Gonorrhea

Topic Overview

What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD). It is a bacterial infection of the urethra in men and the urethra, cervix, or both in women. Gonorrhea can also infect the rectum, anus, throat, pelvic organs, and, in rare cases, the conjunctiva, which is the membrane that lines the eyelid and eye surface.

Gonorrhea can cause serious health problems.

• For a woman, untreated gonorrhea can move into the uterus, fallopian tubes, and ovaries . This can cause painful scar tissue and inflammation, known as pelvic inflammatory disease (PID). And PID can cause infertility or ectopic pregnancy.
• For a man, untreated gonorrhea may increase the risk of bladder cancer.¹

You may hear some people refer to gonorrhea as the clap, drip, or GC.

What causes gonorrhea?

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It can be spread during vaginal, anal, or oral sex with an infected partner. You have a high risk of getting infected when your partner has gonorrhea and you have sex without a condom.²

With or without symptoms, an infected sex partner can give you gonorrhea until he or she has been treated.

A pregnant woman may pass the infection to her newborn during delivery.

Having a gonorrhea infection once does not protect you from getting another infection in the future. A new exposure to gonorrhea will cause a new infection, even if you were previously treated and cured. This is why it is so important for your partner to be treated when you are.

What are the symptoms?

It is fairly common for gonorrhea to cause no symptoms, especially in women. People who do not have symptoms can unknowingly transmit gonorrhea infections to their sex partners.

The throat, anus, urethra, and rectum are common areas of infection in both men and women. If symptoms are present, they may include painful urination, anal itching or bleeding, or abnormal discharge from the penis or vagina. Gonorrhea infection in the throat doesn't usually cause symptoms, such as a sore throat.

In men, symptoms are usually obvious enough that they will cause a man to seek medical attention before complications occur.

In women, the early symptoms are sometimes so mild that they are mistaken for a bladder infection or vaginal infection. When an untreated infection has moved into the pelvic organs, symptoms can include lower pelvic or belly pain, vaginal bleeding, fever, and pain during sex.

The incubation period-the time from exposure to gonorrhea until symptoms develop-is usually 2 to 5 days, but sometimes symptoms may not develop for up to 30 days.

How is gonorrhea diagnosed?

Your health professional will ask you questions about your medical history and will do a physical exam. He or she will ask you questions about your risk factors for STDs. Risk factors for gonorrhea include:

• Having multiple sex partners (more than one sex partner in the past year).
• Having a high-risk partner (who has multiple sex partners, unprotected sex, or gonorrhea-infected sex partner).
• Having unprotected sexual contact (not using condoms).

Lab tests must be done to confirm gonorrhea infection. These tests may include taking samples of fluid from the affected areas (such as the urethra, rectum or throat) or taking urine samples.

How is it treated?

Gonorrhea is treated with antibiotics. Antibiotic treatment, if taken exactly as directed, normally cures gonorrhea infections. If antibiotics are not taken properly, the infection will not be cured. Prompt antibiotic treatment also prevents the spread of the infection and decreases the risk of complications, such as pelvic inflammatory disease (PID).

Avoid any sexual contact while you are being treated for an STD. People taking a single dose of medicine should not have any sexual contact for 7 days after treatment so the medicine will have time to work. If you are diagnosed with gonorrhea, any sex partners you have had within the previous 60 days need to be tested and treated. They should seek treatment whether they have symptoms or not to prevent the spread of, or reinfection with, gonorrhea.

Many people who have gonorrhea also have chlamydia, a similar sexually transmitted disease. When both infections are present, medicine treatment includes antibiotics that are effective in treating both chlamydia and gonorrhea.

Can gonorrhea be prevented?

Preventing an STD is easier than treating an infection after it occurs. You can take measures to reduce your risk of becoming infected with gonorrhea or another STD. You can also lower your risk of transmitting gonorrhea to your sex partner(s) by practicing safe sex.

• Talk with your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for an STD. Remember that it is quite possible to be infected with an STD without knowing it.
• Avoid sexual contact if you have symptoms of an STD or are being treated for an STD.
• Avoid sexual contact with anyone who has symptoms of an STD or who may have been exposed to an STD.
• Don't have more than one sexual relationship at a time. Your risk for an STD increases if you have several sex partners.
• Use condoms. Condom use reduces the risk of spreading or becoming infected with an STD. Condoms must be put on before beginning any sexual contact. Use condoms with a new partner until you are certain he or she does not have an STD and that neither of you has other sex partners. You can use male or female condoms.

