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Gonorrhea

By

Sheldon R. Morris

, MD, MPH, University of California San Diego

Reviewed/Revised Feb 2023 | Modified Sep 2023
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Gonorrhea is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae, which infect the lining of the urethra, cervix, rectum, or throat, or the membranes that cover the front part of the eye (conjunctiva and cornea).

  • Gonorrhea is usually spread through sexual contact.

  • People usually have a discharge from the penis or vagina and may need to urinate more frequently and urgently.

  • Microscopic examination, culture, or DNA tests of a sample of vaginal or penile discharge or DNA tests of urine can detect the infection.

  • Antibiotics can cure the infection, but resistance to the antibiotics used to treat gonorrhea is becoming more common.

  • Using condoms during genital sex can help prevent passing gonorrhea and other sexually transmitted infections (STIs) from one person to another.

Gonorrhea is a very common infectious disease. The Centers for Disease Control and Prevention (CDC) estimates that more than 1 million new infections occur in the United States each year.

Gonorrhea is almost always spread through vaginal, oral, or anal sexual contact. After one episode of vaginal intercourse without a condom, the chance of spread from an infected woman to a man is about 20%. The chance of spread from an infected man to a woman and from a man to a man may be higher.

If a pregnant woman is infected, the bacteria can spread to the eyes of the newborn during birth, causing conjunctivitis in the newborn Conjunctivitis in Newborns Conjunctivitis is inflammation of the conjunctiva, the membrane that lines the eyelid and covers the white of the eye. Conjunctivitis is caused by bacteria, viruses, or a reaction to chemicals... read more Conjunctivitis in Newborns . However, in most high-resource countries, infection is prevented because all newborns are routinely treated after delivery with medicated eye ointment.

Did You Know...

  • If a pregnant woman has gonorrhea, the eyes of the newborn may become infected during birth, so newborns are routinely treated to prevent this infection.

Symptoms of Gonorrhea

Usually, gonorrhea causes symptoms only at the sites of initial infection, most commonly the cervix, penis, urethra, or throat. In a few people, infection spreads through the bloodstream to other parts of the body, especially to the skin, joints, or both.

Some men (about 25%) have minimal symptoms. Symptoms begin within about 2 to 14 days after infection. Men feel mild discomfort in the urethra (the tube that carries urine from the bladder out of the body). This discomfort is followed a few hours later by mild to severe pain during urination, a yellow-green discharge of pus from the penis, and a frequent urge to urinate. The opening at the tip of the penis may become red and swollen. The bacteria sometimes spread to the epididymis Epididymitis and Epididymo-orchitis Epididymitis is inflammation of the epididymis (the coiled tube on top of the testis that provides the space and environment for sperm to mature), and epididymo-orchitis is inflammation of the... read more (the coiled tube on top of each testis), causing the scrotum to swell and feel tender to the touch.

Some women (about 10 to 20%) have minimal or no symptoms. Thus, gonorrhea may be detected only during routine screening or after diagnosis of the infection in their partner. Symptoms typically do not begin until at least 10 days after infection. Some women feel only mild discomfort in the genital area and have a yellow or green vaginal discharge. However, other women have more severe symptoms, such as a frequent urge to urinate or pain during urination. These symptoms develop when the urethra is also infected.

The infection may spread up the reproductive tract and infect the uterus, the tubes that connect the ovaries to the uterus (fallopian tubes), and sometimes the area around the ovaries. In some women, the infection spreads to the lining of the pelvis and abdominal cavity (peritoneum), causing peritonitis. These infections are called pelvic inflammatory disease Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease is an infection of the upper female reproductive organs (the cervix, uterus, fallopian tubes, and ovaries). Pelvic inflammatory disease is often caused by a sexually... read more Pelvic Inflammatory Disease (PID) (PID) and cause severe lower abdominal pain and sometimes fever. Sometimes infection concentrates in the area around the liver, in the upper right part of the abdomen, causing pain, fever, and vomiting—called the Fitz-Hugh-Curtis syndrome.

Anal sex with an infected partner may result in gonorrhea of the rectum (gonococcal proctitis Proctitis Proctitis is inflammation of the lining of the rectum (rectal mucosa). The inflammation has many causes ranging from infection to radiation therapy. Depending on its cause, proctitis can be... read more ). This infection usually causes no symptoms, but it may make bowel movements painful. Other symptoms include constipation, itching, bleeding, and a discharge from the rectum. The area around the anus may become red and raw, and stool may be coated with mucus and pus. When a doctor examines the rectum with a viewing tube (anoscope), mucus and pus may be visible on the wall of the rectum.

Oral sex with an infected partner may result in gonorrhea of the throat (gonococcal pharyngitis). Usually, these infections cause no symptoms, but the throat may be sore.

If infected fluids come into contact with the eyes, gonococcal conjunctivitis may develop, causing swelling of the eyelids and a discharge of pus from the eyes. In adults, often only one eye is infected. Newborns usually have infection in both eyes. Blindness may result if the infection is not treated early.

