Gonorrhea is a common sexually transmitted infection that can cause serious health problems if left untreated. If you have been diagnosed with gonorrhea or suspect you may have it, you may be feeling worried about the implications. Here is some information to help you understand gonorrhea, its risks, and what you can do about it.
What is gonorrhea?
Gonorrhea is an infection caused by the bacteria Neisseria gonorrhoeae. It is transmitted through unprotected oral, vaginal or anal sex with an infected partner. Ejaculation does not have to occur for gonorrhea to spread. Gonorrhea can infect the genitals, rectum, and throat.
Symptoms
Many people with gonorrhea don’t have any symptoms. When symptoms do occur, they often appear 2 to 5 days after infection but it can take as long as 30 days to show up. Symptoms may include:
- Burning or pain when urinating
- Increased vaginal discharge
- Vaginal bleeding between periods
- Sore throat (from oral sex)
- Anal itching, bleeding, discharge or painful bowel movements (from anal sex)
Even when there are no symptoms, gonorrhea can still cause serious damage. In women, gonorrhea that goes untreated can lead to pelvic inflammatory disease, which causes chronic pelvic pain and infertility. In men, untreated gonorrhea can cause epididymitis, a painful condition of the testicles that can lead to infertility if left untreated. Infection in the throat will not cause any symptoms but is important to diagnose because it can facilitate transmission.
Should I be worried?
Yes, you should be concerned if you have gonorrhea or think you may have been exposed. Gonorrhea has become resistant to many commonly used antibiotics, making infections more difficult to treat. Getting prompt diagnosis and treatment is important to prevent complications and transmission to others.
Some key reasons you should take gonorrhea seriously include:
- Antibiotic resistance – Treatment is becoming more difficult as gonorrhea has developed resistance to many oral antibiotics that were previously effective. The CDC now recommends only one class of antibiotic, cephalosporins, to treat gonorrhea.
- Increased risk of HIV – Having gonorrhea makes you more susceptible to contracting HIV if exposed.
- asymptomatic – Many people have no symptoms, so gonorrhea can go undiagnosed and spread easily to partners.
- Infertility – Untreated gonorrhea can cause long-term damage to the reproductive system and lead to infertility in both men and women.
- Pain and discomfort – Advanced gonorrheal infections can cause painful conditions like epididymitis and pelvic inflammatory disease.
- Ophthalmia neonatorum – Babies exposed to gonorrhea during childbirth can develop eye infections that can lead to blindness if untreated.
Getting tested
Getting tested is crucial if you are worried you may have been exposed or have any unusual symptoms. Gonorrhea can be diagnosed through:
- Urine test
- Vaginal, cervical or urethral swabs
- Throat swab
- Rectal swab
Often gonorrhea is diagnosed through a nucleic acid amplification test (NAAT) which detects the bacteria’s genetic material. It may be done alongside testing for chlamydia, another common STI.
You should get tested if:
- You have symptoms of gonorrhea
- You have had unprotected sex with a new partner
- You or your partner have had multiple partners
- You are pregnant – gonorrhea can be passed to a baby during childbirth
- You are a sexually active gay, bisexual or transgender man
Ask your doctor for a test if you are concerned. Getting diagnosed quickly will allow treatment to start faster.
Treatment
Gonorrhea is treatable with antibiotics. The recommended treatment is an injection of ceftriaxone along with oral azithromycin or doxycycline. Dual therapy is used because gonorrhea has developed resistance to various antibiotics used alone.
It is critical to take all prescribed antibiotics exactly as directed and avoid sex until treatment is complete and tests show the infection has cleared. Even if symptoms disappear, finishing medications is important to ensure the infection is fully cured.
All sex partners from up to 60 days before symptoms began should be notified, tested and treated. Avoid sexual contact until 7 days after partners have been treated.
In rare cases gonorrhea does not respond to oral antibiotic treatment alone. Additional injections or IV antibiotics may be necessary in resistant infections.
Follow up
It is advisable to get retested for gonorrhea 3 months after treatment or the next time you have a new partner. This ensures you have not been re-infected and that the infection has been fully cured.
Practicing safer sex by using condoms and dental dams can help reduce your risk of future gonorrhea or other STI infections.
Complications
When left untreated, gonorrhea can cause serious health problems:
In women
- Pelvic inflammatory disease (PID) – an infection of the uterus, fallopian tubes and other reproductive organs. PID causes chronic pelvic pain and can lead to infertility.
- Ectopic pregnancy – increased risk of pregnancy outside the womb, which can be life-threatening.
- Infertility – permanent damage to the fallopian tubes can make it difficult or impossible to get pregnant.
In men
- Epididymitis – inflammation of the coiled tube at the back of the testicles, causing pain and swelling.
- Infertility – gonorrhea can block the vas deferens, preventing sperm from being ejaculated.
