Gonorrhea - Everything you need to know

•  Written by Hannah Kingston - Updated on August 4th, 2021
• Medically reviewed by Dr Andrea Pinto Lopez, M.D.

What is Gonorrhea?

Gonorrhea is a sexual transmitted disease caused by the bacterium Neisseria gonorrhoeae, also known as gonococcus and which can infect a diverse group of mucosal surfaces, including the urethra, the endocervix, the pharynx, conjunctiva and the rectum. [1]

Read: What is gonorrhea?

How do you get gonorrhea?

First, is important to note that as sexual characteristics are different, male or female chances of getting infected are different as well.

In both sex gonorrhea can affect parts of the body as the urethra, rectum or throat, but in females, gonorrhea can also infect the cervix. [2]  

Gonorrhea is then transmitted during sexual activities with an infected person, including vaginal, oral, and anal sex.

As for the characteristics of the genital organs, during sexual intercourse, gonorrhea is more likely to be transmitted from men to women than from women to men. [3]

In summary, after just one episode of sex, women are likely to get infected by 60 to 90%, while men can have a risk to catch infection from women by 20%, increasing to 60% to 80% after four or more intercourse exposures.

This huge difference may be related to the greater exposed area of genital surfaces in women, as it was previously explained, as well as being more exposed to trauma and tissue fractions. [4]

In a more detailed manner, gonorrhea can be acquired through different type of activities, including sexual and non-sexual ones:

Sexual routes:

• Male-to-female transmission of N. gonorrhoeae via semen is very high, 50-70% per episode of vaginal intercourse with ejaculation; transmission also can occur without ejaculation.
• An infected woman can transmit N. gonorrhoeae to the urethra of a male sex partner. This rate of transmission is approximately 20% per episode from vaginal intercourse, and it increases up to 60-80% after four or more intercourse exposures.
• Gonorrhea can be acquired via oral sex (performing or receiving) in both ways and for both sexes.
• Rectal intercourse transmission rates have not been quantified, but rectal intercourse appears to be an efficient mode of transmission. [5]  

Non-sexual routes:

• As a non-sexual route of transmission, perinatal transmission (mother-to-infant) can occur during vaginal delivery if an infected mother has not been treated during the perinatal period. For this reason, if you are pregnant or preparing to conceive a baby, it is important that you test yourself for gonorrhea and other STDs as one measure of prenatal care.

Who is at risk?

Besides any sexual activity (practiced outside a long-term, mutually monogamous relationship with a person who has tested negative) possess a risk of transmission of STDs, there are some actions who increase your chance of acquiring the disease, these are:

• Having sex with new or multiple sex partners (+1 during a timeline (lifetime, yearly, etc.)
• Being a man and having sex with men (MSM)
• Having human immunodeficiency virus (HIV)
• Being sexually active and under 25 years old
• Having a sexual partner who is infected with gonorrhea. [6] Additionally, STDs relate to the risk of other STDs as well. In the case of gonorrhea, it increases your risk of contracting HIV.  

Symptoms of gonorrhea (men & women)

On average, 10-15% of men and about 80% of women may have no symptoms of gonorrhea, [7] specially when is the only STD present in the body.

Besides this, it is important to understand that although symptomless, a person can still develop complications associated to gonorrhea, as well as transmit the disease to others.

When the person does present symptoms, these may vary from person to person depending on the sex of the person.

Signs and symptoms of gonorrhea infection in men include:

• Painful urination (burning sensation when urinating).
• Pus-like discharge from the tip of the penis (white, yellow or green discharge).
• Pain and/or swelling in one or both testicles (less common)

Signs and symptoms of gonorrhea infection in women include:

• Abnormal vaginal discharge that can be watery, creamy, or yellow-green
• Painful urination
• Vaginal bleeding between periods, such as after vaginal intercourse
• Lower abdominal pain

Read: Gonorrhea symptoms | What are the symptoms of gonorrhea?

How do I know if I have gonorrhea?

The only guaranteed method to know if you have gonorrhea is to be tested. If you suspect gonorrhea or any other sexually transmitted disease (STD), please do not delay testing, as besides it can be embarrassing or cause you fear.

Testing is the most responsible act after having had any sexual activity mentioned before. [8]

Additionally, if you are a man and have had any sex activities with another men, please take note your risk of infection with gonorrhea is higher, and you should test yourself for gonorrhea every year while you are in such risk behavior.

If you experience any of the symptoms mentioned above, it can be a sign that you need to take a gonorrhea test (along with tests for other STDs, since many of them share similar symptoms).

