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INTRODUCTION — Gonorrhea is a sexually transmitted infection that can affect both men and women. Approximately 700,000 people are infected with gonorrhea every year in the United States.
Common symptoms of genital tract gonorrhea include abnormal discharge from the vagina or penis, and pain with urination for either men or women. Persons who perform oral sex or have anal sex may have symptoms resulting from infection in those sites. Gonorrhea has potentially serious consequences if it is not treated, but this infection can be cured with antibiotics.
More detailed information about gonorrhea is available by subscription. (See 'Professional level information' below.)
GONORRHEA CAUSES — Gonorrhea is caused by bacteria known as Neisseria gonorrhoeae. Gonorrhea can be spread from one person to another during oral, vaginal/penile, or anal sex. A man does not have to ejaculate to spread the infection. You cannot become infected with gonorrhea by touching objects, like a toilet seat.
Your risk of getting gonorrhea is greater if you have a new sexual partner, more than one sexual partner, or if you have other sexually transmitted infections.
GONORRHEA SYMPTOMS — Symptoms of gonorrhea depend on where the infection is and whether you are male or female. However, some people have no symptoms at all. This means that gonorrhea can spread from person to person before it is diagnosed.
Both men and women can develop infection of the throat, urethra (where urine exits the body), and rectum. In women, infection can also occur in the cervix, uterus, fallopian tubes, and ovaries (figure 1). Infection in men can affect the prostate and the epididymis (figure 2).
Oral gonorrhea can cause a sore throat, but most infections of the throat cause no symptoms at all.
Women — In women, symptoms of gonorrhea can include:
●Vaginal itching or abnormal vaginal discharge
●Vaginal bleeding or spotting
●Pain or burning during urination
●Rectal discharge or constipation
●Pain with bowel movements
Men — The most common symptoms of gonorrhea in men include:
●Pain or discomfort with urination
●A milky discharge from the penis
●Pain and swelling in one testicle
Infection of the rectum can also develop among men who have sex with men. Symptoms include a rectal discharge, constipation, and pain.
However, it is important to remember that not everyone develops symptoms, so it is important to tell your provider what body parts you use for sex.
GONORRHEA DIAGNOSIS — Testing for gonorrhea is usually done in a doctor's office or clinic with a swab of the vagina or cervix (in women), or urine sample (in men). Testing for oral or rectal gonorrhea can also be performed with a swab. Some public clinics can test for gonorrhea from a swab of the urethra in men and provide immediate results. Other clinics may provide results within two to three days, depending on the type of test performed.
TESTING FOR OTHER SEXUALLY TRANSMITTED INFECTIONS — If you or your sexual partner is diagnosed with a sexually transmitted infection, like gonorrhea, you should have testing for other infections, including HIV, chlamydia, hepatitis B, trichomoniasis, and syphilis. (See "Patient education: Testing for HIV (Beyond the Basics)" and "Patient education: Chlamydia (Beyond the Basics)" and "Patient education: Hepatitis B (Beyond the Basics)".)
GONORRHEA COMPLICATIONS — If untreated, gonorrhea can lead to serious complications in both men and women, including:
●Women can develop pelvic inflammatory disease (PID) if gonorrhea spreads from the cervix to the uterus and fallopian tubes (figure 1). PID can scar the fallopian tubes and lead to infertility and an increased risk of ectopic pregnancy (when a pregnancy develops in the fallopian tube).
●Men with untreated gonorrhea can develop epididymitis (inflammation of the epididymis), which can lead to infertility. The epididymis collects sperm after it leaves the testis (figure 2).
●Both women and men can develop bloodstream infection from gonorrhea, accompanied by joint infection and arthritis. (See "Patient education: Joint infection (Beyond the Basics)".)
●People with gonorrhea are at higher risk of becoming infected with HIV. (See "Patient education: Symptoms of HIV (Beyond the Basics)".)
Infection during pregnancy — If you have (or think you may have) gonorrhea and are pregnant or want to get pregnant, it's important to get tested and treated as soon as possible. Untreated infection can cause serious problems in pregnancy, including miscarriage and premature birth. It's also possible to pass the infection on to your baby during delivery. This can cause conjunctivitis (red, swollen eyes that may ooze liquid) that can damage the baby's eyes and affect vision over time. Newborns infected with gonorrhea can have other symptoms and problems as well.
In the United States, most newborn babies get antibiotic ointment put into their eyes soon after birth; this helps prevent infection with gonorrhea.
GONORRHEA TREATMENT — Treatment of gonorrhea is the same for women and men. Most experts recommend a one-time antibiotic treatment given as a shot into the muscle. They also recommend treatment for chlamydia at the same time unless a test for chlamydia was done and was negative. (See "Patient education: Chlamydia (Beyond the Basics)".)
If you have had gonorrhea before, you are at increased risk of getting it (or another sexually transmitted infection) again. You should see your health care provider three months (or if this is not possible, within one year) after your treatment to be retested. Call your provider right away if you continue to have symptoms, as you could have an infection that is resistant to standard antibiotics.
Sexual partner treatment — Treatment is important for you and anyone you have had sex with recently. Your doctor or nurse might ask you to tell your sexual partner(s) to be tested and treated. In some cases, your doctor or nurse will give you a prescription for both you and your partner.
You should not have sex until seven days after treatment. Your recent sex partner(s) should also not have sex until seven days after treatment. It is possible to be infected with gonorrhea more than once.
GONORRHEA PREVENTION — There are several things you can do to help prevent getting gonorrhea:
●Men should use a condom every time they have sex.
●Do not have sex if you or your sexual partner has an abnormal discharge or burning with urination.
●Discuss regular screening for sexually transmitted infections with your doctor or nurse, even if you have no symptoms. If you are in a long-term relationship and neither of you has sex with anyone else, you have a lower risk of sexually transmitted infections.
●See your doctor or nurse if you have any symptoms of gonorrhea or another infection.
WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Avoiding infections in pregnancy (The Basics)
Patient education: Chlamydia and gonorrhea (The Basics)
Patient education: Ectopic pregnancy (The Basics)
Patient education: Anogenital warts (The Basics)
Patient education: Pelvic inflammatory disease (The Basics)
Patient education: Screening for sexually transmitted infections (The Basics)
Patient education: Syphilis (The Basics)
Patient education: Vaginal discharge (The Basics)
Patient education: Epididymitis (The Basics)
Patient education: Anal pruritus (anal itching) (The Basics)
Patient education: Urethritis (The Basics)
Patient education: Bartholin gland cyst (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Testing for HIV (Beyond the Basics)
Patient education: Chlamydia (Beyond the Basics)
Patient education: Hepatitis B (Beyond the Basics)
Patient education: Joint infection (Beyond the Basics)
Patient education: Symptoms of HIV (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Acute cervicitis
Pelvic inflammatory disease: Clinical manifestations and diagnosis
Disseminated gonococcal infection
Epidemiology and pathogenesis of Neisseria gonorrhoeae infection
Pelvic inflammatory disease: Pathogenesis, microbiology, and risk factors
Screening for sexually transmitted infections
Treatment of uncomplicated Neisseria gonorrhoeae infections
Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents
The following organizations also provide reliable health information:
●National Institute of Allergy and Infectious Diseases
(www.niaid.nih.gov/diseases-conditions/gonorrhea)
●Centers for Disease Control and Prevention
(www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm)
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