Gonorrhea is a common sexually transmitted infection that can cause painful urination, discharge, and other symptoms. However, several other conditions can mimic gonorrhea, leading to incorrect diagnoses. Knowing the differential diagnoses of gonorrhea can help ensure proper testing and treatment. This article will explore conditions that may be mistaken for gonorrhea, including chlamydia, bacterial vaginosis, yeast infections, urinary tract infections, and non-infectious causes. Quick answers to key questions about gonorrhea misdiagnosis will be provided upfront, with more details throughout the article.
Quick answers:
– Chlamydia is the most common infection mistaken for gonorrhea, as they cause similar symptoms.
– Bacterial vaginosis and yeast infections can mimic gonorrhea symptoms in women.
– Urinary tract infections may be confused with gonorrhea, especially in men.
– Noninfectious causes like irritation, injury, or anatomical abnormalities can also mimic gonorrhea.
– The only way to confirm gonorrhea is through lab testing like cultures or nucleic acid amplification tests.
– Taking a full history and performing a physical exam can help identify the true cause of symptoms.
Symptoms of Gonorrhea
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It is spread through unprotected oral, vaginal, or anal sex with an infected partner. The highest rates of infection are among sexually active teenagers and young adults. Gonorrhea can also be passed from mother to baby during childbirth.
The most common symptoms of gonorrhea include:
Men:
– Burning/painful urination
– White, yellow, or green penile discharge
– Swelling or pain in the testicles
Women:
– Painful urination
– Vaginal discharge that is yellow, green, or gray
– Bleeding between periods
– Heavier periods
– Abdominal or pelvic pain
– Sore throat (from oral sex)
However, many infected people show no symptoms initially. Without treatment, gonorrhea can cause long-term complications like infertility, increased HIV risk, and pelvic inflammatory disease in women. Rarely, gonorrhea spreads to the blood or joints. This condition is called disseminated gonococcal infection and causes fever, rash, and arthritis.
Chlamydia
Chlamydia is the most common bacterial sexually transmitted infection worldwide. In the United States, over 1.7 million cases were reported to the CDC in 2017. Chlamydia is caused by the bacterium Chlamydia trachomatis.
Chlamydia shares many overlapping symptoms with gonorrhea:
– Burning urination
– Unusual discharge from the penis or vagina
– Pain in the testicles or pelvis
Women may also experience bleeding between periods or after sex. Like gonorrhea, chlamydia can be asymptomatic initially. Without treatment, it can cause fertility problems or adverse pregnancy outcomes. Chlamydia can also increase susceptibility to other STIs.
Because the two infections have such similar presentations, chlamydia is often mistaken for gonorrhea. The only way to distinguish between them is laboratory testing. Nucleic acid amplification tests (NAATs) are recommended as the gold standard.
To avoid misdiagnosis, the CDC advises testing for both gonorrhea and chlamydia in people presenting with symptoms. Dual treatment is also recommended when either infection is detected.
Bacterial Vaginosis
Bacterial vaginosis (BV) results from an overgrowth of bacteria in the vagina. It affects about 30% of women ages 14-49. The most common symptom is a gray, thin vaginal discharge with a fishy odor. Burning or itching may also occur.
BV shares some overlaps with the symptoms of gonorrhea in women, including vaginal discharge. However, BV discharge does not usually have a yellow or green color. The fishy smell is also distinctive from the discharge of gonorrhea.
Microscopic examination and lab tests can confirm bacterial vaginosis. BV is treated with oral or topical antibiotics. It is not considered an STI, although sexual activity can increase the risk. Wearing condoms may help reduce that risk.
Yeast Infections
Yeast infections are caused by overgrowth of a fungus called Candida. Up to 75% of women will experience at least one yeast infection in their lifetime. Symptoms include itching, burning, and thick, white cottage cheese-like discharge.
The abnormal vaginal discharge of a yeast infection may be mistaken for gonorrhea discharge. However, a yeast infection discharge is usually odorless and white, unlike the yellow/green discharge typical of gonorrhea. Yeast infections also cause intense vulvar itching, which is not common with gonorrhea.
