What is gonorrhea? Common signs and symptoms

Gonorrhea often has no symptoms, but it can cause health complications when left untreated. If someone thinks they may have gonorrhea or wants to learn more about sexually transmitted infections (STIs), this article will explain what gonorrhea is, cover how signs of infection can show up differently in different parts of the body, discuss treatment methods and provide information about reducing the risk of contracting and spreading gonorrhea.

In this article:

What is gonorrhea?

Gonorrhea is a treatable STI caused by a strain of bacteria called Neisseria gonorrhoeae. While it mostly affects young people, anyone who engages in vaginal, anal or oral sex without a condom can get gonorrhea. The infection can affect the genitals, rectum and throat and is the second most common STI in the U.S. Gonorrhea is one of the oldest STIs known to humankind.

Causes of gonorrhea

Neisseria gonorrhoeae bacteria can be spread through anal, oral or vaginal sex without a condom with a person who has a gonorrhea infection. Gonorrhea can also be spread through direct contact with infected genital fluids. A person could develop an eye infection if they were to rub their eye after touching infected penile or vaginal fluid with their hand.

Gonorrhea can also be spread during childbirth. Newborn babies can become infected after exposure to the bacteria in the cervix of a pregnant person. The first signs of infection in newborns usually show up within two to five days following birth.

What doesn’t cause gonorrhea?

Gonorrhea is not spread through casual contact. People cannot get gonorrhea through hugging or holding hands. The bacteria cannot be transferred by sitting on toilet seats or through sharing drinkware and utensils.

Risk factors

“Most cases of gonorrhea are spread through sexual contact. This includes vaginal, anal and oral intercourse,” explains board-certified internal medicine physician Dr. Brennan Kruszewski.

Gonorrhea can be spread through sexual contact with people of the same sex or opposite sex. Condomless sex and having multiple sexual partners are also risk factors. Cases are most often seen among young people, with individuals between the ages of 15 and 24 most affected.

Symptoms of gonorrhea

Gonorrhea often has no symptoms, especially in women. Common genital symptoms include pain or a burning sensation with urination and discharge. (For the purposes of this article, “men” and “women” refer to biological sex.)

If the anus or rectum is infected, a person may experience itching, discharge or pain when having a bowel movement. A gonorrhea infection in the eyes may produce symptoms of discharge, itching, light sensitivity (also known as photophobia) or pain.

People who develop the infection in the throat may experience a sore throat or swelling in the neck glands. If gonorrhea spreads to the joints, the area may become red, painful, swollen or warm to the touch. In many cases, people develop no symptoms whatsoever.

Symptoms in men

While some patients may be asymptomatic, common signs of genital infection in men include the following:

• Pain or burning sensation during urination (dysuria)
• Pain or swelling in the testes (This symptom tends to be less common.)
• Penile discharge (green, white or yellow). Discharge may be minimal and mucus-like or heavier and pus-like.

Symptoms in women

For women, gonorrhea usually causes no symptoms. The infection commonly occurs in the cervix, and if signs do develop, they are often similar to a bladder infection or urinary tract infection (UTI). Women with symptoms may experience the following:

• Increased vaginal discharge
• Painful or burning sensation during urination (dysuria)
• Vaginal bleeding between periods

When symptoms appear

Symptoms of gonorrhea usually begin 1 to 14 days after sexual contact with an infected person.

Complications

Gonorrhea doesn’t resolve on its own. If left untreated, the infection can lead to serious and permanent complications.

For women, this can include pelvic inflammatory disease (PID), an increased risk of ectopic pregnancy, and long-term pelvic and abdominal pain. Men may develop scrotal swelling and urethral stricture (a narrowing of the urethra caused by scar tissue).

Untreated gonorrhea may also cause infertility and disseminated gonococcal infection (DGI), and it may make people more susceptible to Human Immunodeficiency Virus (HIV). Newborns who are exposed to gonorrhea during childbirth may develop an eye infection that increases the risk of blindness if left untreated.

Disseminated gonococcal infection (DGI)

In severe cases, untreated gonorrhea can develop into disseminated gonococcal infection (DGI). This occurs when the infection has traveled through the bloodstream to other parts of the body. While uncommon, the spread of bacterial infection can be life threatening.

DGI can lead to arthritis, tenosynovitis (inflammation of the tendon sheath), multiple skin lesions and other complications.

Pelvic inflammatory disease (PID)

PID occurs when an infection causes the upper genital tract in women to become inflamed. Reproductive organs, such as the fallopian tubes, ovaries and uterus, can become infected.

In 85 percent of cases, PID is caused by sexually transmitted bacteria or microbes associated with bacterial vaginosis. Of the offending agents, gonorrhea or chlamydia are the most common pathogens.

Gonorrhea infection can produce more severe cases of PID. People with the condition may develop adhesions, fallopian tube obstruction, persistent pelvic pain and scarring. PID can also increase the risk of infertility and ectopic pregnancy, in which a fertilized egg implants and grows outside the main cavity of the uterus.

Infertility

In about 10 percent of women diagnosed with PID, the condition can cause scarring of the fallopian tubes. This scarring can block the tubes and lead to infertility, as it hinders the fallopian tubes’ ability to transport the egg for fertilization within the tubes and implantation in the uterus. In men, gonorrhea can cause inflammation in epididymis. This inflammation is known as epididymitis. Without treatment, it can lead to infertility.

Diagnosis and tests

People can discuss with their health care provider if testing for STIs would be recommended for them based on their personal medical history and risk factors. It is recommended that sexually active women (including pregnant people) screen for gonorrhea if they are 24 years or younger, or if they are 25 years or older and at an increased risk for infection.

Treatment and management

Gonorrhea can currently be treated with antibiotics. However, some strains of the bacteria that cause gonorrhea have grown resistant to antibiotic treatment. Here’s what people need to know about completing antibiotic treatment for gonorrhea and managing drug resistance.

Antibiotics

Gonorrhea is typically treated with oral antibiotics. These medications prevent the infection from spreading and reduce the risk of complications. While antibiotics can treat gonorrhea, they cannot treat permanent damage done from the infection. Patients will need to finish all medication as directed, and it should not be given to anyone other than the person it is prescribed to.

Patients are advised to speak with their health care provider about when they can return to having sex and when they should be tested again. It is possible to contract gonorrhea more than once. Seek medical care if symptoms do not resolve after treatment.

Management of antibiotic-resistant gonorrhea

Some strains of gonorrhea are antibiotic resistant. The most resistant strains are sometimes referred to as “super gonorrhea.” This means that traditional drug treatment methods are no longer able to effectively treat the bacteria. The current class of antibiotics used to treat gonorrhea in the U.S. remains an effective treatment method.

Prevention

The only way to completely avoid STIs is to not have anal, oral or vaginal sex. Having sex with a condom can help prevent the spread of infection. Regular STI testing can help detect gonorrhea and other common sexually transmitted infections as early as possible.