Frequently Asked Questions

Cause

Gonorrhea is caused by the bacteria Neisseria gonorrhoeae.

Gonorrhea is spread during vaginal, anal, or oral sex with an infected partner. A pregnant woman may pass the infection to her newborn during delivery.

Gonorrhea can be transmitted any time by a person who is infected with the bacteria Neisseria gonorrhoeae, whether or not symptoms are present. A person who is infected with gonorrhea is always contagious until he or she has been treated.

Having a gonorrhea infection once does not protect you from getting another infection in the future. A new exposure to gonorrhea will cause reinfection, even if you were previously treated and cured.

Symptoms

It is fairly common for gonorrhea to cause no symptoms, especially in women. The incubation period-the time from exposure to the bacteria until symptoms develop-is usually 2 to 5 days, but sometimes symptoms may not develop for up to 30 days.

Gonorrhea may not cause symptoms until the infection has spread to other areas of the body. See the What Happens section of this topic.

Symptoms in women

In women, the early symptoms are sometimes so mild that they are mistaken for a bladder infection or vaginal infection. Symptoms may include:

• Painful or frequent urination.
• Anal itching, pain, bleeding, or discharge.
• Abnormal vaginal discharge.
• Abnormal vaginal bleeding during or after sex or between periods.
• Genital itching.
• Irregular menstrual bleeding.
• Lower abdominal pain.
• Fever and general tiredness.
• Swollen and painful glands at the opening of the vagina (Bartholin glands).
• Painful sexual intercourse.
• Sore throat (rare).
• Pinkeye (conjunctivitis) (rare).

Symptoms in men

In men, symptoms are usually obvious enough that they will cause a man to seek medical treatment before complications occur. But some men have mild or no symptoms and can unknowingly transmit gonorrhea infections to their sex partners. Symptoms may include:

• Abnormal discharge from the penis (clear or milky at first, and then yellow, creamy, and excessive, sometimes blood-tinged).
• Painful or frequent urination.
• Anal itching, pain, bleeding, or discharge.
• Sore throat (rare).
• Pinkeye (conjunctivitis) (rare).

Symptoms of gonorrhea that has spread to sites other than the genitals (disseminated gonococcal infection) include:

• Rash.
• Joint pain or arthritis.
• Inflamed tendons.

What Happens

Gonorrhea causes no long-term problems if it is treated early in the course of the infection before any complications develop. Left untreated, gonorrhea can lead to serious complications.

Complications in women

Women with untreated gonorrhea may develop the following complications of the female reproductive system :

• Pelvic inflammatory disease (PID). The risk of infertility increases with each episode of PID.
• An abscess in or near the ovaries (tubo-ovarian abscess)
• Inflammation of the Bartholin glands
• An ectopic (tubal) pregnancy
• Chronic pelvic pain
• Infertility
• Fitz-Hugh-Curtis syndrome (rare)

Complications in pregnant women

Problems related to untreated gonorrhea in pregnant women include:

• The possibility of a miscarriage.
• Preterm labor. The woman may be given drugs to prevent premature birth, which could require a stay in the hospital.
• Premature rupture of the membranes (PROM), which happens before labor contractions start. The amniotic sac breaks open, causing amniotic fluid to gush out, or less commonly, to slowly leak.
• Premature delivery. A premature infant has an increased risk of health problems.
• Infection of the lining of the uterus (endometritis).

If a woman has gonorrhea when she gives birth, her newborn can be infected.

Women with untreated gonorrhea and infected newborns are more likely to develop long-term complications of gonorrhea.

Complications in newborns

Newborns of women with untreated gonorrhea may have any of the following complications:

• Pinkeye (conjunctivitis). Most newborns who have gonorrhea also get pinkeye.
• An infection in the bloodstream (sepsis)
• Inflammation of a joint (arthritis)
• Scalp infections at the site of a fetal monitoring device
• Infection of the fluid and tissues that surround the brain and spinal cord (meningitis)

Complications in men

Men with untreated gonorrhea may develop:

• An infection of the urethra (urethritis).
• Epididymitis, an inflammation and infection of the epididymis-the long, tightly coiled tube that lies behind each testicle and collects sperm.
• An inflammation of the prostate gland (prostatitis).
• A higher than normal risk of getting bladder cancer.¹

Complications of untreated gonorrhea in other areas of the body

Complications of disseminated gonococcal infection (DGI) include:

• Fever.
• Skin infection (cellulitis).
• An infection in the bloodstream (sepsis).
• Inflammation of a joint (arthritis). It most often affects the knees and hands.
• An infection and inflammation of the heart valves and the chambers of the heart (endocarditis).
• An infection of the fluid and tissues that surround the brain and spinal cord (meningitis).