- Chronic prostatitis – inflammation of the prostate gland that causes pain and urinary difficulty.
In both men and women
- Disseminated gonococcal infection (DGI) – the spread of infection into the bloodstream, causing fever, rash, and arthritis-like joint pain.
- Increased risk of HIV infection – gonorrhea makes transmission of HIV more likely if exposed.
In newborns
- Ophthalmia neonatorum – eye infection that can lead to blindness if untreated.
- Sepsis – overwhelms the bloodstream, resulting in organ failure and death in severe cases.
Prevention
You can take steps to prevent contracting or spreading gonorrhea:
- Use condoms during vaginal, anal and oral sex. Dental dams can also reduce risk during oral sex.
- Limit your number of sexual partners and avoid sex with partners who have multiple partners.
- Ask partners to get tested before sex and share STI test results.
- Get vaccinated for hepatitis B, which provides some protection against gonorrhea.
- Don’t douche, which can push bacteria further into the reproductive tract.
- Avoid alcohol and drug misuse, which can increase risky sexual behaviors.
If you are pregnant, get prenatal screening for gonorrhea early in pregnancy and again before delivery. Prompt treatment can prevent infecting your baby during childbirth.
Conclusion
Gonorrhea is a common STI that requires prompt diagnosis and treatment. Left untreated it can have serious consequences like infertility and chronic pain. The good news is gonorrhea is curable, especially when caught early. Getting tested if you have symptoms or following risky behaviors is key.
With appropriate antibiotic treatment, following up to confirm the infection is gone, and telling partners to get treated, the long-term outlook for gonorrhea is excellent. Practicing safer sex and getting regular STI screenings are important to reduce your risks going forward.
While gonorrhea should always be taken seriously, try not to panic. If you get diagnosed quickly and follow your doctor’s treatment plan, you should make a full recovery and avoid any lasting complications. Work closely with your healthcare provider and avoid sex until fully cured.
| Type of Gonorrhea Test | What it Involves |
|---|---|
| Urine test | Peeing into a cup to collect a urine sample |
| Urethral swab | Inserting a cotton swab a short way into the urethra to collect a sample |
| Cervical swab | Swabbing the opening of the cervix to collect a sample |
| Vaginal swab | Swabbing the vaginal walls to collect a sample |
| Rectal swab | Inserting a cotton swab just inside the anus to collect a sample |
| Throat swab | Swabbing the back of the throat to collect a sample |
Nucleic acid amplification tests (NAATs) that detect gonorrhea bacteria DNA or RNA are the preferred method. Samples can come from urine, swabs, or other body fluids.
When to get tested for gonorrhea
| Situation | Recommendation |
|---|---|
| You have symptoms of gonorrhea | Get tested immediately |
| You have a new sex partner | Get tested before having sex |
| You or your partner have had multiple sex partners | Get tested every 3-6 months |
| You are pregnant | Get tested early in pregnancy and again before delivery |
| You are a sexually active gay, bisexual or transgender man | Get tested every 3-6 months |
| You have another STI | Get tested for gonorrhea and chlamydia |
| Your partner tests positive for gonorrhea | Get treated immediately, even if no symptoms |
Gonorrhea Treatment Guidelines
The CDC currently recommends combination therapy with two antibiotics to treat gonorrhea due to increasing resistance:
- Ceftriaxone: injection of 250mg given intramuscularly in a single dose
- Azithromycin: 1g oral dose given once
- Doxycycline: 100mg oral dose twice daily for 7 days
Dual treatment with ceftriaxone and either azithromycin or doxycycline is highly effective in curing uncomplicated gonorrhea at all sites of infection. Always take medications exactly as prescribed and finish the full course.
Sex partners from the prior 60 days should be referred for presumptive treatment to prevent reinfection and transmission.
A test of cure should be performed 1-3 weeks after finishing treatment to confirm the infection has resolved.
How Gonorrhea Spreads During Sex
| Type of Sex | Risk Level |
|---|---|
| Vaginal | High risk of transmission |
| Anal | High risk of transmission |
| Oral | Low but present risk of transmission |
| Deep kissing | Very low risk of transmission |
| Sex toys | Low risk if shared without cleaning |
| Fingering/handjobs | Low risk of transmission |
| Sexual touching/frottage | Low risk of transmission |
Gonorrhea is most likely to spread through unprotected vaginal and anal sex. Proper condom use protects against transmission.
How to Prevent Gonorrhea
- Use condoms during vaginal, anal and oral sex
- Limit your number of sexual partners
- Ask partners to get STI tested before sex
- Get vaccinated against hepatitis B
- Don’t douche
- Avoid excessive alcohol and drug use
- Get regular STI screenings if sexually active
- Take preventive antibiotics if exposed
Safer sex practices like using condoms, knowing partner’s STI status, and getting vaccinated can reduce gonorrhea risk.