What You Need to Know About Gonorrhea

Gonorrhea is a common sexually transmitted infection (STI), affecting 1.6 million people every year in the U.S. It is an infection caused by the bacteria Neisseria gonorrhoeae, which is most often spread by sexual contact. It can infect many different sites in the body, so the symptoms can vary. More importantly, many cases are asymptomatic so many people do not even realize they are infected. And gonorrhea can cause some serious issues if it’s not treated. 

Here we’ll discuss symptoms of gonorrhea, the issues it can cause, and how it’s diagnosed and treated.

Symptoms of gonorrhea 

Gonorrhea does not always produce symptoms. People can be infected by the bacteria and not even know they have it. 1 out of 10 men who have gonorrhea don’t have any symptoms. Up to 4 out of every 5 women might be asymptomatic as well.

When gonorrhea does cause symptoms, it depends on what part of the body is infected. It tends to affect areas of the body that contain ‘mucous membranes,’ such as the lining of the genital tract, rectum, or throat. The infection can cause painful inflammation and irritation in these areas.

Symptoms of gonorrhea in female reproductive organs

Gonorrhea can infect the cervix and urethra of the female reproductive tract. These symptoms may be similar to other STIs or UTIs (urinary tract infections). 

Some common symptoms are:

• Pain or burning with urination
• A frequent urge to urinate
• Vaginal itching 
• Abnormal vaginal discharge, particularly if it has a new foul smell or a thick and yellow appearance 
• Vaginal bleeding or spotting between periods

If the infection is left untreated, it can spread up the reproductive tract and into the uterus. This is called pelvic inflammatory disease (PID), and it can lead to additional symptoms like:

• Pelvic pain
• Abdominal pain
• Fever
• Nausea and vomiting 

Symptoms of gonorrhea in male reproductive organs

If gonorrhea infects the male reproductive tract, it involves the urethra. In this situation, it can cause symptoms such as:

• Burning with urination
• Discharge from the penis, which often appears white or yellow

Untreated cases of gonorrhea can also spread further into the epididymis, which is a structure that sits on top of the testicles. This condition is called “epididymitis'' and can lead to pain and sometimes swelling in the testicles. It usually only affects one side. 

Symptoms of gonorrhea in the rectum

Gonorrhea can also infect the rectum in people who have anal sex. Most of these infections are asymptomatic. When symptoms are present, they can include:

• Anal itching or irritation
• Tenesmus, which is a sensation that you need to pass stool, even if there is nothing there
• Anal discharge that looks white or yellow
• Anal pain with bowel movements
• Bloody bowel movements

Symptoms of gonorrhea in the throat

Gonorrhea can also spread to the throat, which typically happens through oral sex. The large majority of throat infections are also asymptomatic. Symptoms to watch for are:

• Sore throat
• Redness and mucus in the throat
• Swollen lymph nodes in the neck

How is gonorrhea diagnosed? 

Gonorrhea is easy to diagnose. There are two main ways to test for it:

• A urine sample can be used to test for the presence of gonorrhea DNA.
• A swab of the potentially affected tissue (female cervix, male urethra, throat, or anus) can be ‘cultured.’ This means the swab is spread on a special plate to see if gonorrhea bacteria will grow.

The urine test is usually quicker and can often give you same-day results. A culture test usually takes 1 to 2 days for a result, because you need to give the bacteria time to grow. 

Even in the absence of symptoms, there are many reasons you should still be tested:

• If you have had sexual contact with someone who has symptoms of an STI
• If you have had sexual contact with someone diagnosed with an STI
• Routine screening for people who have had multiple sexual partners
• Routine screening for people who are sexually active under the age of 25

Experts specifically recommend routine screening for people who are born genetically female. This is because the risk of problems from untreated infections, like infertility, are greater in this group.

Even if the above criteria don’t apply to you, you may still need regular STI testing. It’s understandably difficult to talk about sexual practices with your provider. But it’s important to mention this to them if you are having any of these symptoms. This is because they could be easily mistaken for other causes like UTIs. 

When someone is tested for gonorrhea, they are typically tested for chlamydia — another type of STI — at the same time. This is because these infections can cause similar symptoms and can also occur together.

How is gonorrhea treated?

Most cases of gonorrhea are easy to treat. There are a few options for treatment:

• The first-choice treatment is a one-time injection of the antibiotic ceftriaxone into a muscle.
• People who are allergic to ceftriaxone are usually treated with a combination of a gentamicin injection, and a single pill dose of another antibiotic called azithromycin.

In many cases, people will receive treatment at the same time their testing is done, even before a test result is known. This saves them from a return to their provider’s office, since treatment requires a shot. 

In all cases, you should avoid sexual contact for at least 7 days after completing treatment for gonorrhea. This makes sure the infection is fully treated, because it can still spread within a week of treatment. And even though it can be a difficult conversation to have, it’s important to let all recent sexual partners know that you tested positive so they can get tested as well. 

Issues of gonorrhea

Gonorrhea infections are easily treated and cured with antibiotics. But there are some issues that can result from gonorrhea if it’s not treated. These occur when gonorrhea spreads to other parts of the body.

Pelvic inflammatory disease (PID)

PID happens when gonorrhea has spread to the uterus. If you develop PID, you will need stronger and longer courses of antibiotics for treatment. In some cases, you might need to stay in the hospital to get IV antibiotics. 

PID can also lead to: 

• Pockets of infection, called “abscesses,” that sometimes need a procedure to remove them
• Infertility, which results from the scar tissue that forms in the uterus from the infection

Disseminated gonorrhea

Gonorrhea can spread to the rest of the body through the blood. This most typically affects the joints, causing joint pain or redness. It can also affect the skin and cause painless skin rashes that look like blisters or red bumps. In rare cases, it can also spread to the heart and brain. Treatment of disseminated gonorrhea usually requires staying in the hospital for IV antibiotics.

Eye infections in newborns

If a pregnant woman has gonorrhea at the time of childbirth, it can infect the baby’s conjunctiva, which is the lining of the newborn’s eyes. The baby’s eyes might look red and have a green or white discharge. This infection can permanently damage the eyes and cause blindness. To prevent this from happening, all newborn babies get erythromycin eye drops shortly after birth.