Gonorrhoea

Female genitals

What is gonorrhoea?

Gonorrhoea is an infection affecting mainly the genital areas. It can also affect the throat and eyes. Very occasionally the infection can spread to other parts of the body. Gonorrhoea accounts for 9 out of every 100 sexually transmitted infections (STIs) diagnosed in sexual health clinics in England. There were 57,084 cases in England in 2020. One in three of those cases were in young people aged 15-24 years.

Gonorrhoea is caused by the germ (a bacterium) Neisseria gonorrhoeae. It is passed on if you have:

• Unprotected vaginal, oral or anal sex with an infected person.

• Shared sex toys that have not been washed or covered with a new condom during use.

As gonorrhoea can be transmitted vaginally, anally and orally, it can therefore be passed during sex between men and women or sex between men and men.

In men, the infection usually affects the urethra (the tube between the bladder and the end of the penis) but can cause infection of the mouth or anus of both sexes. Vaginal liquid can be a source of infection so in theory it could be passed on during sex between women but this is very uncommon.

The bacterium that causes gonorrhoea cannot survive outside the human body for long. Therefore it is not spread by using communal swimming pools, public toilets, sharing baths, towels and cutlery, or hugging and kissing.

Symptoms of gonorrhoea in women

Female genitals

• There are no symptoms in about half of women who have infection with gonorrhoea.

• About 1 in 2 women develop an increase or change in vaginal discharge.

• About 1 in 4 women develop pain in the lower part of the stomach.

• Rarely, women may notice bleeding between periods, or heavy periods.

• Pain when passing urine can sometimes mimic a urine infection.

• There may be pain when having sex in some women.

• Infection of the back passage (rectum) or throat (pharynx) can develop. Such infections do not usually cause symptoms, although occasionally rectal itching or a sore throat may be noticed.

Symptoms of gonorrhoea in men

Infection of the urethra (urethritis) is the typical infection in men. This commonly develops 5-7 days after having sex with an affected person. Symptoms include:

• Discharge from the penis. This may stain underpants. It occurs in at least 8 out of 10 men with the infection.

• Pain or burning sensation when passing urine. This occurs in about half of cases.

• Irritation inside the penis, or a feeling of wanting to pass urine frequently.

• Redness at the opening of the urethra at the end of the penis.

• Infection of the back passage (rectum) or throat (pharynx) can develop. Such infections do not usually cause symptoms, although occasionally rectal pain, discharge or itching or a sore throat may be noticed.

Gonorrhoea is believed to cause symptoms in most infected men (about 9 in 10 affected). However, about 1 in 2 women with gonorrhoea do not have any symptoms.

The symptoms may clear over time, even without treatment. This may take up to six months but can be just a couple of weeks or so. However, without treatment, some germs (bacteria) usually remain in the urethra. It is just that the symptoms may go.

It is important to get tested and treated If you suspect that you have gonorrhoea or any other STI. You will need your diagnostic test to be done in a specialist genitourinary medicine (GUM) clinic, so if you think you have gonorrhoea you should make an appointment at your local genitourinary medicine GUM clinic. If you are not sure you can see your GP first, but they will need you to be seen at the clinic for proper diagnosis. In the UK you can go to the local GUM clinic without a referral from your GP. You can ring your GP surgery, local hospital or health authority and ask where the nearest clinic is. Local and national information is also available on the internet - for example, see Further Reading for the 'Find a sexual health clinic service'.

You will normally be advised to have tests if gonorrhoea is suspected - even if symptoms go. Ideally you should attend a local GUM clinic for this.

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What happens during a gonorrhoea test?

A urine sample and/or a sample (swab) of the discharge will be taken to try to identify the germ (bacterium) that causes gonorrhoea. A urine test is not as accurate in women as it is in men. If a swab is taken for a man, it will be taken from the inside end of the penis (the urethra).

In women, a swab is taken from high up in the vagina. Another swab is taken from the inside the neck of the womb (the endocervix) at the womb's entrance. You will also be advised to have tests for other STIs. It will also be suggested that any sexual partners attend for tests and/or treatment.

Complications of gonorrhoea in women

• Infection can spread to the womb (uterus) to cause pelvic inflammatory disease. This can cause long-standing (chronic) pelvic pain and can lead to infertility.

• Pregnancy can be complicated by premature labour, ectopic pregnancy or miscarriage.

• Infection present during pregnancy can lead to infection spreading to the eyes of a newborn baby. This is called ophthalmia neonatorum.

• Pelvic infection can spread to the liver.

• Abscesses can develop in the Bartholin's glands on either side of the lower part of the vaginal opening.

• Rarely, there can be spread in the bloodstream to other parts of the body.

Complications of gonorrhoea in men

• In a small number of cases the infection travels up the urethra to the prostate gland. It may also cause infection of the testicles or the tubes around them (epididymo-orchitis).

• Rarely, a narrowing (stricture) of the urethra may develop.

• It can affect future fertility.

• Men who have sex with men can get infections of the back passage (anus) and throat.

• Rarely, there can be spread in the bloodstream to other parts of the body.

The usual treatment is a single injection of an antibiotic medicine plus a single large dose of a different antibiotic taken by mouth. However, sometimes other treatment regimes and schedules are used. For example, if you have an allergy to the usual antibiotic, or if you have another infection at the same time. Symptoms of gonorrhoea usually start to improve within a few days.

Previous successful treatment for gonorrhoea does not prevent you from catching it again.

Does my sexual partner need treatment?

Yes. Sexually active men and women should be tested for infection, even if they have no symptoms. Treatment with antibiotics is usually advised for sexual partners, even if the tests are negative, because:

• Germs (bacteria) that cause gonorrhoea are often passed on during sex. Tests for bacteria are not foolproof. Treatment with antibiotics helps to make sure that any possible infection is cleared.

• If a sexual partner is infected and not treated, infection can be passed back to you.

• If you have gonorrhoea without symptoms then you may have had it for some time. In this situation any sexual partners within the previous three months should be tested and treated.

Treatment follow-up

A doctor or healthcare professional will normally want to know that treatment has worked. It is usual to be reviewed soon after you finish treatment. This is to check that symptoms have gone and to do a test to check that the infection has gone. Sometimes further treatment (perhaps with a different antibiotic) is needed if the infection has persisted despite treatment.

You should not have sex until both you and your sexual partner have finished treatment. Note: this will normally be for at least seven days after treatment has commenced. Even if the treatment is the usual one-dose schedule of two antibiotics as described above, it takes several days for the infection to clear after taking the treatment.

Wearing a condom during sex (including anal sex and oral sex) helps to prevent the spread of STIs.

The risk of STIs increases with the number of changes of sexual partner. So, the fewer partners you have, the lower your risk of STIs.