Gonorrhea

JAMA Patient Information Sheet on cefixime resistant gonorrhoea.

What is it?

Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhea bacteria.

How is it spread?

Gonorrhea is spread through unprotected oral, vaginal or anal sex with an infected person. It can also be passed from an infected mother to her baby during birth.  Individuals infected with Gonorrhea are at increased risk of contracting and transmitting HIV.

What are the symptoms?

You can get gonorrhea at different sites in the body. In many cases symptoms never appear so you can have gonorrhea without knowing it.  Symptoms can develop between two to 10 days after possible exposure and may include the following:

Vaginal/cervical infection: Those individuals who have symptoms may notice an increase or change in vaginal discharge, vaginal irritation, pain during sex, pain during urination and/or pain in the lower abdomen. 

Urethral (penis) infection: Common symptoms include pain/burning during urination and/or a yellow-green or off-white discharge from the penis. 

Throat infection: Throat infections often have no symptoms at all however some may experience a sore throat.

Anal/rectal infection: Gonorrhea can be transmitted through unprotected anal intercourse, sharing sex toys or anal play.  Some infected people may notice anal itching, painful bowel movements, an urgency to have a bowel movement, or an anal discharge. 

How is it diagnosed?

Vaginal/Cervical:  Upon examination, the cervix can sometimes appear irritated and may contain some discharge; or it can also look normal. A swab is inserted into the vagina and a sample of the secretions is taken from the cervix.

Urethral (penis):  Diagnosis is usually made through a urine sample although, if discharge is present, a swab may also be taken.  You should not urinate for one hour before a urine test.

Throat/anus:  Swabs are taken from the throat and/or rectum and are sent for testing.

If your partner is diagnosed with gonorrhea, you should also be tested and treated.

What are the complications?

Untreated gonorrhea can cause serious infection of the uterus and fallopian tubes called pelvic inflammatory disease (PID) which can lead to increased risk of ectopic pregnancy (a pregnancy in the fallopian tubes) and/or miscarriage and infertility. 

Gonorrhea can cause epididymitis, a painful condition of the testicles that can lead to infertility if left untreated. Without prompt treatment gonorrhoea can also affect the prostate and can lead to scarring inside the urethra.

It can also cause an eye infection if the infected discharge touches the eye.

How is it treated?

Gonorrhea is curable with antibiotics but it is possible to get re-infected.  It is very important to follow the instructions given with the medication.  People may have chlamydia at the same time as gonorrhea, so an antibiotic to treat chlamydia will often be given at the same time. 

What about my sexual partner(s)?

All sexual partner(s) within the last two months should be informed, tested and treated, even though they may have no symptoms.

Follow-up

You may be advised to return for a follow-up test after treatment to make sure that the infection has cleared up.   You may need to get re-treated if your strain of gonorrhea is resistant to the drug you were given.  Avoid having intercourse (oral, anal or vaginal) until your partner(s) have been tested and treated as well.  If your partner(s) are not treated, there is a high risk that you will be re-infected.

Prevention

Using a condom every time you have oral, vaginal and anal sex will greatly reduce your chances of getting gonorrhea and other sexually transmitted infections.