Gonorrhea

MMST, MBBS

Last updated on: 26 Mar 2025 | 12:42 PM (IST)

Overview

Gonorrhea is a sexually transmitted disease (STD) caused by bacteria, Neisseria gonorrhoeae. It is transmitted from one person to another during sexual contact which includes oral, vaginal, and anal sex. Pregnant women can also transmit the infection to the newborn. It can infect both men & women.

It targets male and female reproductive organs, urethra, eyes and throat. It can affect people of any age group but is more common in young people of age 15 to 24 years.

The disease is usually asymptomatic. Even when a patient has symptoms, they are often mild and nonspecific. The symptoms are often mistaken for a bladder or vaginal infection in females. Swabs from the genital organs are taken for examination. The presence of bacteria is confirmed either through nucleic acid amplification tests or culture methods.

The disease can be treated with antibiotics. Untreated gonorrhea can lead to long term complications such as pelvic inflammatory diseases (in women) and epididymitis (in men). One can prevent gonorrhea by adopting safe sexual practices such as using condoms, dental dams, and avoiding multiple sexual partners.

Key Facts

Usually seen in

All age groups
Adults between 15 to 24 years of age

Gender affected

Both men and women but more common in women

Body part(s) involved

Urethra
Vagina
Uterus
Penis
Cervix
Throat

Prevalence

Worldwide: 30.6 million (2016)

Mimicking Conditions

Chlamydia
Trichomoniasis
Syphilis
Mycoplasma genitalium
Herpes simplex virus
Conjunctivitis
Urethritis
Cervicitis
Proctitis,
Pharyngitis
Arthritis

Necessary health tests/imaging

Physical examination
Nucleic acid amplification test (NAAT)
Culture test
Smear test

Treatment

Causes Of Gonorrhea

Gonorrhea is caused by an obligate pathogen, Neisseria gonorrhoeae. Obligate pathogens are the bacteria that transmit disease from one host to another. These bacteria cannot survive outside the host body.

The bacteria is mainly present in the discharge of penis & vagina. The disease can be transmitted through:

Unprotected vaginal, anal & oral sex
Sharing of contaminated vibrators & sex toys
Infected mother to baby during childbirth

Neisseria gonorrhoeae cannot survive on the surfaces outside the body. Due to which, the infection of gonorrhea does not spread by kissing, hugging, or sharing swimming pools, toilet seats, towels, or utensils.

Types of Gonorrhea

Gonorrhea can be classified as either uncomplicated or complicated.

Uncomplicated gonorrhea

This type is much more common and causes urogenital, anogenital, or pharyngeal infections.

Complicated gonorrhea

The infection that leads to the spread of bacteria to joints and other tissues is considered as complicated gonorrhea.

Symptoms Of Gonorrhea

The incubation period of gonorrhea (the time between exposure to the infection and the appearance of symptoms) is 10 days in women and 1-3 days in men. The various symptoms are listed below:

A. Symptoms of uncomplicated gonorrhea in men

Urethral discharge
Dysuria (painful urination)
Urgency
Frequent urination
Urinary itch
Painful erection

B. Symptoms of uncomplicated gonorrhea in women

Dysuria
Hematuria (blood in urine)
Inflammation of the anus
Increase in vaginal discharge

Here’s more on the common causes & treatment of vaginal discharge.

C. Symptoms of complicated gonorrhea in men

1. Epididymitis: It refers to inflammation of epididymis(a coiled tube attached to each of the two male reproductive organs, the testes). The typical symptoms include:

Swelling of the epididymis
Severe pain in epididymis, groin and lower abdomen
Discharge from the urethra

2. Seminal vesiculitis: It refers to the inflammation of the tube that produces fluid for the semen known as the seminal vesicles. The typical symptoms include:

Dysuria (painful urination)
Frequent urination
Hematuria (passage of clear urine with blood)
Hemospermia (blood in semen)
Lower abdominal pain

3. Prostatitis: It refers to the inflammation of the prostate gland. The typical symptoms in gonorrhea include:

Chills
Fever
Frequent urination
Pain or discomfort in the pubic region

D. Symptoms of complicated gonorrhea in women

1. Pelvic inflammatory disease: It refers to the inflammation of the female genital tract). It is characterized by the following symptoms:

Chills
Fever
Anorexia (loss of appetite)
Nausea
Vomiting
Lower abdominal pain
Irregular vaginal bleeding
Abnormal vaginal discharge

2. Perihepatitis: It refers to the inflammation of the liver capsule. It is characterized by:

Sudden pain in the upper abdomen
Fever
Nausea
Vomiting

E. Symptoms of gonorrhea at other sites

1. Oral gonorrhea: It is also known as pharyngeal gonorrhea. Oral contact with either penis or vagina can cause oral gonorrhea. Usually oral gonorrhea remain asymptomatic but can cause following symptoms:

Sore throat
Difficulty in swallowing food
Redness of the throat
White spots on the throat
Swollen lymph nodes in the neck
Fever

These symptoms are common for men and women and usually take 7-21 days to appear after oral contact with the infected genitals. Kissing does not spread oral gonorrhea as bacteria do not infect the mouth and tongue.

