Gonorrhoea

Gonorrhoea is a common sexually transmitted infection, which has seen an recent increase in the UK in the last few years.

Symptoms

What are the symptoms of Gonorrhoea?

The symptoms of Gonorrhoea are very similar to those produced by Chlamydia and Mycoplasma infection, and often they occur together.

However, the urethral discharge in men, pain in testes and epididymis in men and abdominal pain can be a lot more acute and pronounced in Gonorrhoea when compared to Chlamydia and other infections.

Tests for Gonorrhoea and Chlamydia are generally done together due to similarities in the symptoms they produce and their presence together in lots of patients.

    What are the symptoms of Gonorrhoea in men?

    Symptoms in the Genital Area

    • Discharge from urethra
    • Pus-like discharge from urethra (Classically copious amounts of pus like discharge from the urethra, with staining of underwear. Sometimes the discharge can be severe enough that patient feels the need to wrap his penis in a tissue paper)
    • “Wetness” at penile tip
    • Discomfort in water pipe
    • Irritation in water pipe
    • Irritation on passing urine
    • Pain on passing urine
    • Pain in one or both testicles
    • Less commonly, red spots on the glans (head) of penis (Balanitis)

    Symptoms in the Eyes

    • Redness of one or both eyes
    • Stickiness in one or both eyes
    • Discharge in one or both eyes

    Symptoms in the Throat

    • Sore throat

    Symptoms in the Ano-rectal area (in homosexual men)

    • Irritation in back passage
    • Mucoid or slimy or blood-stained discharge from the back passage

    Disseminated Gonorrhoea

    Many cases of disseminated gonorrhoea have been identified recently, and refers to gonorrhoea infection away from their usual mucosal sites of infection, involving skin and joints (see image below of Gonorrhoea spread to the legs).

      What are the symptoms of Gonorrhoea in women?

      • Abnormal discharge
      • Change in discharge
      • Spotting
      • Bleeding after sexual contact (post-coital bleeding)
      • Bleeding between periods (intermenstrual bleeding)
      • Abdominal pain
      • Pain on having sexual intercourse
      • Pain on passing urine
      • Pelvic Inflammatory Disease (PID)
      • Bacterial vaginosis

      Many patients with bacterial vaginosis may have an underlying infection (Gonorrhoea, Chlamydia, Trichomonas vaginalis). The correct diagnosis and treatment of underlying infection is the best way to manage bacterial vaginosis in such patients. If the underlying cause is not addressed, symptoms of bacterial vaginosis are very likely to return.

      Eyes: see above
      Throat: as above
      Ano-rectal symptoms: as above
      Disseminated gonorrhoea: as above

      Are the symptoms of Gonorrhoea similar to another STI?

      Yes. The symptoms of Gonorrhoea, Chlamydia and Mycoplasma may overlap a lot, and in fact are often found to be present together in many patients. It is important that different infections are diagnosed correctly, and treated appropriately for complete resolution of symptoms.

      Can I have Gonorrhoea without knowing it?

      Yes. It is much more common in women to have Gonorrhoea infection in their genitalia without any symptoms, than it is in men. Sometimes symptoms can be vague and non-specific, and diagnosis can be easy to miss in the absence of appropriate tests.

      Many patients, especially heterosexual women and homosexual men, have Gonorrhoea in their throat without any symptoms. Furthermore, diagnosis of throat infection requires a throat swab for Gonorrhoea.

      I think I have Gonorrhoea. What should I do?

      Seek advice from a sexual health specialist.

      Urethral discharge in men due to Gonorrhoea is one of the most distressful symptoms of an STI. Fortunately the infection responds very well with dramatic improvement in the symptoms within a day or so with administration of correct antibiotics.

      Early treatment helps in prevention of complications as well as reduces transmission of the infection to others.

      Complications

      Gonorrhoea, often in conjunction with other associated infections like Chlamydia and Mycoplasma Genitalium, can lead to certain complications.

      In men and women: SARA (Sexually Acquired Reactive Arthritis)

      Less commonly, Gonorrhoea can cause pain and inflammation of the joints and tendons, known as sexually acquired reactive arthritis (SARA); this can sometimes also cause inflammation of the eyes, and skin lesions. This tends to be seen more often in men than women, and occurs due to a reaction in tissues against the Gonorrhoea bacteria, away from the site of original infection in the genitalia. This can sometimes occur weeks and even months after the genital infection has been effectively treated.