However, simply being sexually active is reason enough to get tested once a year, even if you don’t have symptoms of an STD.

How early can you detect gonorrhea?

The incubation period (the time from exposure to the bacteria until symptoms develop) for gonorrhea is usually 2 to 5 days.

However, some people won’t develop symptoms for up to 30 days after infection, or not cause symptoms until the infection has spread to other areas of the body.

This does not mean the infection is not present in the body, but just that the body hasn’t developed any symptoms (something you can feel or see in your own body).

As the recommended test (NAAT) looks for genetic material (DNA) of the bacteria, is possible to be tested within a few days after any sexual activity has taken please.

Besides this, a normal recommendation is to wait at least 7 days since the last sexual activity. Please take note that as gonorrhea has proven to be symptomless in many cases (especially for women), testing is possible and positive even if you do not have any symptoms.

How do you collect a sample for gonorrhea testing?

The types of test available to collect a sample for testing are:

• Urine test: This can help identify bacteria in your urethra.
• Swab of affected area: A swab of your throat, urethra, vagina or rectum can collect bacteria that can be identified in a lab. As mentioned in the first test, most of the time urine can be used to test for gonorrhea. However, if you have had oral and/or anal sex, swabs may be used to collect samples from your throat and/or rectum. 2 3 Both procedures of collection of samples (urine or swab) are painless and can be performed if desired from the comfort of your own home.

Important: Before testing, please tell your healthcare provider about any use of antibiotics or, for women, douches or vaginal creams within 24 hours before testing vaginal samples since they may affect test results.

Menstruation will not affect results. For a urine sample, you may be instructed to wait one to two hours after you last urinated before collecting the sample.

Where can I get tested?

Depending on your personal preferences and circumstances, you can get tested in a physician’s consultation office, a lab, or your own home. 

In the case of a physician’s office, and to determine whether you have gonorrhea, your doctor will send a sample of cells to analysis.

These samples can be collected by urine test and swab test. In the case you want to test from the comfort of your home, home test kits are available for gonorrhea.

They may include a urine collection tube, and/or swabs for self-testing that are sent to a specified lab for testing.

You can choose to be notified by email or text message when your results are ready. Also, normally you will have the option to view your results online or receive them by calling a toll-free hotline. [9]

How accurate are gonorrhea test results?

There are two primary methods of testing collected samples for gonorrhea: NAATs (nucleic acid amplification tests) and cell cultures.

NAATs are more sensitive than cultures and result in more diagnoses. [1] [7] NAAT is also the most recommended method for gonorrhea testing, as advised by the CDC, and can performed from a urine sample as well as vaginal, anal and oral swabs. [10] [11]

Different tests for gonorrhea & chlamydia

Chlamydia & Gonorrhea Urine Test

Providers: LetGetChecked, Priority STD, myLAB Box & Health Testing Center

Sensitivity: PCR 56% [12], NAAT 95% [5] Specificity: NAAT 95% [5]  

Chlamydia & Gonorrhea|  Oral Swab Test

Test Providers: myLAB Box, Health Testing Center & NURX

Sensitivity: PCR 80% [13]

Specificity: PCR 73% [7]  

Chlamydia & Gonorrhea Anal Swab Test

Test Providers: myLAB Box, Health Testing Center

Sensitivity: NAAT 80%-93% [14]

Specificity: NAAT 95% [8]  

Chlamydia & Gonorrhea Vaginal Swab Test

Test Providers: Health Testing Center

Sensitivity: NAAT 80%-93% [14]

Specificity: NAAT 95% [8]

Can gonorrhea be cured?

Most cases of gonorrhea after detected, can be cured using antibiotic treatments. [15]

Among the antibiotics used for gonorrhea are: Azithromycin, Cefixime, Ceftriaxone, Ciprofloxacin, Gentamicin, Tetracycline, or other antimicrobials.

Yet, it is important to understand that besides treatment is available in many cases, prevention is the most important aspect to fight the disease.

For this reason, we should be responsible and do all which is in our power to prevent transmission of the disease to us or others, as almost ~10% of cases of gonorrhoea account for multi-drug resistant gonorrhoea (MDR-GC), an increasing public health issue nowadays. [16]

What happens if I don’t get treated?

Untreated gonorrhea can cause serious and permanent health problems in both women and men, for this reason prevention and early detection through testing play both a key role.