2. Gonococcal conjunctivitis (GC): GC infects the eyes and spreads through the direct contact of the eye with the infected secretions of the genitals.

An infected pregnant woman can also transmit the infection to the neonates during delivery. It occurs due to exposure of the neonate to the vaginal secretions which contain bacteria. When it occurs in neonates, GC is also known as gonococcal ophthalmia neonatorum. Symptoms take 24 to 28 hours following exposure to the bacteria and include:

Red eyes
Thick pus in the eyes
Swelling of the eyelid and conjunctiva
Turbid and foggy cornea

3. Proctitis: It refers to the inflammation of the lining of the rectum. It is developed due to anal-genital intercourse. In most of the cases, it is asymptomatic. Some patients may experience symptoms such as :

Itching and burning sensation in anus
Discharge from the anus
Rectal bleeding
Blood in the stool
Rectal pain
Tenesmus (frequent and urgent feeling of passing the stool)

Risk Factors For Gonorrhea

You are at higher risk of gonorrhea if you:

Have unprotected oral, anal or vaginal sex with an infected partner
Have low immunity
Have been diagnosed with gonorrhea in the past
Are having multiple sexual partners
Have sexual partner who has multiple partners
Are sexually active
Are a sex worker
Have sex with somone from endemic are, having previous gonorrhea, having any sexually transmitted infections & having human immunodeficiency infection (HIV)

Lack of education & low socioeconomic status also increases the risk of developing gonorrhea. If the condom breaks during sex with an infected partner, it increases the risk of gonorrhea. Men who have sex with men (MSM) are more likely to cause gonorrhea.

Diagnosis Of Gonorrhea

The laboratory confirmation is done through the detection of bacteria in samples from the urinary tract, rectum, throat or eyes. In various cases, urine samples are also used. In case of any symptoms of gonorrhea, abstain from any kind of sexual activity until it is confirmed negative by the tests. The following tests helps in the diagnosis of gonorrhea:

1. Physical examination: It includes looking for any signs of gonorrhea. Manifestations such as discharge from throat, rash, eye symptoms, and pain in abdomen are evaluated by the health-care provider.

2. Nucleic acid amplification test (NAAT): This method detects the genetic material of the Neisseria gonorrhoeae in either urine or swab samples of the patients. The swab sample is taken from urethra for males. In females, the sample is taken from vagina or cervix. In case of rectal or pharyngeal infection, samples may be taken from rectum or throat respectively.

3. Culture: This test is one of the most widely used tests for gonorrhea as it has a specificity of 100%. The test can be done from the samples collected from the throat, urethra, vagina or rectum except the urine in both men and women.

4. Smear test: This test is usually used to diagnose uncomplicated gonorrhea in men. It involves examination of urethral smears under the microscope.

Prevention Of Gonorrhea

Gonorrhea is a sexually transmitted disease (STD) that spreads by sharing sexual fluids. This can be prevented by following safer sex practices like:

Using condoms, dental dams or latex/nitrile gloves while having oral, anal or vaginal sex
Getting tested for STDs regularly, if you are sexually active
Avoiding sex with your partner until he/she has finished his/her treatment for any STD
Washing hands after touching your partner’s genitals
Washing the sex toys with soap and water regularly
Using condoms on sex toys
Avoiding multiple partners

Note: Washing the genitals, urinating, or douching after sex will not prevent gonorrhea.

Are you using condoms in the right way? Here’s 9 condom mistakes that you should avoid.

Specialist To Visit

Gonorrhea can affect anyone who is sexually active. You should immediately consult the doctor if you fall under the following category:

If you have symptoms such as genital discharge, burning during urination, rash, unusual rash etc.
If your partner has been recently diagnosed with any STD

The annual gonorrhea screening is also recommended, if you:

Are young and sexually active
Are old but have risk factors such as multiple sex partners etc.

Pregnant women should also be tested for any STD including gonorrhea as a part of routine examination. This will help in reducing complications in the fetus.

In most cases, the best place to visit is a sexual health clinic also called a genitourinary medicine clinic (GUM). The specialists who can help treat this infection include:

General physician
Infectious disease specialist
Gynecologist

If you are falling into any of the categories mentioned above, seek advice from our professionals.

Treatment Of Gonorrhea

Gonorrhea can be treated by antibiotics. The various treatment options for different symptoms or types of gonorrhea are discussed as follows:

Urogenital infections

The following antibiotics are prescribed for managing urogenital infections:

If a person is allergic to ceftriaxone other antibiotics can be used such as:

Gonococcal conjunctivitis

Newborns who developed gonococcal conjunctivitis are treated with ceftriaxone as per their body weight. The eyes should be washed every hour with normal saline. Mothers of infected newborns should be examined, and those with gonorrhea should be treated.

