Gonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae and can infect the genitals, urethra, rectum, eyes and throat. Many people do not exhibit symptoms, which makes it easy for partners to unknowingly pass on the infection. After chlamydia, gonorrhoea is one of the most common STIs, with an estimated 78 million new cases each year worldwide. Gonorrhoea can usually be treated and cured with antibiotics, but if left untreated, it can cause serious complications, such as pelvic inflammatory disease (PID) or even infertility.

Symptoms of gonorrhoea can include:

  • Greenish yellow or whitish discharge from the vagina or penis
  • Burning when urinating

In women

  • Pain in the stomach
  • Bleeding during and after sex
  • Bleeding between periods (spotting)

In men

  • Pain and swelling in the testicles

How can I get it?

Gonorrhoea is a bacterial infection that is transmitted through sexual contact between partners. It is transmitted through bodily fluids, so it is not restricted to the genitals and infection can also occur in the eyes and back of the throat. Women with gonorrhoea can also transmit the infection to their baby through childbirth, although this is rare. Gonorrhoea is most commonly found in sexually active people between the ages of 15 and 34. It is important to remember that even if someone does not present any symptoms, they are still contagious. Most people do not experience symptoms, so it is easy for gonorrhoea to be transmitted from partner to partner without them being aware of the risk.  This is why it is important to get tested if you suspect that you or your partner may be at risk for gonorrhoea infection.

What are the risk factors?

Risk factors for gonorrhoea include:

  • Multiple sexual partners or frequent changing of sexual partners in the past year
  • Inconsistent or incorrect condom use
  • Past history of gonorrhoea infection
  • Having other sexually transmitted infections

What are the symptoms?

In women

Most women do not experience any symptoms. However, in women, the most common symptoms are:

  • pain during urination
  • yellow or bloody vaginal discharge
  • pain in the lower abdomen or pelvis
  • pain or bleeding during sex
  • bleeding after sex
  • bleeding between periods

If gonorrhoea is left untreated, it can spread to the womb and cause a serious condition called pelvic inflammatory disease (PID). This is a major cause of ectopic pregnancy and infertility in women.

In men

Many men do not experience any symptoms. If they do notice symptoms, the most common include:

  • pain during urination
  • pus-like discharge from the penis
  • burning or itching in the urethra (the tube that carries urine out of the body)
  • pain or swelling in one testicle

If gonorrhoea is left untreated, the infection can cause swelling in the epididymis (the tubes that carry sperm from the testicles) and the testicles. This could affect fertility.

The incubation period for gonorrhoea is usually between 1-3 weeks after exposure to the bacteria, but initial symptoms can be seen anywhere from a few days to several months after initial exposure.

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Gonorrhoea can also infect:

  • the rectum if you have unprotected anal sex – this can cause discomfort and discharge from your rectum
  • the throat if you have unprotected oral sex – this is uncommon and usually causes no symptoms
  • the eyes if they come into contact with infected semen or vaginal fluid – this can cause eye redness, pain, and discharge (conjunctivitis)

Diagnosis

Testing for gonorrhoea involves either a urine sample or a swab of the infected area. Men usually are asked to provide a urine sample, while women are usually tested using a swab as a urine sample is less accurate in women. Some clinics may be able to test the sample right away, and give you immediate results, but other labs will take up to two weeks. If there is a high chance that you have gonorrhoea (for example, you are presenting multiple symptoms or your partner has been diagnosed with gonorrhoea), you may want to start antibiotics before the test results are ready.

Some questions to consider:

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  • do you have reason to believe you have been exposed to a sexually transmitted infection?
  • have you told your partner?
  • what are your symptoms?
  • is there any abnormal discharge? If so, can you describe it? (colour, smell etc.)
  • is there swelling around the genitals or any other area of the body?
  • do you have urinary symptoms, such as frequent urination, burning or stinging when urinating, or urinating in small amounts?
  • is there any pain during intercourse?
  • what method of contraception do you use? Do you use condoms? If so, how do you use them? (Are you using them properly?)
  • have you ever had a sexually transmitted infection in the past? If so, was it treated?

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Treatment

Gonorrhoea is usually treated with a short course of antibiotics. This usually involves a single antibiotic injection followed by a single antibiotic pill. It is sometimes possible to give a second antibiotic pill instead of the injection. Patients may be started on antibiotics once they get their test results, but if it is highly likely that they have gonorrhoea, they may be started on antibiotics before their results are confirmed.

Symptoms usually improve within a few days, but it can take up to two weeks. There is usually a follow up appointment a week or two after treatment to check that the antibiotics have worked properly. Sex should be avoided until you and your partner have been given the all-clear, to avoid retransmission of the infection.

If tested positive for gonorrhoea, it is important that current and past partners (during the last six months) of the patient get tested (and treated) as well.

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