Rarely, disseminated gonococcal infection (arthritis-dermatitis syndrome) develops. It occurs when the infection spreads through the bloodstream to other parts of the body, especially the skin and joints; rarely, infection spreads to the heart. Joints become swollen, tender, and extremely painful, limiting movement. The skin over infected joints may be red and warm. People typically have a fever, feel generally ill, and develop joint pain (due to arthritis) in one or more joints. Small, red spots may appear on the skin, usually on the arms and legs. The spots are slightly painful and may be filled with pus. Joint, bloodstream, and heart infections can be treated, but recovery from arthritis may be slow.

Gonococcal septic arthritis is a form of disseminated gonococcal infection that causes painful arthritis. Usually, it affects one or two large joints, such as the knees, ankles, wrists, or elbows, Symptoms often begin suddenly. People usually have a fever. Infected joints are painful and swollen, and movement is limited. The skin over the infected joints may be warm and red.

In children, gonorrhea is usually a sign of sexual abuse. In girls, the genital area (vulva) may be irritated, red, and swollen, and they may have a discharge from the vagina. If the urethra is infected, children, mainly boys, may have pain during urination.

Diagnosis of Gonorrhea

  • Usually, testing of a sample of discharge from the cervix, vagina, penis, throat, or rectum or of a sample of urine

To diagnose gonorrhea, doctors collect a sample of discharge and send it to a laboratory. Highly sensitive tests can be done to detect the DNA of gonococci and of chlamydiae (which are often also present). Laboratories can test for both infections in a single sample. For some of these tests (called nucleic acid amplification tests, or NAATS), techniques that increase the amount of the bacteria's genetic material are used. Because these techniques make the organisms easier to detect, urine samples can be used. Thus, these tests are convenient for screening people who have no symptoms or who do not want to have samples of fluid taken from their genitals. Sometimes, the sample is also sent for culture (to grow the organisms).

For men, gonorrhea may be diagnosed rapidly (within 1 hour) by examining samples of the discharge and identifying the bacteria (gonococci), if the facility has the appropriate equipment and trained personnel. If a discharge is obvious, doctors touch a swab or slide to the end of the penis to collect the sample. If there is no obvious discharge, doctors insert a small swab a half inch or more into the urethra to collect a sample. Men are asked to refrain from urinating for at least 2 hours before the sample is collected.

Diagnosing gonorrhea in women is more difficult than in men, because identifying bacteria in a sample of discharge from the cervix is more difficult than from a penis. The bacteria in a sample taken from the cervix can be seen under the microscope in only about half of infected women.

If a joint is red and swollen, doctors draw fluid from the joint using a needle. The fluid is sent for culture and other tests.

Screening for Gonorrhea

Certain people who have no symptoms are screened for gonorrhea because they are at increased risk of this infection.

If screening is recommended, it is done even if a person uses condoms consistently. Tests are done using samples taken from the rectum, the urethra, or, if the person engaged in oral sex, the throat.

For example, women are screened annually if they are sexually active and under age 25 or if they are 25 years or older, sexually active, and have one or more of the following risk factors:

  • A previous STI

  • Risky sexual activities (such as having many sex partners or multiple sex partners, using condoms inconsistently when not in a mutually monogamous relationship, or engaging in sex work)

  • A history of incarceration

  • Have a sex partner who participates in risky sexual activities or has an STI

Pregnant women are screened during their first prenatal visit and again during their 3rd trimester if they are at high risk.

Men who have sex with women are not routinely screened, but screening is available if a person requests it and is often offered to all people at adolescent clinics, STI clinics, and correctional facilities.

Men who have sex with men are screened as follows:

Transgender and gender diverse people are screened if they are sexually active on the basis of sexual practices and anatomy. For example, all people with a cervix who are under age 25 are screened annually. If they are 25 years or older, people with a cervix should be screened annually if at increased risk. Rectal swab screening is done on transgender and gender diverse people based on reported sexual behaviors and exposure.

Treatment of Gonorrhea

  • An antibiotic

  • Testing and treatment of sex partners

Doctors usually give people with gonorrhea a single injection of the antibiotic ceftriaxone into a muscle.

If gonorrhea has spread through the bloodstream, people are usually treated in the hospital and given antibiotics intravenously or by injection into a muscle.

If symptoms recur or persist after treatment, doctors may take samples for culture to determine whether people are cured and may do tests to determine whether the gonococci are resistant to the antibiotics used.

People with gonorrhea should abstain from sexual activity until treatment is completed to avoid infecting sex partners.

Sex partners

All sex partners who have had sexual contact with infected people in the past 60 days should be tested for gonorrhea and other STIs and, if the tests are positive, should be treated. If sex partners were exposed to gonorrhea within the past 2 weeks, they are treated for it without waiting for test results.

Expedited partner therapy is an option doctors sometimes use to make it easier for sex partners to be treated. This approach involves giving people with gonorrhea a prescription or medications to give to their partner. Thus, the sex partner is treated, even if they have not yet seen a doctor. Seeing a doctor is better because then the doctor can check for allergies to medications and the presence of other STIs. However, if the partner is unlikely to see a doctor, expedited partner therapy is useful.

Prevention of Gonorrhea

The following general measures can help prevent gonorrhea (and other STIs):

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Ceftrisol Plus, Rocephin
NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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