Microscopic examination can identify yeast under the microscope. Treatment involves antifungal creams or suppositories. Maintaining proper hygiene and avoiding douching may help prevent yeast infections.
Urinary Tract Infections
Urinary tract infections (UTIs) are caused by bacteria infecting the urinary system. UTIs are more common in women but can occur in men as well. The hallmark symptom is painful and frequent urination. Cloudy, bloody, or foul-smelling urine may also occur.
Men with UTIs may mistake their painful urinary symptoms for gonorrhea. However, UTIs typically do not cause penile discharge. Urinalysis and urine culture can confirm the presence of bacteria and lead to proper antibiotic treatment.
In women, UTIs can cause pelvic discomfort that may resemble pelvic inflammatory disease from gonorrhea. UTIs also occasionally trigger vaginal discharge, which could be mistaken for gonorrhea. Urinalysis and pelvic exam can help differentiate between the two conditions.
Non-Infectious Causes
Sometimes abnormal urethral or vaginal discharge can stem from non-infectious causes:
Urethritis: Inflammation of the urethra, often due to irritation or injury during sex. Symptoms include painful urination and discharge. Usually resolves with time.
Bladder prolapse: The bladder drops down into the vagina, sometimes causing leakage of urine that may resemble discharge. Treated with Kegel exercises or medical devices.
Forgotten tampon: Can cause abnormal vaginal discharge with foul odor. Resolves once tampon is removed.
Cervicitis: Inflammation of the cervix, which can manifest as yellow or gray discharge. Often occurs with hormonal changes.
Vaginitis: Generalized inflammation of the vagina, causing discharge that may be mistaken for an STI. Improved hygiene often helps treat vaginitis.
These conditions should resolve once the underlying irritation or anatomical problem is addressed. In persistent cases, further medical evaluation is recommended.
Diagnosing Gonorrhea
Given the overlapping symptoms, the only way to confirm gonorrhea is through lab testing:
– Gram stain: A quick microscopic exam of discharge sample that may show typical gonorrhea bacteria. Can provide immediate guidance for treatment.
– Culture: Gold standard test that grows and positively identifies gonorrhea bacteria. May take 2-3 days for results.
– NAATs: Nucleic acid amplification tests detect gonorrhea genetic material. Highly accurate with fast results. The preferred gonorrhea test.
– Urine test: NAATs or cultures can also be performed on a urine sample in men or women to check for gonorrheal urethritis.
Always discuss your symptoms with a healthcare provider, who can perform the appropriate exams and order confirmatory lab tests. Do not assume symptoms are due to gonorrhea without testing.
Physical Exam
A physical exam is also important when gonorrhea is suspected:
– Gynecologic exam in women to inspect discharge and cervix
– Penile exam in men to check for discharge
– Testicular exam to check for swelling or pain
– Pelvic exam to assess for tenderness, masses, or discharge
The findings can help steer the provider towards or away from gonorrhea as the diagnosis.
Treatment
The CDC currently recommends dual therapy for gonorrhea with ceftriaxone injection plus azithromycin oral treatment. This covers both gonorrhea and chlamydia.
Prompt antibiotic treatment cures most gonorrhea infections. It is important to:
– Take all medications as directed
– Abstain from sex for one week after treatment
– Ensure partner(s) are treated to prevent reinfection
– Retest after three months to confirm cure
Seeking care for unusual discharge, urination symptoms, or pelvic pain can both identify or rule out gonorrhea. Open communication with sexual partners is also critical to prevent spread of infections. With appropriate diagnosis and dual treatment, cases of gonorrhea – and misdiagnoses – can be reduced.
Conclusion
Gonorrhea has some overlapping symptoms with several common conditions like chlamydia, yeast infections, urinary tract infections, and non-infectious causes. This can lead to incorrect assumptions and misdiagnoses, especially if proper exams and lab testing are not performed. To accurately diagnose gonorrhea, providers should take a detailed history, perform a physical exam, and order confirmatory labs like cultures or NAATs. Dual antibiotic therapy can then rapidly cure gonorrheal infections. Increased screening and proper treatment of gonorrhea cases and their partners will limit spread of disease. Being aware of potential mimics like chlamydia and urinary tract infections will also improve diagnosis and treatment outcomes.