      In Men: Epididymitis or Epididymo-orchitis

      Gonorrhoea can cause the inflammation of one or both testicles and epididymis (the tubes carrying sperm from the testicles). This can be very painful and lead to reduction in fertility.

      In women: Gonorrhoea during pregnancy

      Untreated Gonorrhoea also increases the risk of preterm labour and an underweight baby.

      In women: Gonorrhoea in the newborn baby

      Untreated gonorrhoea at the time of vaginal delivery can lead to infection occurring in the eyes of the newborn baby. These symptoms normally develop within 5 days of birth. This is a very serious infection and can lead to reduced vision or even complete blindness in the newborn.

      In women: Pelvic Inflammatory Disease (PID)

      When Gonorrhoea spreads to the womb, ovaries and/or fallopian tubes, there is a much higher chance of getting PID. It is important to note that one may have PID without having Gonorrhoea.

      Fortunately, this condition can be treated with a course of antibiotics and if seen early enough, further complications can be avoided. This may include:

      • Difficulty in getting pregnant (which may progress to infertility)
      • Persistent pelvic pain
      • Greater risk of ectopic pregnancy (i.e. when a fertilised egg is implanted outside of the womb)

       

      If you are experiencing symptoms of Gonorrhoea, we would recommend getting tested and begin treatment without delay.

      Images

      These illustrations show the anatomical sites where the symptoms of Gonorrhoea are experienced.

      Causes

      What causes Gonorrhoea?

      • Unprotected vaginal, anal or oral sex
      • Sharing of unclean sex toys (with/without a condom)
      • Very close contact with partners’ genitals
      • Infected semen and/or vaginal fluid in the eye
      • During childbirth from infected mother

      You CANNOT get Gonorrhoea from the following:

      • Close contact (e.g. kissing and/or hugging)
      • Sharing showers, towels, swimming pools
      • Toilet seats
      • Cutlery

      What can increase my chances of getting Gonorrhoea?

      • If you have had Gonorrhoea before
      • If you have a greater number of sexual partners

      How can I prevent getting Gonorrhoea?

      • Have protected vaginal, oral and anal sex
      • Use a condom, femidom and/or dental dam with a new partner
      • Only use sex toys that you know are clean
      • You and your new partner get tested before having sex
      • Don’t have sex with your partner if they were treated for Gonorrhoea less than 7 days ago

      Can I pass Gonorrhoea to my child?

      If you leave Gonorrhoea untreated whilst pregnant, then there is a chance of passing it onto your child. This may result in your child developing conjunctivitis (an eye infection) and/or pneumonia (lung infection). The risk of a premature birth also increases (before 37 weeks of pregnancy) as well as the possibility of your child being born underweight.

      If you are pregnant and/or think you have Gonorrhoea, please see your sexual health clinician without any delay. Treatment is simple and complications can be avoided.

      Gonorrhoea Testing

      This is a RT-PCR test which means that the smallest amount of Gonorrhoea (and Chlamydia) can be found in a good quality sample.

      Furthermore, we are able to provide results on the same day (i.e. in 3 hours) to our patients in Birmingham.

       

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      Window Period

      7 days after exposure

      Sample required for men

      For men: urine sample (please don’t urinate 1-2 hours before your appointment)

      For women: (self-taken) high vaginal swab

      Time for test results

      Express: within 3 hours (Birmingham only)

      Standard: within 4 working days

      Cost of test

      £130 (or £80 if taken with another test)

      Do I need a Gonorrhoea test?

      • you or your partner have any symptoms of Gonorrhoea
      • you’ve had unprotected sex with a new partner
      • a condom splits while you’re having sex
      • you or your partner have had unprotected sex with other people
      • you think you could have a sexually transmitted infection (STI)
      • a sexual partner tells you they have Gonorrhoea
      • you’re pregnant or planning a pregnancy

      When should I take a Gonorrhoea test?

      If you are experiencing symptoms of Gonorrhoea or your partner has tested positive for Gonorrhoea, please get tested without delay. Otherwise, we recommend waiting 7 days after sexual contact to get a Gonorrhoea test.

      Does it require a physical examination?

      A physical examination is recommended if you are experiencing symptoms, but we will only carry out physical examinations with your informed consent.

      What happens if my Gonorrhoea test is positive?

      If you are tested positive for Gonorrhoea (i.e. Gonorrhoea is DETECTED) then we will discuss what it means for you, provide Gonorrhoea treatment to manage the condition and ensure you don’t pass it on to your partner.