In men, persistent infection can lead to epididymitis, which in a small number of cases can lead to infertility. [17] [18]

In women, untreated gonorrhea can cause pelvic inflammatory disease (PID). Complications of PID are:

• Formation of scar tissue that blocks fallopian tubes
• Ectopic pregnancy (pregnancy outside the womb exit disclaimer icon)
• Infertility (inability to get pregnant)
• Long-term pelvic/abdominal pain

What type of long-term damage can gonorrhea cause?

• Evidence has demonstrated gonorrhea increases the risk of transmission of other STDs, particularly chlamydia, which often accompanies gonorrhea, and HIV.
• In women it can cause pelvic inflammatory disease (PID), an infection that can cause pelvic pain, infertility (inability to get pregnant), and ectopic pregnancy (pregnancy outside the uterus) which can be life-threatening. Good news is that, after diagnosed, PID can be treated with antibiotics.
• In pregnant woman, gonorrhea can cause miscarriage and premature labor as a mother can pass it on to her baby. Additionally, it can cause eye infections such as conjunctivitis, which in serious cases can lead to blindness.
• In men untreated gonorrhea can cause an infection in the testicles called epididymitis. This can result in fever, scrotal pain and swelling and, in rare cases, infertility.
• In rare cases, for both women and men, untreated gonorrhea can spread to other parts of the body. Thought rate, this can cause inflammation and swelling of joints and tendons, skin irritation and redness, and inflammation around the brain and spinal cord (meningitis) or the heart.[19]

How can I reduce my risk of getting gonorrhea?

• As a real fact, the only 100% safe method to prevent yourself from being infected with gonorrhea is abstaining from sexual activities (oral, anal, vaginal).
• Being in a long-term, mutually monogamous relationship with a person who has tested negative for STDs, including gonorrhea, is additionally, the closest method ~100% safe to prevent yourself from an STD such as gonorrhea.
• Reducing the number of MSP (Multiple Sexual Partners) reduces proportionally your risk of infection from gonorrhea and other STDs.
• The CDC and the USPSTF recommend 1 test per year for t N. gonorrhoeae in all sexually active women younger than 25 years of age, and 2 test per year N. gonorrhoeae in all women if they are considered to have increased risk for gonococcal infection.
• Reduce your alcohol intake and avoid binge drinking (gonorrhea is 5 times higher among women who binge drink compared with women who do not drink at all.) [20]

How do you prevent gonorrhea? 

The only 100% sure method to prevent yourself from an STDs is to not have vaginal, anal, or oral sex. [21]

Additionally, being in a long-term, mutually monogamous relationship with a person who has tested negative for STDs, including gonorrhea, is additionally, the closest method ~100% safe to prevent yourself from an STD such as gonorrhea.

For this reason, being responsible and testing yourself are also key steps to prevent yourself from gonorrhea.

As mentioned, these are the key practices to prevent gonorrhea. It is important to understand this, as besides most people tend to think condoms are the safest method to prevent yourself from STDs, epidemiologic studies have evidenced condoms offer a highly variable protection against STIs other than HIV, such as gonorrhea and chlamydia. [22]

I’m pregnant. How does gonorrhea affect my baby?

If you are pregnant and have gonorrhea, you can give the infection to your baby during delivery causing serious health to him/her. In such case, detecting and treating gonorrhea as soon as possible will make health complications for your baby less likely.

For this reason, if you are pregnant or looking to conceive a baby, please talk to your health care provider so that you get the correct examination, testing, and treatment if necessary.

As already mentioned, in babies, gonorrhea most commonly affects the eye causing gonococcal conjunctivitis (red eyes, pus), [23] additionally it increases the risk of the baby to suffer from low birth weight (40% higher risk), the baby being small for gestational age (60% higher risk) and other complications. [24]

I was treated for gonorrhea. When can I have sex again?

A combination of antibiotics is commonly used to treat gonorrhea.

In such case, is important to take all the medicine as directed by the health professional, otherwise the medicine may not work.

Additionally, in some states, when a case is detected, both sex partners will receive a prescription for treatment in order to keep from passing the infection back and forth.

Additionally, many people who have gonorrhea also have chlamydia, another STD.

In such case, if you have gonorrhea and chlamydia, you will get medicine that treats both infections.

Read: Gonorrhea treatment | How do you treat gonorrhea?

• While being treated: Avoid all sexual contact while you are being treated for an STD.  
• After treatment: If your treatment is a single dose of medicine, you should not have any sexual contact for 7 days after treatment so the medicine will have time to work. [25]

Written by Tommy Gonzales on May 21, 2020. Updated and republished in June 2021. 