Because many women do not have early symptoms of gonorrhea that cause them to seek treatment, they are more likely than men to have more serious complications from gonorrhea spreading to other parts of the body.

Having a gonorrhea infection once does not protect you from getting another infection in the future. A new exposure to gonorrhea will cause reinfection, even if you were previously treated and cured.

What Increases Your Risk

Risk factors for getting gonorrhea include:

• Having multiple sex partners (more than one sex partner in the past year).
• Having a high-risk partner (partner has other sex partners, unprotected sex, or gonorrhea-infected sex partners).
• Having unprotected sexual contact (not using condoms).

Any child with gonorrhea needs to be evaluated by a health professional to determine the cause and to assess for possible sexual abuse.

When To Call a Doctor

Gonorrhea causes no long-term problems if it is treated early in the course of the infection before any complications develop. Untreated gonorrhea can lead to many complications.

Call your health professional immediately if you have the following symptoms.

In women:

• Sudden, severe pain in the lower abdomen
• Lower abdominal pain with vaginal bleeding or discharge and a fever of 100 °F (38 °C) or higher
• Urinary burning, frequent urination, or inability to urinate and a fever of 100 °F (38 °C) or higher

In men:

• Discharge from the penis and a fever of 100 °F (38 °C) or higher
• Urinary burning, frequent urination, or inability to urinate and a fever of 100 °F (38 °C) or higher
• Pain, swelling, or tenderness in the scrotum and a fever of 100 °F (38 °C) or higher

Call your health professional to determine when an evaluation is needed if you have the following symptoms.

In women:

• Vaginal discharge that has become yellowish, thicker, or bad-smelling
• Bleeding between periods that occurs more than once when periods are usually regular
• Pain during sexual intercourse
• Bleeding after sexual intercourse
• Sores, bumps, rashes, blisters, or warts on or around the genital or anal area
• Burning, pain, or itching with urination or frequent urination lasting longer than 24 hours
• Pelvic or lower abdominal pain that occurs without a known cause, such as diarrhea or menstrual cramps
• Pinkeye (conjunctivitis)

In men

• Sores, bumps, rashes, blisters, or warts on or around the genital or anal areas
• Burning, pain, or itching with urination or frequent urination lasting longer than 24 hours
• Suspected exposure to a sexually transmitted disease
• Abnormal discharge from the penis
• Pinkeye (conjunctivitis)

Call your health professional or clinic if you have unprotected sex with someone who has, or who you think may have, a sexually transmitted disease.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate for a gonorrhea infection. Gonorrhea causes no long-term problems if it is treated early in the course of the infection before any complications develop, but untreated gonorrhea can lead to many complications. Avoid sexual contact until you have been examined by your health professional so that you will not infect someone else.

If you know you have been exposed to gonorrhea, both you and your sex partner(s) must be treated. You need treatment even if you don't have symptoms.

You must notify anyone with whom you have had sex in the 60 days before noticing symptoms or being diagnosed, even if you used condoms during sexual contact. Even if you have not had sex for more than 60 days, your most recent sex partner must be treated.³

If you are unable to contact your sex partners or you are uncomfortable doing so, health departments and sexually transmitted disease (STD) clinics can help with this process.

Who To See

Health professionals who can diagnose and treat gonorrhea include:

• Nurse practitioner.
• Physician assistant.
• Family medicine physician.
• Internist.
• Gynecologist.

Low-cost diagnosis and treatment of gonorrhea is usually available at local health departments and family planning clinics, such as Planned Parenthood.

Some people are not comfortable seeing their usual health professional for sexually transmitted disease treatment. Most counties have confidential clinics for diagnosing and treating gonorrhea and other sexually transmitted diseases. See the Other Places to Get Help section of this topic.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Diagnosis of gonorrhea includes a medical history and a physical exam. Your health professional may ask you the following questions.

• Do you think you have been exposed to any sexually transmitted diseases (STDs)? How do you know? Did your partner tell you?
• What are your symptoms?
  • Do you have any discharge? If you have discharge from your vagina or penis, it is important to note any smell or color.
  • Do you have sores in your genital area or anywhere else on your body?
  • Do you have any urinary symptoms, including frequent urination, burning or stinging with urination, or urinating in small amounts?
  • Do you have any unusual belly or pelvic pain?
• What method of birth control do you use? Do you use a condom to protect against STDs every time you have sex?
• Do you or your partner engage in high-risk sexual behaviors?
• Have you had an STD in the past? How was it treated?

