Gonorrhea - American Sexual Health Association


Gonorrhea is a curable infection caused by the bacteria Neisseria gonorrhoeae. In 2015 395,216 cases were reported to the Centers for Disease Control and Prevention (CDC), but the actual number of gonorrhea cases in the U.S. each year is thought to be closer to 820,000. It is transmitted during vaginal, anal, and oral sex (performing or receiving). Many men infected with gonorrhea have symptoms, while most women do not. Even when women do have symptoms, they can be mistaken for a bladder infection or other vaginal infection.

Since symptoms may not be present, the only way for a person who has been at risk for gonorrhea to tell whether they’re infected is to be tested. Gonorrhea can be diagnosed through a urine test or by taking a specimen from the infected area. If left untreated, gonorrhea can cause complications such as PID and infertility.

Yearly gonorrhea testing is recommended for all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection (STI).

Using latex condoms from the very beginning of sexual contact until there is no longer skin contact reduces the risk of transmission of gonorrhea.


What is gonorrhea?
Gonorrhea is a sexually transmitted infection (STI), also known as “the clap.” It is a curable infection caused by the bacteria Neisseria gonorrhoea. The bacteria targets the cells of the mucous membranes including:

  • the surfaces of the urethra, vagina, cervix and endometrium
  • the fallopian tubes
  • the anus and rectum
  • the lining of the eyelid
  • the throat

How is it transmitted?

  • Gonorrhea is passed during vaginal sex, oral sex (performing or receiving), or anal sex. It can be passed when the mucous membrane, the soft skin covering all the openings of the body, comes into contact with the mucous membrane secretions or semen of an infected person.
  • Gonorrhea can be passed even if the penis or tongue does not go all the way into the vagina or anus. If the vagina, cervix, anus, penis or mouth come in contact with infected secretions or fluids; then transmission is possible.
  • Even a woman who has not had anal sex can get gonorrhea in the anus or rectum if bacteria are spread from the vaginal area, such as when wiping with toilet paper.
  • Eye infections in adults may result when discharge caries the disease into the eye during sex or hand-to-eye contact.
  • It can also be passed from mother to newborn as the baby passes through the infected birth canal. This can result in eye infections, pneumonia or other complications
  • Gonorrhea is not passed through things like shaking hands or toilet seats.
  • In children, gonorrhea may be a possible sign of sexual abuse.

What are the symptoms?
Many men exhibit symptoms within two days to five days after exposure, with a possible range of one to 30 days. Although most women infected will remain asymptomatic (without symptoms), women who develop symptoms will do so within 10 days of infection.

Men may be asymptomatic (without symptoms) but might experience:

  • Yellowish-white discharge from the penis
  • Burning or pain when urinating
  • Urinating more often than usual
  • Pain or swelling of the testicles

Women are usually asymptomatic (without symptoms) but might experience:

  • Abnormal discharge from the vagina that is yellow and sometimes bloody.
  • Burning or pain when urinating

When the infection spreads to the fallopian tubes, some women still have no signs or symptoms. Others may experience one or more of the following symptoms, which can be an indication that the infection has progressed to pelvic inflammatory disease: lower abdominal pain, lower back pain, pain during intercourse, bleeding between menstrual periods, nausea, fever
Both men and women might have rectal or anal infection. Symptoms are usually not present in about 90% of cases. When present, symptoms include anal or rectal itching, discharge, and pain during defecation.

Gonorrhea infections of the mouth and throat are usually without symptoms. If present, symptoms include soreness and redness in the mouth or throat. A culture test is used to determine if gonorrhea is causing these symptoms.

If gonorrhea infects the eye, men and women might experience conjunctivitis (inflammation of the eyelid lining). Symptoms of conjunctivitis include redness, itching, and discharge from the eye.

The most common symptoms in newborns include conjunctivitis and pneumonia, which usually develop 5 to 12 days after birth.

How is gonorrhea diagnosed?
There are several different testing options for gonorrhea such as urine or swab tests. It may be helpful to speak to your health care provider about what testing options they have available.