Gonorrhea during pregnancy

Erythromycin or amoxicillin are the drug of choice for treating gonorrhea during pregnancy.

Follow-up

Usually follow-up testing is not recommended for rectal and genital infections. However, if the symptoms persist even after getting treatment for a few days, he/she should consult the doctor.
Re-evaluation after 7-14 days of treatment is recommended for throat infection.
Re-test is advised after 3 months of treatment to check re-infection.

Sexual partner management

If you are diagnosed with gonorrhea, it is important to test the sexual partner, if you had sex before the onset of symptoms or within two months of the diagnosis.
Any kind of sexual activity should be avoided before the completion of treatment.

The mother of a neonate diagnosed with gonococcal conjunctivitis should be tested for gonorrhea alongwith her sexual partner.

Complications Of Gonorrhea

Untreated gonorrhea usually spread to other part of the body leading to several complications:

1. Pelvic inflammatory disease (PID)

Gonorrhea can spread from vagina to the other reproductive parts of the female such as the fallopian tubes & uterus. The symptoms of PID include fever & abdominal pain and can lead to reproductive complications such as:

Long term pelvic pain
Infertility
Internal abscesses
Endometritis
Ectopic pregnancy

2. Pregnancy related complications

Gonorrhea in pregnant women increases the chances of miscarriages, premature labor, and first trimester abortion.

A pregnant woman can also pass the infection to the fetus. It can develop several abnormalities in the baby such as conjunctivitis, joint pain, blindness, and blood infections.

However, early treatment of the pregnant woman can reduce the chances of these complications.

3. Infertility in men

Gonorrhea can cause a painful infection in the testicles and prostate gland. It can also cause inflammation of the epididymis. All these changes can affect the fertility in men.

4. Disseminated gonococcal infection (DGI)

DGI occurs as a result of untreated gonorrhea over a long period of time. In DGI, infection spreads through the bloodstream and can cause sepsis. It can also lead to conditions such as

Septic arthritis (inflammation of the joints)
Tenosynovitis (inflammation of a tendon and its sheath)
Endocarditis (inflammation of the inner lining of the heart's chambers and valves)
Dermatitis (inflammation of the skin)

5. Fitz- Hugh-Curtis Syndrome

It is also known as perihepatitis. It is developed due to PID and is characterized by inflammation of the liver capsule. It causes formations of adhesions in the liver that results in persistent pain.

Did you know?

Gonorrhea, if not treated, increases the risk of acquiring or spreading HIV infection. Read more about HIV infection.

Home-care For Gonorrhea

Home remedies

Gonorrhea can be easily treated with antibiotics. However, the following home remedies can be used as an adjunct to the antibiotics:

1. Garlic (lehsun): It possesses antibacterial properties and can be used to combat bacterial infections like gonorrhea.

2. Apple cider vinegar: It is well known for its antibacterial properties. It is consumed every morning using a metal straw as it can abrade the teeth.

3. Aloe-vera gel: It moisturizes the skin and fastens the recovery of wounds due to its antibacterial and antiinflammatory properties.

4. Goldenseal: This plant is also known for its antimicrobial properties. It is available in capsule and cream form. It is advised to take recommendation from the doctor for the right dosage before taking or applying it.

5. Echinacea: This plant is used to reduce inflammation in the genitals due to its anti-inflammatory properties. It is available in the form of creams and gels.

Living With Gonorrhea

Though gonorrhea can be managed with antibiotics a few important points are to be kept in mind:

Avoid sexual activity

Patient diagnosed with gonorrhea should avoid any kind of sexual actvity for atleast 1 week following antibiotic treatment. It is advised to resume the sexual activity only after the symptoms subside.

Retesting for gonorrhea

It is advised to test for the infection after the completion of the therapy or if symptoms persist for a long period of time. Retesting helps in identifying any antibiotic resistance and avoiding further treatment failure.

Testing for other sexually transmitted infections(STIs)

Infected patients with gonorrhea are also at increased risk of contracting other STIs, including HIV. So, it is necessary for the patients to get themselves tested for other STIs such as HIV infection.

Frequently Asked Questions

Is gonorrhea contagious?

Yes, gonorrhea is highly contagious and can spread through exposure to the infected genital secretions. However, it does not spread through activities such as kissing and hugging.

When can I have sex after gonorrhea treatment?

You have to wait for seven days after finishing your therapy even if symptoms are completely gone. This will help you and your partner to prevent gonorrhea again in the future.

Can I get gonorrhea more than once?

Yes, one can catch the bacteria again either with the untreated partner or a new sexual partner.

What to do If I am pregnant and have gonorrhea?

Consult your doctor. Gonorrhea can be treated with antibiotics that are safe during pregnancy. Abstain from any kind of sexual activity until you and your partner have completely recovered from the infection.

References

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Overview

Key Facts

Causes

Types

Symptoms

Risk factors

Diagnosis

Prevention

Specialist to visit

Treatment

Complications

Home-care

Living with

FAQs

References