      You will need to get re-tested 2 weeks after receiving treatment to make sure the infection has gone.

      Do I have to tell my partner, if I test positive for Gonorrhoea?

      Yes. We will give you all the necessary support in conveying your diagnosis to your partner and get them tested. We will discuss the risk of passing on the infection and any tests and/or treatment your partner may need.

      Gonorrhoea Treatment

      Method of treatment

      Injectable antibiotics

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      Length of Treatment:

      One dose, given in clinic

      9

      Further actions:

      1. Abstain from sexual intercourse for 7 days, after beginning treatment
      2. Test & treat your partner(s)
      3. Re-test for Gonorrhoea in 2 weeks

      Cost of treatment

      £100 (or £150 if tested elsewhere)

      Can Gonorrhoea be cured?

      Yes. Gonorrhoea can easily be treated and cured.

      What is the treatment for Gonorrhoea?

      Gonorrhoea is mainly treated with a one-off intramuscular injection.

      How long does the treatment take to work?

      The medication starts to work once inside the body, but it can take a few days to alleviate any symptoms associated with this infection.

      Are there any side effects?

      Antibiotics to treat Gonorrhoea can be taken safely with most commonly used medications. However, we will be able to advise if any extra precautions are needed in your specific circumstances to reduce the side effects. They may include:

      • nausea (feeling sick)
      • vomiting
      • stomach cramps/pains
      • diarrhoea
      • headaches
      • dizziness
      • rashes

      Can I drink alcohol whilst on Gonorrhoea treatment?

      Yes, you can. Ideally, it is best to avoid alcohol when taking antibiotics as this puts less pressure on the liver. If it is an occasion/night out, using alcohol will not affect the medication.

      Be mindful of the side effects of antibiotics and alcohol; the medication needs to remain in the body to work against the infection.

      How effective is the treatment for Gonorrhoea?

      The antibiotic is very effective against Gonorrhoea. However, due to overuse of antibiotics worldwide, some infections become resistant to the medication we use.

      This is why we recommend a Test Of Cure for Gonorrhoea at 14 days after treatment to ensure the infection has gone.

      Does my partner need treatment?

      Yes. Gonorrhoea is an easily transmissible infection so we strongly advise that you inform your current partner(s) to be treated and tested.

      It is also advised that you inform any other sexual partner(s) from the last 3 months that you have the infection, so that these people can get tested and treated. This breaks the chain of infection.

      Can I begin treatment before receiving my test results?

      Yes. Treatment can begin before receiving results, especially if you are experiencing uncomfortable symptoms.

      However, it is really important to have appropriate specimens taken before any treatment is commenced. This helps in confirming the diagnosis, detect other infections that may require separate treatment, and serve as a baseline for repeat tests 2 weeks later to check for a cure.

      How long do I have to wait before having sex again?

      To be sure the antibiotic has eradicated the infection, we advise no sexual contact for 7 days. If your partner had treatment after you, then it must be 7 days after their treatment.

      Do I have to get re-tested?

      Yes. It is strongly advised to have a Test Of Cure (TOC) 2 weeks after receiving the injection. This just involves repeat samples from where the infection was diagnosed; throat, vagina, urethra and rectum.

      Can I get the infection again?

      Yes, having unprotected oral,vaginal and anal sex increases the risk.

      In fact, getting Gonorrhoea once makes you more susceptible to getting Gonorrhoea again. Using condoms/dams provides the best protection against catching Gonorrhoea.

      What happens if I don’t get treated?

      The infection will remain in your system and be passed onto any other sexual partners if no condoms/dams are used. In both men and women, inflammation due to the infection in the genital area can cause infertility in the long term.

      If untreated in pregnancy, there is some evidence that this can cause miscarriage, preterm (early) delivery. The baby can also become infected with Gonorrhoea during the birthing process, it often causes an eye infection called conjunctivitis.

      Ultimately, when left without treatment, Gonorrhoea can spread to other parts of the body and cause serious health problems.

      Page reviewed by Dr. Manoj Malu (Clinical Director)

      Last reviewed date: 3 March 2020
      Next review due: 3 March 2023

      Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.

      If you think you may have Gonorrhoea

      It is important to refer to a healthcare provider as soon as possible. Our experience combined with timely detection can help put you on the right track without delay and avoid complications in the future.

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