Gonorrhea

How gonorrhea spreads

Gonorrhea passes through contact with infected fluids during vaginal, anal or oral sex, even without ejaculation. It can also pass from a mother to her baby during vaginal birth. It does not spread through toilet seats, swimming pools or sharing cups.

Symptoms

Symptoms, when they occur, usually appear 2 to 14 days after exposure, though many infections never cause symptoms.

In women

Most women have no symptoms or mild ones mistaken for a bladder or vaginal infection:

• increased or changed vaginal discharge
• burning or pain when urinating
• bleeding between periods or after sex
• lower belly or pelvic pain

In men

Men are more likely to have symptoms:

• white, yellow or green discharge from the penis
• burning when urinating
• painful or swollen testicles (epididymitis), less commonly

Other sites

• Rectal infection: often silent; or discharge, itching, soreness, bleeding or painful bowel movements.
• Throat infection: usually no symptoms; sometimes a sore throat.
• Eyes: conjunctivitis with heavy pus discharge, from touching the eye with infected fluid.

Complications

• Pelvic inflammatory disease: infection spreading to the uterus, tubes and ovaries, which can cause chronic pelvic pain, infertility and ectopic pregnancy.
• Epididymitis: painful testicular inflammation, rarely affecting fertility.
• Disseminated gonococcal infection: spread through the bloodstream causing fever, skin lesions, joint pain and swelling (septic arthritis), and rarely heart or brain infection.
• Increased HIV risk: gonorrhea makes it easier to acquire and transmit HIV.
• Newborn eye infection: can cause blindness if untreated, which is why newborns receive preventive eye ointment.

Testing

• NAAT on a urine sample (first-catch, men and women) or a vaginal swab (often self-collected) is the main test.
• Throat and rectal swabs are recommended for people who have oral or receptive anal sex, because urine tests miss these sites.
• Culture is used when treatment fails, to test antibiotic sensitivity.
• Testing for chlamydia, syphilis and HIV is usually done at the same time.

Who should be screened?

The CDC and USPSTF recommend yearly screening for:

• sexually active women under 25
• women 25 and older with new or multiple partners, or a partner with an STI
• pregnant people at risk
• men who have sex with men, at least yearly and every 3 to 6 months if at increased risk
• people with HIV

Treatment

• Ceftriaxone: a single injection is the recommended treatment for uncomplicated gonorrhea of the genitals, rectum and throat in the US.
• Chlamydia co-treatment: if chlamydia has not been ruled out, doxycycline tablets for 7 days are added.
• Alternatives exist for people with severe allergies to cephalosporins, chosen by a clinician.
• Disseminated infection and complications need hospital treatment with IV antibiotics.

Do not use leftover or someone else's antibiotics: gonorrhea has developed resistance to many antibiotics over time.

After treatment

• avoid sex for 7 days after treatment and until symptoms have resolved and partners are treated
• partners from the past 60 days should be tested and treated; some clinics offer expedited partner therapy
• test of cure 7 to 14 days after treatment for throat infections
• retest at 3 months, because reinfection is common
• return if symptoms persist

Prevention

• condoms used correctly every time, including for oral sex, greatly reduce the risk
• regular testing if you have new or multiple partners
• mutual monogamy with a tested partner
• doxy-PEP: for men who have sex with men and transgender women with a recent STI, taking doxycycline within 72 hours after sex reduces bacterial STIs; it is less effective against gonorrhea than against chlamydia and syphilis
• notifying partners after a diagnosis

Frequently asked questions

What are the first signs of gonorrhea?

In men, the first signs are often burning when urinating and discharge from the penis, 2 to 14 days after exposure. Women often have no symptoms or mild discharge, burning or bleeding between periods. Throat and rectal infections are usually silent.

How is gonorrhea treated?

Gonorrhea is treated with a single injection of the antibiotic ceftriaxone. Doxycycline is added if chlamydia has not been ruled out. Partners must be treated too, and you should avoid sex for 7 days after treatment.

Can gonorrhea go away on its own?

No. Untreated gonorrhea can persist and cause serious complications, including pelvic inflammatory disease and infertility. It needs antibiotic treatment, and partners must be treated to prevent reinfection.

How long after exposure should I get tested for gonorrhea?

NAAT tests can usually detect gonorrhea within a few days to 2 weeks after exposure. If you test too early and have ongoing concerns, repeat the test. Get tested sooner if you develop symptoms.

Can you get gonorrhea from oral sex?

Yes. Gonorrhea can infect the throat through oral sex and can be passed from the throat to a partner's genitals. Throat infections usually cause no symptoms, so a throat swab is needed to detect them.