Gonorrhoea is a sexually transmitted infection caused by a germ (bacterium). It can be treated with antibiotics. Treatment is important to prevent complications.
What is gonorrhoea?
Gonorrhoea is an infection affecting mainly the genital areas. It can also affect the throat and eyes. Very occasionally the infection can spread to other parts of the body. It is caused by a germ (a bacterium) called Neisseria gonorrhoeae. Gonorrhoea accounts for 9 out of every 100 sexually transmitted infections (STIs) diagnosed in sexual health clinics in England. There were over 36,000 cases in England in 2016.
How do you get gonorrhoea?
It is passed on if you have sex with an infected person. This can be due to vaginal, anal or oral sex. It can therefore be passed during sex between men and women or sex between men and men. In men, the infection usually affects the urethra (the tube between the bladder and the end of the penis) but can cause infection of the mouth or anus of both sexes. Vaginal liquid can be a source of infection so in theory it could be passed on during sex between women but this is very uncommon.
What are the symptoms of gonorrhoea?
Possible symptoms in women with gonorrhoea
- There are no symptoms in about half of women who have infection with gonorrhoea.
- About 1 in 2 women develop an increase or change in vaginal discharge.
- About 1 in 4 women develop pain in the lower part of the stomach.
- Rarely, women may notice bleeding between periods, or heavy periods.
- Pain when passing urine can sometimes mimic a urine infection.
- There may be pain when having sex in some women.
- Infection of the back passage (rectum) or throat (pharynx) can develop. Such infections do not usually cause symptoms, although occasionally rectal itching or a sore throat may be noticed.
Possible symptoms in men with gonorrhoea
Infection of the urethra (urethritis) is the typical infection in men. This commonly develops 5-7 days after having sex with an affected person. Symptoms include:
- Fluid (discharge) from the penis. This may stain underpants. It occurs in at least 8 out of 10 men with the infection.
- Pain or burning when passing urine. This occurs in about half of cases.
- Irritation inside the penis, or a feeling of wanting to pass urine frequently.
- Redness at the opening of the urethra at the end of the penis.
- Infection of the back passage (rectum) or throat (pharynx) can develop. Such infections do not usually cause symptoms, although occasionally rectal pain, discharge or itching or a sore throat may be noticed.
Gonorrhoea is believed to cause symptoms in most infected men (about 9 in 10 affected). However, about 1 in 2 women with gonorrhoea do not have any symptoms.
The symptoms may clear over time, even without treatment. This may take up to six months but can be just a couple of weeks or so. However, without treatment, some germs (bacteria) usually remain in the urethra. It is just that the symptoms may go.
Note: even if symptoms go or are not present, there is a good chance that you can pass on the infection if you do not have treatment.
Do I need tests?
If you suspect that you have gonorrhoea or any other STI then contact your local genitourinary medicine (GUM) clinic or see your GP. In the UK you can go to the local GUM clinic without a referral from your GP. You can ring your GP, local hospital or health authority and ask where the nearest clinic is. Local and national information is also available on the internet - for example, from the Family Planning Association's 'Find a clinic' service. You will normally be advised to have tests if gonorrhoea is suspected - even if symptoms go. Ideally you should attend a local GUM clinic for this.
A urine sample and/or a sample (swab) of the discharge will be taken to try to identify the germ (bacterium) that causes gonorrhoea. A urine test is not as accurate in women as it is in men. If a swab is taken for a man, it will be taken from the inside end of the penis (the urethra). In women, a swab is taken from high up in the vagina. Another swab is taken from the inside the neck of the womb (the endocervix) at the womb's entrance. You will also be advised to have tests for other STIs. It will also be suggested that any sexual partners attend for tests and/or treatment.
Are there any possible complications from gonorrhoea?
- Infection can spread to the womb (uterus) to cause pelvic inflammatory disease. This can cause long-standing (chronic) pelvic pain and can lead to infertility.
- Pregnancy can be complicated by premature labour, ectopic pregnancy or miscarriage.
- Infection present during pregnancy can lead to infection spreading to the eyes of a newborn baby. This is called ophthalmia neonatorum.
- Pelvic infection can spread to the liver.
- Abscesses can develop in the Bartholin's glands on either side of the lower part of the vaginal opening.
- Rarely, there can be spread in the bloodstream to other parts of the body.
- In a small number of cases the infection travels up the urethra to the prostate gland. It may also cause infection of the testicles or the tubes around them (epididymo-orchitis).
- Rarely, a narrowing (stricture) of the urethra may develop.
- It can affect future fertility.
- Men who have sex with men can get infections of the back passage (anus) and throat.
- Rarely, there can be spread in the bloodstream to other parts of the body.
What is the treatment for gonorrhoea?
The usual treatment is a single injection of an antibiotic medicine plus a single large dose of a different antibiotic taken by mouth. However, sometimes other treatment regimes and schedules are used. For example, if you have an allergy to the usual antibiotic, or if you have another infection at the same time.
Does my sexual partner need treatment?
Yes. They should be tested for infection, even if they have no symptoms. Treatment with antibiotics is usually advised for sexual partners, even if the tests are negative, because:
- Germs (bacteria) that cause gonorrhoea are often passed on during sex. Tests for bacteria are not foolproof. Treatment with antibiotics helps to make sure that any possible infection is cleared.
- If a sexual partner is infected and not treated, infection can be passed back to you.
- If you have gonorrhoea without symptoms then you may have had it for some time. In this situation any sexual partners within the previous three months should be tested and treated.
A doctor or healthcare professional will normally want to know that treatment has worked. It is usual to be reviewed soon after you finish treatment. This is to check that symptoms have gone and to do a test to check that the infection has gone. Sometimes further treatment (perhaps with a different antibiotic) is needed if the infection has persisted despite treatment.
You should not have sex until both you and your sexual partner have finished treatment. Note: this will normally be for at least seven days after treatment has commenced. Even if the treatment is the usual one-dose schedule of two antibiotics as described above, it takes several days for the infection to clear after taking the treatment.
Can gonorrhoea be prevented?
Wearing a condom during sex (including anal sex and oral sex) helps to prevent the spread of STIs.
The risk of STIs increases with the number of changes of sexual partner. So, the fewer partners you have, the less your risk of STIs.
Further reading and references
Management of gonorrhoea; British Association for Sexual Health and HIV (2011)
UK National Guideline on Gonorrhoea Testing; British Association for Sexual Health and HIV (2012)
Sexually Transmitted Infections in Primary Care; Royal College of General Practitioners and British Association for Sexual Health and HIV (Apr 2013)
Gonorrhoea; NICE CKS, May 2017 (UK access only)
Bignell C et al; 2012 European guideline on the diagnosis and treatment of gonorrhoea in adults, International Union against Sexually Transmitted Infections (IUSTI)
Sexually transmitted infections (STIs): surveillance, data, screening and management; Public Health England, 2016
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