What is gonorrhoea?
Gonorrhoea is a sexually transmitted infection (STI) caused by a germ (bacterium) called the gonococcus.
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
- 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.
- Infection of the rectum or back of the 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.
- Pain or burning when passing urine.
- 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.
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 get 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?
You will normally be advised to have tests if gonorrhoea is suspected - even if symptoms go. You may be referred to a local genitourinary medicine (GUM) clinic for this. You can also go to the local GUM clinic without a referral from your GP. (See later for details.)
A urine sample and/or a sample (swab) of the discharge will be taken to try to identify the germ (bacterium) that causes gonorrhoea. In men, the swab will be taken from 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 may also be advised to have tests for other STIs.
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.
- In a small number of cases the infection travels up the urethra to the prostate gland. Rarely, a narrowing (stricture) of the urethra may develop.
- Spread in the bloodstream to other parts of the body is rare.
- Men who have sex with men can get infections of the back passage (anus) and throat.
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.
If you suspect that you have gonorrhoea or any other STI then contact your local 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 the 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.
Further reading and references
Sexually transmitted infections (STIs): surveillance, data, screening and management; Public Health England, 2016
Sexually Transmitted Infections in Primary Care; Royal College of General Practitioners and British Association for Sexual Health and HIV (Apr 2013)
National guideline for the management of chancroid; British Association of Sexual Health and HIV (2014)
Towards elimination of HIV transmission, AIDS and HIV-related deaths in the UK; Public Health England (November 2017)
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