Gonorrhea is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It can infect the genitals, rectum, and throat and may cause no noticeable symptoms. This is one reason the infection can spread between sexual partners without either person realizing it.
Gonorrhea is treatable and curable with appropriate antibiotics, but delaying treatment can lead to complications affecting reproductive and overall health. Increasing antibiotic resistance also makes correct diagnosis, treatment, and follow-up increasingly important.
Begin Health Life presents this article on gonorrhea, covering its symptoms, causes, transmission, testing, treatment, and prevention. Through this article, you can learn the key facts to better understand this common sexually transmitted infection and protect your health.
What Causes Gonorrhea?
Gonorrhea is caused by N. gonorrhoeae, a bacterium that grows particularly well in the moist lining of the reproductive tract, urethra, rectum, and throat.
The infection is mainly transmitted through vaginal, anal, or oral sex with an infected person. A person can spread gonorrhea even when they have no symptoms. Infection can also pass from a pregnant person to a baby during childbirth.
Gonorrhea is not spread through ordinary activities such as hugging, sharing food or drinks, or using a toilet after an infected person.
Gonorrhea Symptoms
One of the most important facts about gonorrhea symptoms is that they may be absent, particularly in women and in throat or rectal infections. Many infected women have no noticeable symptoms, while some men also have mild or no symptoms.
When symptoms occur, they may include:
- Burning or pain while urinating
- Unusual vaginal discharge
- White, yellow, or green discharge from the penis
- Vaginal bleeding between periods
- Pain or swelling of the testicles
- Pelvic or lower abdominal pain
Gonorrhea rectal infection may cause itching, soreness, discharge, bleeding, or painful bowel movements. Throat infections can cause a sore throat, although pharyngeal gonorrhea is frequently asymptomatic, around 90% cases.
Because symptoms can be mild or completely absent, relying on symptoms alone is not a reliable way to identify the infection.
How Is Gonorrhea Spread?
Gonorrhea transmission occurs primarily through sexual contact with an infected person. It can spread during vaginal, anal, or oral sex.
The bacteria can infect different body sites depending on the type of sexual exposure. For example, oral sex can result in infection of the throat, while receptive anal sex can expose the rectum.
Using condoms correctly and consistently can substantially reduce the risk of transmission. Having a mutually monogamous relationship with a partner who has tested negative also reduces risk.
Who Is at Higher Risk?
Anyone who is sexually active can develop gonorrhea. Risk increases with factors such as a new sexual partner, multiple partners, inconsistent condom use, a partner with an STI, or a previous STI.
In the United States, CDC recommends annual screening for sexually active women younger than 25 and for older women with increased risk. Sexually active men who have sex with men are also recommended to receive regular testing based on their risk and sites of sexual exposure.
Testing recommendations vary according to country, age, anatomy, sexual practices, and individual risk.
How Is Gonorrhea Diagnosed?
Gonorrhea testing commonly involves a urine sample or a swab from the infected area. Modern molecular tests, particularly nucleic acid amplification tests (NAATs), can detect small amounts of bacterial genetic material.
Testing should match the sites that may have been exposed. Someone who has had oral or anal sex may need throat or rectal testing in addition to a urine or genital test.
Healthcare professionals may also recommend testing for other STIs, including chlamydia, syphilis, and HIV.
Gonorrhea Treatment
Gonorrhea treatment requires antibiotics prescribed by a healthcare professional. Current CDC guidance recommends ceftriaxone by injection for uncomplicated gonorrhea, with the dose adjusted for body weight. If chlamydia has not been excluded, additional treatment for chlamydia may be needed.
The exact treatment should be determined by a healthcare professional rather than by using leftover antibiotics or medication prescribed for someone else.
This is particularly important because N. gonorrhoeae has developed resistance to several classes of antibiotics. WHO estimates that in 2020 about 82.4 million new gonorrhea infections occurred worldwide among adults aged 15-49 with frequent treatment failure by antibiotic resistance, illustrating the substantial global burden.
What Happens If Gonorrhea Is Untreated?
Untreated gonorrhea can move beyond the initial site of infection and cause significant complications.
In women, infection can spread into the reproductive organs and contribute to pelvic inflammatory disease (PID). PID may cause scarring of the fallopian tubes, infertility, ectopic pregnancy, or persistent pelvic pain.
In men, infection can cause inflammation around the testicles and, less commonly, complications that affect fertility. Rarely, gonorrhea can enter the bloodstream and spread to joints or other parts of the body.
Gonorrhea is also associated with an increased risk of acquiring or transmitting HIV.
Gonorrhea and Pregnancy
Gonorrhea during pregnancy needs prompt medical attention. As an infected pregnant person can also transmit the bacteria to the baby during childbirth, potentially causing serious infection, particularly involving the newborn's eyes, pregnancy care is vital against gonorrhea.
CDC recommends gonorrhea screening during pregnancy for pregnant women younger than 25 and for older pregnant women with increased risk. It includes prenatal visit, third trimester retesting and follow-up after treatment.
Appropriate testing and treatment during pregnancy can reduce the risk of complications for both the pregnant person and baby.
Can Gonorrhea Come Back After Treatment?
Yes. Treatment can cure the existing infection, but it does not provide immunity against future exposure. People who have been treated can become infected again if they have sexual contact with someone who has untreated gonorrhea.
CDC recommends retesting about three months after treatment because repeat infections are common. After treatment, people should follow their healthcare professional's instructions about sexual activity. CDC also recommends avoiding sex for seven days after treatment and until all sex partners have been treated.
How Can Gonorrhea Be Prevented?
The most effective prevention strategies include:
- Using condoms correctly every time
- Having mutually tested, mutually monogamous partnerships
- Getting regular STI testing when appropriate
- Informing sexual partners about a diagnosis
- Completing prescribed treatment
- Avoiding sexual contact until the recommended treatment period has passed
There is currently no widely available vaccine that prevents gonorrhea, so prevention and testing remain important.
Final Takeaways
Gonorrhea is a common bacterial STI that can affect the genitals, throat, and rectum. Gonorrhea symptoms sometimes may stay absent, so testing is important when exposure or risk is present. When diagnosed promptly, the infection can be cured with appropriate antibiotics.
However, untreated infection can cause infertility, pelvic inflammatory disease, complications in men, infection in newborns, and occasionally infection throughout the body. Due to the growing antibiotic resistance in gonorrhea, Begin Health Life also recommends responsible antibiotic use and continued surveillance.