References

[1] Hill, S., Masters, T., & Wachter, J. (2016, September 5). Gonorrhea - an evolving disease of the new millennium. Retrieved May 20, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354566/

[2] Gonorrhea. (2019, December 06). Retrieved May 20, 2020, from https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774

[3] Factsheet about gonorrhoea. (2018, August 31). Retrieved May 20, 2020, from https://www.ecdc.europa.eu/en/gonorrhoea/facts

[4] STD Testing Process at STDCenterNY. (n.d.). Retrieved May 20, 2020, from https://stdcenterny.com/articles/std-risk-with-one-time-heterosexual-encounter.html

[5] Gonorrhea. (2020, May 20). Retrieved from https://www.std.uw.edu/pdf/pathogen-based/gonorrhea/core-concept/all

[6] Hhs.gov. (2019, April 03). Gonorrhea. Retrieved May 20, 2020, from https://www.hhs.gov/opa/reproductive-health/fact-sheets/sexually-transmitted-diseases/gonorrhea/index.html

[7] Department of Health. (n.d.). Retrieved May 20, 2020, from https://www.health.ny.gov/diseases/communicable/gonorrhea/fact_sheet.htm

[8] (n.d.). Retrieved May 20, 2020, from https://www.nhs.uk/conditions/gonorrhoea/diagnosis/

[9] Gonorrhea. (2019, December 06). Retrieved May 20, 2020, from https://www.mayoclinic.org/diseases-conditions/gonorrhea/diagnosis-treatment/drc-20351780

[10] Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. (n.d.). Retrieved May 20, 2020, from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm

[11] Gonorrhea Testing. (n.d.). Retrieved May 20, 2020, from https://labtestsonline.org/tests/gonorrhea-testing

[12] Effectiveness of the Varicella Vaccine. (2005, December 01). Retrieved May 20, 2020, from https://www.aafp.org/afp/2005/1201/p2354.html

[13] Bachmann, L., Johnson, R., Cheng, H., Markowitz, L., Papp, J., & Hook, E. (2009, April). Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae oropharyngeal infections. Retrieved May 20, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668347/

[14] Effectiveness of the Varicella Vaccine. (2005, December 01). Retrieved May 20, 2020, from https://www.aafp.org/afp/2005/1201/p2354.html

[15] Gonorrhoea symptoms & treatment. (2020, April 17). Retrieved May 20, 2020, from https://www.avert.org/sex-stis/sexually-transmitted-infections/gonorrhoea

[16] Martin, I., Sawatzky, P., Allen, V., Lefebvre, B., Hoang, L., Naidu, P., . . . Mulvey, M. (2019, February 7). Multidrug-resistant and extensively drug-resistant Neisseria gonorrhoeae in Canada, 2012-2016. Retrieved May 20, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461123/

[17] Gonorrhea. (n.d.). Retrieved May 20, 2020, from https://www.catie.ca/en/fact-sheets/sti/gonorrhea

[18] Bodie, M., Gale-Rowe, M., Alexandre, S., Auguste, U., Tomas, K., & Martin, I. (2019, February 7). Addressing the rising rates of gonorrhea and drug-resistant gonorrhea: There is no time like the present. Retrieved May 20, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461120/

[19] Gonorrhoea symptoms & treatment. (2020, April 17). Retrieved May 20, 2020, from https://www.avert.org/sex-stis/sexually-transmitted-infections/gonorrhoea

[20] The Relationship Between Alcohol Use and STDs. (2019, November 05). Retrieved May 20, 2020, from https://www.alcoholrehabguide.org/resources/medical-conditions/alcohol-and-stds/

[21] STD Facts - Gonorrhea. (2014, January 29). Retrieved May 20, 2020, from https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm

[22] Lee, Newman, R., D., D., H., Kamb, L., M., . . . Rogers. (2004, February 01). Condom Effectiveness for Reducing Transmission of Gonorrhea and Chlamydia: The Importance of Assessing Partner Infection Status. Retrieved May 20, 2020, from https://academic.oup.com/aje/article/159/3/242/79876

[23] Conjunctivitis. (2019, January 04). Retrieved May 20, 2020, from https://www.cdc.gov/conjunctivitis/newborns.html

[24] Heumann, C., Quilter, L., Eastment, M., Heffron, R., & Hawes, S. (2017, May). Adverse Birth Outcomes and Maternal Neisseria gonorrhoeae Infection: A Population-Based Cohort Study in Washington State. Retrieved May 20, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407319/

[25] Gonorrhea. (n.d.). Retrieved May 20, 2020, from https://www.healthlinkbc.ca/health-topics/hw188975