People infected with gonorrhea are often also infected with chlamydia; therefore, in patients with gonorrhea treatment is often prescribed for chlamydia as well, since the cost of the treatment is less than the cost of testing for chlamydia. According to the 2002 CDC STD Treatment Guidelines, health care providers do not need to consider re-testing patients after treatment unless the patient still has symptoms or if reinfection is suspected.

How is gonorrhea treated?
There are antibiotic treatments that are effective in treating gonorrhea. Some strains of gonorrhea have been found to be resistant to certain drugs (known as antimicrobial resistance), so the recommended treatment for most cases involves two antibiotics: one delivered as an injection and the other as an oral medication (usually just a single pill).

Patients with gonorrhea should also be treated for chlamydia (unless testing has ruled out chlamydia infection).

Here are some important points about treatment:

  • All medications should be taken as directed.
  • All partners should be examined and treated.
  • Sexual contact should be avoided until the patient and all partner(s) have been treated and cured.
  • Persons with symptoms after treatment should be tested again by culture.
  • Persons who were treated with a non-recommended course of antibiotics (sometimes done if a patient is allergic or the drugs are unavailable) should also be tested again one week after treatment, even if they have no symptoms.
  • Infections detected after treatment with the recommended medications more commonly occur because of reinfection rather than treatment failure.

What does it mean for my health?
If untreated, gonorrhea can cause complications in men, women and infants. Untreated gonorrhea infections in men may lead to:

  • Prostatitis: inflammation of the prostate gland
  • Scarring of the urethra, which can cause a narrowing or closing of the urethra
  • Infertility
  • Epididymitis: inflammation of the epididymis, the elongated, sperm-carrying, cord-like structure along the posterior border of the testes

Untreated gonorrhea infections in women may lead to:

  • Pelvic inflammatory disease (PID): PID can develop from several days to several months after infection with gonorrhea. Left untreated, PID can cause infertility.
  • Chronic menstrual difficulties
  • Postpartum endometritis: inflammation of the lining of the uterus after childbirth
  • Miscarriage
  • Cystitis: inflammation of the urinary bladder
  • Mucopurulent cervicitis: characterized by a yellow discharge from the cervix.

About 1% of men or women with gonorrhea may develop Disseminated Gonococcal Infection (DGI), which is sometimes called gonococcal arthritis. DGI occurs when gonorrhea infection spreads to sites other than genitals, such as the blood, skin, heart, or joints.

Symptoms of DGI include fever, multiple skin lesions, painful swelling of joints (arthritis), infection of the inner lining of the heart, and inflammation of the membrane covering the brain and spinal cord (meningitis). Symptoms of DGI in infants include arthritis, meningitis and sepsis, a bacterial infection of the blood

DGI can be successfully treated using antibiotic regimens similar to those recommended for treating uncomplicated gonorrhea.

Gonorrhea can be passed from mother to newborn as the baby passes through the infected birth canal. Complications in infants include: blindness, from untreated eye infections.

How can I reduce my risk?

  • Abstinence (not having sex) is a sure way to eliminate risk of infection.
  • Mutual monogamy (having sex with only one uninfected partner) is another way to eliminate risk.
  • Water-based spermicides are not recommended for the prevention of gonorrhea. Recent studies have shown that nonoxynol-9 (“N-9”), which is found in most water-based spermicides, is not effective in preventing gonorrhea.
  • Using latex condoms for vaginal and anal sex will reduce risk.
  • Since gonorrhea can be transmitted even if the penis or tongue does not completely enter the vagina, mouth or rectum, using latex condoms at the beginning of sexual contact until there is no longer skin contact is the best form of prevention.
  • Several barrier methods can be used to reduce the risk of transmission of gonorrhea during oral sex. A non-lubricated condom can be used for mouth-to-penis contact. Household plastic wrap, a dental dam, or a latex condom cut-up and opened flat can reduce the risk of transmission during mouth-to-vulva/vagina or oral-anal (rimming) contact.

How do I tell my partner?
Telling a partner can be hard, but keep in mind that most people with an STD don’t know they have it. It’s important that you talk to your partner as soon as possible so she or he can get treatment. It is possible to pass gonorrhea back and forth, so if you get treated and your partner doesn’t, you may get infected again.

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