Gonorrhea: Causes, Symptoms, Diagnosis and Treatment

Gonorrhea is a common sexually transmitted disease (STD), with about 1.14 million new infections occurring in the United States each year, according to the Centers for Disease Control and Prevention (CDC).

It is particularly common among 15- to 24-year-olds.

The disease is caused by the gonorrhea bacteria Neisseria gonorrhoeae, and is sometimes called “the clap” — for reasons unknown — or “the drip,” because of the vaginal, penile, or rectal discharge it can cause.

Gonorrhea

Gonorrhea is highly contagious and is the second most commonly reported notifiable disease in the United States. You can get it by having unprotected vaginal, anal, or oral sex with someone who has it. It can spread even if a man doesn't ejaculate during sex.

Signs and Symptoms of Gonorrhea

In women, gonorrhea often doesn't cause symptoms. If a woman does experience symptoms, they are typically mild and can be mistaken for a bladder or vaginal infection.
According to Planned Parenthood, symptoms in women may include:

• Strong-smelling vaginal discharge
• Pain and burning while peeing
• Peeing more often than usual
• Pain during vaginal sex
• Sore throat
• Fever and severe lower abdominal pain, if the infection has spread to the fallopian tubes and stomach area

Men with gonorrhea also often don’t have any symptoms. If symptoms are present, they can include the following:

• Pain and burning while peeing
• Peeing more often than usual
• White, yellow, or green discharge from the penis
• Red or swollen urethral opening
• Sore throat
• Rectal gonorrhea can cause anal discharge, itching, pain, bleeding, as well as painful bowel movements in men and women.

Gonorrhea in the throat can cause a sore throat (pharyngitis) or swollen lymph nodes but it usually doesn't lead to any other symptoms, according to the Mayo Clinic. However, in rare cases, it can be passed on to other people through kissing or oral sex.
Both men and women can get gonorrhea in the mouth, urethra, eyes, and anus, and in women it can also infect the cervix, uterus, and fallopian tubes.
Both sexes can also have the infection and not know it, which is one reason that regular STD testing is a good idea if you have any risk factors for acquiring a gonorrhea infection.
Untreated gonorrhea, even if it’s causing no symptoms, can lead to serious health problems and complications.

Causes and Risk Factors of Gonorrhea

The cause of gonorrhea, the Neisseria gnorrhoeae bacteria, can infect the mucous membranes of the reproductive tract in men and women, as well as those of the mouth, throat, eyes, and rectum.
There are several factors that can increase a person’s risk for getting gonorrhea:

• Being a sexually active female under 25
• Being a man who has sex with men
• Having a new sex partner
• Having multiple sex partners or having sex with someone who has multiple sex partners
• Not using condoms consistently or correctly
• Having a history of gonorrhea or another sexually transmitted disease

How Is Gonorrhea Diagnosed?

Gonorrhea is diagnosed using a lab test that requires either a urine sample or a swab taken from the urethra (for men) or the cervix or vagina (for women). If a person has had anal or oral sex, and a rectal or pharyngeal infection is suspected, a swab specimen may be collected from the throat or the rectum for testing.

The recommended method for gonorrhea testing is the nucleic acid amplification test, which detects the genetic material of Neisseria gonorrhoeae in the urine or swab sample provided. In a second type of lab test, called a culture, the sample is placed in a container to see whether gonorrhea bacteria grow over several days, according to LabTestsOnline.

If you think you may have gonorrhea, make an appointment to see your healthcare provider. Healthcare providers at public health or STD clinics and Planned Parenthood can also perform gonorrhea tests.

At-home test kits are also available for both men and women who wish to test themselves for gonorrhea. To perform the test, you will need to collect a urine sample or take a swab from an affected area. You then mail the sample to a specified lab, and a notification for a positive or negative result is usually sent via email or text message.

Since a person may have gonorrhea without displaying symptoms, regular testing can help to detect the disease before it causes complications. This is particularly important for people who are at increased risk of contracting the disease, defined by the CDC as those who have a new sexual partner, more than one sex partner, a sex partner who has a sexually transmitted infection (STI), previous or coexisting sexual infections, or those who are using condoms inconsistently outside a monogamous relationship.

The CDC recommends that the following groups of people get tested for gonorrhea regularly:

• Sexually active women under 25 should be tested once yearly.
• Sexually active women over 25 who are at increased risk should be tested once yearly.
• All pregnant women under 25 should be tested early in their pregnancy, as should pregnant women over 25 if they are at increased risk.
• Men who have sex with men should be tested at least once yearly, regardless of condom use.
• Men who have sex with men and are at increased risk should get tested every three to six months.
• People living with HIV should be tested for gonorrhea at their first HIV evaluation, and subsequently at least once yearly.
• People with HIV who are at increased risk for gonorrhea should be screened more than once yearly (depending on individual risk behaviors and the local epidemiology)

It can be tough to tell one sexually transmitted infection from another, which is why you should see a doctor if you have symptoms that concern you.

Prognosis of Gonorrhea

When gonorrhea is diagnosed and treated in a timely way, people usually make a complete recovery. In some cases where treatment is delayed and pelvic inflammatory disease develops, it can cause infertility, scarred fallopian tubes (which increase the risk of tubal pregnancy in women), ectopic pregnancy (whereby pregnancy occurs outside the womb), and chronic abdominal pain.

