Gonorrhoea

What is it?

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. Those most often affected are  young men and women under the age of 25.

Gonorrhoea is usually passed from person to person through unprotected vaginal, oral or anal sex. It can be transmitted after contact with your partner’s genitals, even if there is no ejaculation. Rarely it can be transmitted by infected semen or vaginal fluid coming into contact with your eye and sometimes from sharing sex toys. Pregnant mothers can also pass the infection to their baby. Gonorrhoea isn't spread by kissing, hugging, sharing baths or towels, swimming pools, toilet seats, or sharing crockery and cutlery, because the bacteria can't survive outside the human body for long.

How does it affect you?

The bacteria can infect the cervix (entrance to the 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 infected men with urethral gonorrhoea, and approximately half of infected 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 being infected, although sometimes they don't appear until many 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 (this is less common)
  • pain during sex
  • bleeding between periods
  • heavier periods and bleeding after sex (this is less common)

 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 in men. Rarely it results in an arthritis (inflammation of the joints) or septicaemia (infection 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.

It's possible to be tested within a few days of having sex especially if you have symptoms, but 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 before performing the test. This is because our tests may not reliably detect very early infection, and testing too early after a sexual risk may give you false reassurance (i.e. your test result may be negative when you are actually infected). 

Treatment

If you have been found to have gonorrhoea you will need to attend your nearest sexual health clinic for treatment.

Gonorrhoea is usually treated with a single antibiotic injection and a single dose of an oral antibiotic. With effective treatment, any 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. You are also often asked to attend a clinic for repeat gonorrhoea testing 1-2 weeks after treatment to ensure the infection has definitely cleared.

Contacting partners

If you are diagnosed with penile gonorrhoea you will need to inform anyone you have had sex with, within the last two weeks, or the last 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 attend a sexual health clinic for testing and may be offered treatment on the day they attend. 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.

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 being re-infected and requiring further treatment.

If you have been infected with gonorrhoea it is possible you may also have another STI. Therefore, it is advisable that you have a full sexual health screen for chlamydia, syphilis and HIV.

Previous successful treatment for gonorrhoea doesn't make you immune to catching the infection again. In fact you should consider having another sexual health screen three months after being treated for gonorrhoea because there is a higher risk of becoming infected with it or another STI (including HIV) over the next year.

To protect yourself use condoms and encourage your partner to test for STIs also.