Your health professional will ask you questions about your medical history. Then:

• A woman will have a pelvic exam.
• A man will have a genital exam to look for signs of urethritis and epididymitis.

Several gonorrhea tests can be used to detect or confirm an infection. Your health professional will collect a sample of body fluid or urine to be tested for gonorrhea bacteria (Neisseria gonorrhoeae). Most tests give results within a few days.

Other sexually transmitted diseases may be present with a gonorrhea infection. Your health professional may recommend testing for:

• Chlamydia, a bacterial infection of the urethra in men, and the urethra, the cervix, or the upper reproductive organs (or all three) in women. Up to 40% of people who have gonorrhea also have chlamydia.⁴
• Syphilis, a bacterial infection in which the most common symptom is a painless sore called a chancre (pronounced "shanker") that develops on the genitals.
• Hepatitis B, a viral infection that causes the liver to become swollen and tender (inflamed).
• Human immunodeficiency virus (HIV), a virus that attacks the immune system, making it difficult for the body to fight off infection and some diseases.

In the United States, your health professional must report that you have gonorrhea to the state health department.

Early Detection

If you engage in high-risk sexual behaviors, you may want to consider being tested once a year for gonorrhea even though you don't have symptoms. Testing will allow gonorrhea to be quickly diagnosed and treated. This helps reduce the risk of transmitting gonorrhea and avoid complications of the infection.

The Centers for Disease Control and Prevention (CDC) also recommends screening for pregnant women who engage in high-risk sexual behaviors to prevent them from transmitting gonorrhea to their babies. All pregnant women should be screened during their first prenatal visit. If a pregnant woman is at high risk for gonorrhea, she may be tested again during the third trimester before delivery, to prevent transmitting the infection to her newborn.

Treatment Overview

Gonorrhea causes no long-term problems if it is treated early in the course of the infection before any complications develop. Untreated gonorrhea can lead to many complications.

Initial treatment

Gonorrhea is treated with antibiotics.⁵ Treatment is recommended for:

• A person who has a positive gonorrhea test.
• Anyone who has had sexual contact in the past 60 days with a person diagnosed with gonorrhea, whether or not they have symptoms or used condoms.
• A newborn whose mother has gonorrhea at the time of delivery.

If you are prescribed more than one dose of an antibiotic, be sure to take your antibiotic exactly as directed. If you miss doses or don't take the full course of medicine, the gonorrhea infection may not be cured.

Do not have sexual contact with anyone:

• While you are being treated.
• Until both you and your partner(s) have been tested and treated. If you are treated for gonorrhea and your sex partner is not, you will probably become infected again.

If your treatment is a single dose of antibiotic, wait at least 7 days after taking the dose before having any sexual contact.

Always use a condom when you have sex. This helps protect you from sexually transmitted diseases.

Treatment if the condition does not get better

Symptoms that do not go away after treatment may be caused by another gonorrhea infection or treatment failure.

Certain strains of the gonorrhea bacteria have become resistant to some antibiotics, including quinolones, penicillin, tetracycline, and sulfa drugs. When bacteria become resistant to an antibiotic, they no longer can be killed by that medicine.⁵

If you have been treated for gonorrhea and don't get better, you may be retested with a gonorrhea culture to see if there is bacterial resistance to the antibiotic you were taking. If there is bacterial resistance, you will need another antibiotic to cure the infection.

What To Think About

To prevent reinfection, don't have sex until any partner that might be infected is tested and treated. ³

Some people who have gonorrhea also have chlamydia. The CDC recommends that drug treatment for gonorrhea also include antibiotics that are effective in treating chlamydia. For more information, see the topic Chlamydia.

Pelvic inflammatory disease (PID) is a serious complication of gonorrhea that can lead to infertility, chronic pelvic pain, and ectopic pregnancy. To prevent PID, prompt treatment of gonorrhea is important. For more information, see the topic Pelvic Inflammatory Disease (PID).

Treatment of disseminated gonococcal infection (DGI) usually requires hospitalization and antibiotic treatment given intravenously (IV) or into a muscle (intramuscularly, IM).

In the United States, your health professional must report to the state health department that you have gonorrhea.

Prevention

You can take measures to reduce your risk of becoming infected with gonorrhea or another sexually transmitted disease (STD). You can also reduce the risk of transmitting gonorrhea to your sex partner(s).

Practice safe sex

Preventing a sexually transmitted disease (STD) is easier than treating an infection after it occurs.

