women should be tested and treated for gonorrhoea to protect both their health and their baby's health.

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