Gonorrhea

Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. Any type of sex can spread gonorrhea. You can get it through contact with the mouth, throat, eyes, urethra, vagina, penis, or anus.

Over one million cases occur in the United States each year.

The bacteria grow in warm, moist areas of the body. This can include the tube that carries urine out of the body (urethra). In women, the bacteria may be found in the reproductive tract (which includes the fallopian tubes, uterus, and cervix). The bacteria can also grow in the eyes.

Health care providers are required by law to report all cases of gonorrhea to the local Department of Health. The goal of this law is to make sure the person gets proper follow-up care and treatment. Sexual partners also need to be found, tested, and treated.

You are more likely to develop this infection if:

• You have multiple sex partners.
• You have a partner with a past history of any STI.
• You do not use a condom during sex.
• You abuse alcohol or illegal substances.

Symptoms of gonorrhea most often appear 2 to 5 days after infection. However, it may take up to a month for symptoms to appear in men.

Some people do not have symptoms. They may not know that they have caught the infection, so do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person.

Symptoms in men include:

• Burning and pain while urinating
• Need to urinate urgently or more often
• Discharge from the penis (white, yellow, or green in color)
• Red or swollen opening of penis (urethra)
• Tender or swollen testicles
• Sore throat (gonococcal pharyngitis)

Symptoms in women can be very mild. They can be mistaken for another type of infection. They include:

• Burning and pain while urinating
• Sore throat
• Painful sexual intercourse
• Severe pain in the lower abdomen (if the infection spreads to the fallopian tubes and uterus area)
• Fever (if the infection spreads to the fallopian tubes and uterus area)
• Abnormal uterine bleeding
• Bleeding after sex
• Abnormal vaginal discharge with greenish, yellow or foul smelling discharge

If the infection spreads to the bloodstream, symptoms include:

• Fever
• Rash
• Arthritis-like symptoms

Gonorrhea can be quickly detected by looking at a sample of discharge or tissue under the microscope after it has been treated with special chemicals. This is called a Gram stain. This method is fast, but it is not the most certain.

Gonorrhea is most accurately detected with DNA tests. DNA tests are useful for screening. The ligase chain reaction (LCR) test is one of the tests. DNA tests are quicker than cultures. These tests can be performed on urine samples, which are easier to collect than samples from the genital area.

Prior to DNA tests, cultures (cells that grow in a lab dish) were used to provide proof of gonorrhea, but are less commonly used now.

Samples for a culture are most often taken from the cervix, vagina, urethra, anus, or throat. Rarely, samples are taken from joint fluid or blood. Cultures can often provide an early diagnosis within 24 hours. A confirmed diagnosis is available within 72 hours.

If you have gonorrhea, you should ask to be tested for other sexually transmitted infections, including chlamydia, syphilis, HIV, herpes, and hepatitis.

Screening for gonorrhea in asymptomatic people should take place in the following groups:

• Sexually active females 24 years and younger
• Women older than 24 years who are at increased risk for infection

It is unclear whether screening men for gonorrhea is beneficial.

A number of different antibiotics may be used for treating this type of infection.

• You may receive one large dose of oral antibiotics or take a smaller dose for seven days.
• You may be given an antibiotic injection or shot, and then be given antibiotic pills. Some types of pills are taken one time in the provider's office. Other types are taken at home for up to a week.
• More severe cases of PID (pelvic inflammatory disease) may require you to stay in the hospital. Antibiotics are given intravenously.
• Never treat yourself without being seen by your provider first. Your provider will determine the best treatment.

About one half of the women with gonorrhea are also infected with chlamydia. Chlamydia is treated at the same time as a gonorrhea infection with additional antibiotics.

You will need a follow-up visit 7 days after treatment if your symptoms include joint pain, skin rash, or more severe pelvic or abdomen pain. Tests will be done to make sure the infection is gone.

Sexual partners must be tested and treated to prevent passing the infection back and forth. You and your partner must finish all of the antibiotics. Use condoms until you both have finished taking your antibiotics. If you've contracted gonorrhea or chlamydia, you are less likely to contract either disease again if you always use condoms.

All sexual contacts of the person with gonorrhea should be contacted and tested. This helps prevent further spread of the infection.

• In some places, you may be able to take information and medicines to your sexual partner yourself.
• In other places, the health department will contact your partner.

A gonorrhea infection that has not spread can almost always be cured with antibiotics. Gonorrhea that has spread is a more serious infection. Most of the time, it gets better with treatment.

Complications in women may include:

• Infections that spread to the fallopian tubes which can cause scarring. This can cause problems getting pregnant at a later time. It can also lead to chronic pelvic pain, PID, infertility, and ectopic pregnancy. Repeated episodes will increase your chances of becoming infertile due to tubal damage.
• Pregnant women with severe gonorrhea may pass the disease to their baby while in the womb or during delivery.
• It can also cause complications in pregnancy such as infection and preterm delivery.
• Abscess in the womb (uterus) and abdomen.

Complications in men may include:

• Scarring or narrowing of the urethra (tube that carries urine out of the body)
• Abscess (collection of pus around the urethra)

Complications in both men and women may include:

• Joint infections
• Heart valve infection
• Infection around the brain (meningitis)

Contact your provider right away if you have symptoms of gonorrhea. Most health department-sponsored clinics will diagnose and treat STIs without charge.

Avoiding sexual contact is the only sure way to prevent gonorrhea. If you and your partner do not have sex with any other people, this can greatly reduce your chance also.

Safe sex means taking steps before and during sex that can prevent you from getting an infection, or from giving one to your partner. Safe sex practices include screening for STIs in all sexual partners, using condoms consistently, having fewer sexual contacts.

Ask your provider if you should receive the hepatitis B vaccine-link and the HPV vaccine-link. You may also want to consider the HPV vaccine.

Clap; The drip

Dinulos JGH. Sexually transmitted bacterial infections. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 10.

Embree JE. Gonococcal infections. In: Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO, eds. Remington and Klein's Infectious Diseases of the Fetus and Newborn Infant. 8th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 15.

Marrazzo JM, Apicella MA. Neisseria gonorrhoeae (Gonorrhea). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 212.

US Preventive Services Task Force website. Final recommendation statement: chlamydia and gonorrhea: screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening. Updated September 14, 2021. Accessed April 17, 2023.

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. PMID: 34292926 pubmed.ncbi.nlm.nih.gov/34292926/.

Updated by: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.