What is Gonorrhoea?
Gonorrhoea is a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae. It is the second most common bacterial STI in the UK after chlamydia. Young men and women under the age of 25 tend to have higher rates if infection.
Gonorrhoea is usually passed from person to person through condomless vaginal, oral or anal sex. It can be transmitted after contact with your partner’s genitals, even if there is no penetration or ejaculation. Rarely it can be transmitted by infected semen or vaginal fluid coming into contact with your eye and sometimes from sharing sex toys.
How does it affect you?
The bacteria can infect the uterus (womb), the urethra (tube through which urine passes out of the body), the rectum (bottom), and less commonly the throat or eyes.�
Typical symptoms of gonorrhoea are provided below. However, around 1 in 10 men with urethral gonorrhoea, and approximately half of women with vaginal gonorrhoea don't experience any symptoms. Individuals with gonorrhoea in the throat and rectum have even fewer symptoms and are largely symptom free. In people that develop symptoms these usually appear within about two weeks of acquiring gonorrhoea, although sometimes they don't appear until weeks to months later.
In women, symptoms of gonorrhoea can include:
- an unusual vaginal discharge, which may be thin or watery and green or yellow in colour
- pain or a burning sensation when passing urine
- pain or tenderness in the lower abdominal area
- pain during sex
- bleeding between periods
- heavier periods and bleeding after sex
In men, symptoms of urethral gonorrhoea can include:
- a white, yellow, or green discharge from the penis
- pain in the urethra or a burning sensation when urinating
- inflammation (swelling) of the foreskin/head of penis
- pain or tenderness in the testicles
Rectal infection: anal discomfort, pain or discharge
Eye infection: Irritation, pain, swelling and/or discharge (conjunctivitis)
Throat infection: sore throat
During pregnancy gonorrhoea can be associated with miscarriage, premature labour, and the baby being born with conjunctivitis (inflammation of the eye) which can lead to permanent vision damage.
Left untreated, gonorrhoea can lead to pelvic inflammatory disease (PID) (10-20% cases), ectopic pregnancy in women, reduced fertility, and testicular swelling/pain or prostatitis in men. Rarely it results in an arthritis (inflammation of the joints) or septicaemia (infection in in the bloodstream).
Diagnosis
Gonorrhoea can be diagnosed from a urine sample (in men) and/or swabs taken from the male urethra or female vagina. Sometimes additional swabs from the throat or anus are taken. In the sexual health clinic, swabs take from the cervix (female), urethra or rectum can be viewed with a microscope to identify gonorrhoea. This gives an immediate diagnosis and treatment will be provided at the point of testing.
If you have no symptoms and just want a sexual health check-up, you may want to wait up to two weeks after the last sexual contact with your partner before performing the test. This is because our tests may not reliably detect very early infection, and testing too early (within two weeks) after a sexual risk may give you false reassurance (i.e. your gonorrhoea test result may be negative when you have actually acquired it). If you have symptoms though its best to test as soon as you can even if you your last sexual contact was very recent.
Treatment
If you test positive for gonorrhoea you will need to attend your nearest sexual health clinic for treatment, which usually involves a single antibiotic injection. With effective treatment, symptoms should improve within a few days.
There is increasing bacterial resistance to gonorrhoea treatment with only a few options left for eradicating the infection. This means additional swabs (cultures) may need to be taken before your treatment is given, where we grow the bacteria in a laboratory and see what drugs are effective in treating it. Once treated you should have a “test of cure” to make sure the infection has cleared – this means getting re-tested for gonorrhoea two weeks after your treatment. A test of cure is especially important when gonorrhoea is found in the throat, if the infection was acquired abroad, if symptoms/signs persist or you have not received first line recommended injectable treatment.
Contacting partners
If you test positive for gonorrhoea in your penis you should inform anyone you have had sex with, within the last two weeks, or the last sexual partner before that, if longer ago. If you have gonorrhoea at any other body site or have been symptom free you will need to contact partners from within the last three months. Your sexual contacts should be advised to get tested. Your partner can test through SHL if they wish to but will need to obtain treatment in a clinic.
Informing, testing and treating partners is really important because it helps prevent you from becoming re-infected again and minimises onward transmission to other partners.
Some partners may be given gonorrhoea treatment at the same time as being tested (ie before their test results are available). This is called epidemiological treatment and can be obtained from clinic.
If you feel unable to inform previous sexual partners one of our Health Advisers will be able to notify them on your behalf without revealing your identity if you prefer.
Maintaining good sexual health and preventing re-infection
You should not have oral, anal or vaginal sex for seven days after your treatment?and, also until your current partner completes their treatment?and?until both you and your partner’s symptoms have abated. This is to avoid acquiring gonorrhoea again and requiring further treatment.
If you have been diagnosed with gonorrhoea it is possible you may also have another STI. Therefore, we advise you have a full sexual health screen including tests for syphilis and HIV.
Successful treatment for gonorrhoea doesn't make you immune so protect yourself by using condoms and encourage your partner(s) to test for STIs.
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