• Talk with your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for an STD. Remember that it is quite possible to be infected with an STD without knowing it. Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood.
• Be responsible.
  • Avoid sexual contact if you have symptoms of an STD or are being treated for an STD.
  • Avoid sexual contact with anyone who has symptoms of an STD or who may have been exposed to an STD.
• Don't have more than one sexual relationship at a time. Your risk for an STD increases if you have several sex partners at the same time.

If you or your partner have had several sex partners within the past year, or you are a man who has unprotected sex with men, talk to your health professional about screening for gonorrhea and other STDs even if you don't have symptoms.

Condom use

Condom use reduces the risk of becoming infected with an STD, especially gonorrhea, chlamydia, and HIV. Condoms must be in place before beginning any sexual contact. Use condoms with a new partner every time you have sex, until you know from test results that he or she does not have an STD. You can use either male or female condoms.

Even if you are using another birth control method to prevent pregnancy, you can use condoms to reduce your risk of getting an STD. Female condoms are available for women whose male partners do not have or will not use a male condom. See tips on female condom use.

Home Treatment

Prescription antibiotic medicine normally cures gonorrhea infections. Gonorrhea does not cause long-term problems if it is treated before any complications develop. However, gonorrhea can lead to many complications if it is not treated.

If you have been diagnosed with gonorrhea:

• Take the full course of antibiotics as prescribed by your doctor. If you skip doses or do not complete the treatment, the infection may not be cured.
• Do not have sexual contact with anyone while you are being treated. If your treatment is a single dose of antibiotics, wait at least 7 days after taking the dose before having any sexual contact.
• Make sure your partner knows that he or she needs to be treated even if there are no symptoms. You can spread the infection to others even if you do not have symptoms.
• Call your doctor if your symptoms continue or reappear after treatment or if new symptoms develop. You may need a different antibiotic medicine or further evaluation.

Finding out that you have gonorrhea may cause you to have negative thoughts or feelings about yourself or about sex. Talking to a counselor or joining a support group for people who have sexually transmitted diseases (STDs) may be helpful.

Medications

Antibiotics, if taken exactly as directed, normally cure gonorrhea infections. If antibiotics are not taken properly, the infection will not be cured. Prompt antibiotic treatment also prevents the spread of the infection and decreases complications, such as pelvic inflammatory disease (PID).

Avoid all sexual contact while you are being treated for an STD. People taking a single dose of medicine should not have any sexual contact for 7 days after treatment to give the medicine time to work. Exposed sex partners need treatment whether they have symptoms or not.

Medication Choices

Antibiotics

What To Think About

Some strains of gonorrhea can't be killed by (are resistant to) certain antibiotics. If your health professional finds that your gonorrhea is resistant to the drug you are taking, he or she might prescribe another antibiotic to cure the infection. If you continue to have symptoms after you have been treated for gonorrhea, you will need to be retested with a gonorrhea culture to determine whether there is bacterial resistance to the antibiotic you were taking.

Call your health professional if symptoms continue or new symptoms develop 3 to 4 weeks after treatment.

Treatment in a hospital with intravenous (IV) medicines may be needed for women who have pelvic inflammatory disease (PID). For more information, see the topic Pelvic Inflammatory Disease.

Surgery

There is no surgical treatment for gonorrhea.

Other Treatment

There is no other treatment for gonorrhea at this time.

Other Places To Get Help

Organizations

Related Information

• Chlamydia
• Exposure to Sexually Transmitted Diseases
• Genital Herpes
• Genital Warts (Human Papillomavirus)
• Gonorrhea Test
• Human Immunodeficiency Virus (HIV) Infection
• Syphilis

References

Citations

1. Michaud DS, et al. (2007). Gonorrhoea and male bladder cancer in a prospective study. British Journal of Cancer, 96(1): 169-170.

2. Handsfield HH, Sparling PF (2005). Neisseria gonorrhoeae. In GL Mandell et al., eds., Principles and Practice of Infectious Diseases, vol. 2, 6th ed., pp. 2514-2529. Philadelphia: Elsevier Churchill Livingstone.

3. Centers for Disease Control and Prevention (2006). Sexually transmitted diseases treatment guidelines, 2006. MMWR, 55(RR-11): 42-49.

4. Moran J (2006). Gonorrhea, search date July 2005. Online version of Clinical Evidence (15): 1-7.

5. Centers for Disease Control and Prevention (2007). Updated recommended treatment regimens for gonococcal infections and associated conditions-United States, April 2007. Available online: http://www.cdc.gov/STD/treatment.

Credits