Duration of Gonorrhea

Gonorrhea gets better very quickly with antibiotic therapy — usually within a few days. However, if your symptoms persist for longer than a few days after you are treated, contact your healthcare provider.right up arrow
If untreated, gonorrhea can cause serious health issues, some that could last throughout a person’s lifetime.right up arrow
People with gonorrhea who are cured of it once with antibiotics can still get the infection again.

Treatment and Medication Options for Gonorrhea

Over the years, gonorrhea has become resistant to almost all of the classes of antibiotics once used to treat it. Successful treatment now relies on the one remaining class of antibiotics — cephalosporins — that’s effective against it, per the CDC.

For First Time, Standard Antibiotic Regimen Fails to Cure a Case of Gonorrhea
Medication Options
As of December 2020, the CDC recommends a single 500-milligram (mg) intramuscular dose of the antibiotic Rocephin (ceftriaxone) for uncomplicated gonorrhea. Treatment for coinfection with Chlamydia trachomatis with oral doxycycline (100 mg twice daily for seven days) should be administered when chlamydial infection has not been excluded.

Be sure to tell those who you have sex with that you are being treated for gonorrhea so they can be treated, too. This will help you avoid passing it back and forth to each other.

You should not have sex for seven days after treatment, and you should refrain from having sex with partners who have not been treated for gonorrhea until after they have been tested and, if necessary, treated.

Alternative and Complementary Therapies

Gonorrhea is curable with antibiotics, provided the medications are taken as prescribed; there aren’t any alternative therapies that have been proven to cure the disease.

There does appear to be potential for the mouthwash Listerine to help with gonorrhea control. In one small 2017 study published in the journal Sexually Transmitted Infections, researchers instructed men with pharyngeal gonorrhea (gonorrhea of the throat) to gargle with Listerine for one minute.right up arrow A control group of men gargled with a saline solution. Five minutes after gargling, the men received pharyngeal swabs to see what effect, if any, the Listerine had had on the amount of N. gonorrhoeae bacteria in their throats. The researchers found that men who’d gargled with Listerine were significantly less likely to have positive tests than the men who’d gargled with saline. Even so, all the men in the study were then treated with antibiotics to cure their gonorrhea.

While the Listerine study raises intriguing possibilities, it does not prove that Listerine cures gonorrhea. People who test positive for gonorrhea should still be treated with antibiotics. In addition, Listerine is not intended to be used in body cavities other than the mouth.

Prevention of Gonorrhea

The only way to absolutely keep yourself safe from catching gonorrhea is to avoid having vaginal, anal, or oral sex. However, since many people wish to have sex at some point in their lives, that may be unrealistic.

But there are ways you can lower your risk of getting the disease while still being sexually active, such as the following:

• Using a condom during vaginal or anal sex
• Using a condom (for men) or a dental dam (for women) during oral sex
• Thoroughly washing sex toys — or changing the condom on them — before a new person uses them
• Not having sex with anyone until you’ve finished your treatment (if you are currently being treated for gonorrhea)
• Also, having sex with fewer partners can help reduce your chances of getting gonorrhea.
• 
  

Preventing Gonorrhea in Infants

Gonorrhea in a pregnant woman can increase the risk for miscarriage and premature birth, according to the American Pregnancy Association.right up arrow
Pregnant women with gonorrhea can also pass it to their baby during childbirth, which can cause a severe eye infection possibly leading to blindness, a joint infection, or a deadly blood infection in their infant.

For these reasons, it’s recommended that women get screened for gonorrhea at their first prenatal visit so that they can be treated as soon as possible if they have it.

If gonorrhea is detected in an infant after birth, it’s treatable with Rocephin, notes the CDC.

Complications of Gonorrhea

Women with untreated gonorrhea are at risk for pelvic inflammatory disease (PID), which may cause no symptoms or may cause pain in the pelvis, lower abdomen, or lower back. If left untreated, PID can lead to:

• Chronic pelvic pain
• Infertility

Ectopic pregnancy, in which the fertilized egg implants outside the uterus, possibly leading to internal bleeding or a ruptured fallopian tube and miscarriage
Complications of gonorrhea in men may include epididymitis, an inflammation of the epididymis, a long coiled tube at the back of the testicles that stores sperm and carries it between the testicles and the vas deferens, which conveys it to the urethra. Epididymitis can cause testicular or scrotal pain, and, if left untreated, infertility.

Disseminated Gonococcal Infection

Gonorrhea can also spread throughout the body, in a condition called systemic, or disseminated, gonococcal infection (DGI).

Symptoms of DGI commonly include joint or tendon pain, a skin rash, and fever. More advanced stages of DGI cause septic, or infectious, arthritis, in which the bacteria directly invade the joint space, according to the Merck Manual.

If gonorrhea spreads to the joints, it can cause a type of arthritis known as gonococcal arthritis, which is typically experienced in large joints such as the knees, wrists, or ankles. Gonococcal arthritis is treatable with antibiotics, according to CreakyJoints.org.

HIV Risk Rises With Untreated Gonorrhea

If gonorrhea goes untreated, it may increase a person’s chances of getting or transmitting HIV, the virus that causes AIDS.right up arrow Treating gonorrhea helps reduce that risk and protect your overall health but by itself will not prevent a person from contracting HIV. Practicing safer sex and limiting your number of sexual partners can help reduce the risk of contracting HIV.