Gonorrhea

What Is Gonorrhea? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Joseph Bennington-Castro
By
Natalia Johnsen, MD
by
Updated on May 12, 2023
Gonorrhea is a common sexually transmitted disease (STD) with about 1.14 million new infections occurring in the United States each year.

 It is particularly common among those ages 15 to 24.

The disease is caused by the bacterium Neisseria gonorrhoeae and is sometimes called “the clap,” for reasons unknown, or “the drip,” because of the vaginal, penile, or rectal discharge it can cause.

Gonorrhea is highly contagious and is the second most commonly reported notifiable disease in the United States.

 You can get it by having unprotected vaginal, anal, or oral sex with someone who has it. It can spread even if a man doesn’t ejaculate during sex.

Signs and Symptoms of Gonorrhea

In women, gonorrhea often doesn’t cause symptoms. If a woman does experience symptoms, they are typically mild and can be mistaken for a bladder or vaginal infection.

Symptoms in women may include:

Men with gonorrhea also often don’t have any symptoms. If symptoms are present, they can include the following:

  • Pain and burning while urinating
  • Urinating more often than usual
  • White, yellow, or green discharge from the penis
  • Red or swollen urethral opening
  • Sore throat
  • Painful and/or swollen testicles

Both men and women may also experience eye discharge or sensitivity.

Rectal gonorrhea can cause anal discharge, itching, pain, bleeding, as well as painful bowel movements in men and women.

Gonorrhea in the throat can cause a sore throat (pharyngitis) or swollen lymph nodes, but it usually doesn’t lead to any other symptoms.

 However, in rare cases, it can be passed on to other people through kissing or oral sex.
Both men and women can get gonorrhea in the mouth, urethra, eyes, and anus, and in women it can also infect the cervix, uterus, and fallopian tubes.

Both sexes also can have the infection and not know it, which is one reason that regular STD testing is a good idea if you have any risk factors (listed below) for acquiring a gonorrhea infection.

Untreated gonorrhea, even if it’s causing no symptoms, can lead to serious health problems and complications.

Causes and Risk Factors of Gonorrhea

The gonorrhea bacterium can infect the mucous membranes of the reproductive tract in men and women, as well as the membranes of the mouth, throat, eyes, and rectum.

There are several factors that can increase a person’s risk for getting gonorrhea:

  • Being a sexually active female under 25
  • Being a man who has sex with men
  • Having a new sex partner
  • Having multiple sex partners or having sex with someone who has multiple sex partners
  • Not using condoms consistently or correctly
  • Having a history of gonorrhea or another sexually transmitted disease

How Is Gonorrhea Diagnosed?

Gonorrhea is diagnosed using a lab test that requires either a urine sample or a swab taken from the urethra (for men) or the cervix or vagina (for women). If a person has had anal or oral sex, and a rectal or pharyngeal infection is suspected, a swab specimen may be collected from the throat or the rectum for testing.

The recommended method for gonorrhea testing is the nucleic acid amplification test, which detects the genetic material of Neisseria gonorrhoeae in the urine or swab sample provided. In a second type of lab test, called a culture, the sample is placed in a container to see whether gonorrhea bacteria grow over several days.

If you think you may have gonorrhea, make an appointment to see your healthcare provider. Healthcare providers at public health or STD clinics and Planned Parenthood also can perform gonorrhea tests.

In addition, at-home test kits are available for both men and women who wish to test themselves for gonorrhea. To perform the test, you will need to collect a urine sample or take a swab from an affected area. You then mail the sample to a specified lab, and a notification for a positive or negative result is usually sent via email or text message. However, this type of testing is not always reliable. This type of test is available from companies including LetsGetChecked.com, Nurx, and a number of websites listed by GoodRx, with prices starting around $80 for a testing kit.

Since a person may have gonorrhea without displaying symptoms, regular testing can help detect the disease before it causes complications. This is particularly important for people who are at increased risk of contracting the disease, including those who have a new sexual partner, more than one sex partner, a sex partner who has a sexually transmitted infection (STI), previous or coexisting sexual infections, or those who are using condoms inconsistently outside a monogamous relationship.

The following groups of people get tested for gonorrhea regularly:

  • Sexually active women under 25 should be tested once yearly.
  • Sexually active women over 25 who are otherwise at increased risk should be tested once yearly.
  • All pregnant women under 25 should be tested early in their pregnancy, as should pregnant women over 25 if they are otherwise at increased risk.
  • Men who have sex with men should be tested at least once yearly, regardless of condom use.
  • Men who have sex with men and are otherwise at increased risk should get tested every three to six months.
  • People living with HIV should be tested for gonorrhea at their first HIV evaluation and subsequently at least once yearly.
  • People with HIV who are otherwise at increased risk for gonorrhea should be screened more than once yearly (depending on individual risk behaviors and the local epidemiology).

Prognosis of Gonorrhea

When gonorrhea is diagnosed and treated in a timely way, people usually make a complete recovery. In some cases where treatment is delayed and pelvic inflammatory disease develops, it can cause infertility, scarred fallopian tubes (which increase the risk of tubal pregnancy in women), ectopic pregnancy (whereby pregnancy occurs outside the womb), and chronic abdominal pain.

Duration of Gonorrhea

Gonorrhea gets better very quickly with antibiotic therapy — usually within a few days. However, if your symptoms persist for longer than a few days after you are treated, contact your healthcare provider.

If untreated, gonorrhea can cause serious health issues, including some that could last throughout a person’s lifetime.

People with gonorrhea who are cured of it once with antibiotics can still get the infection again.

Treatment and Medication Options for Gonorrhea

Over the years, gonorrhea has become resistant to almost all of the classes of antibiotics once used to treat it. Successful treatment now relies on the one remaining class of antibiotics — cephalosporins — that’s effective against it.

Medication Options

As of December 2020, the Centers for Disease Control and Prevention (CDC) recommends a single intramuscular dose of the antibiotic ceftriaxone (Rocephin) for uncomplicated gonorrhea. Treatment for coinfection with Chlamydia trachomatis with oral doxycycline (Vibramycin) should be administered when chlamydial infection has not been excluded.

Be sure to tell those with whom you have sex that you are being treated for gonorrhea so they can be treated, too. This will help you avoid passing it back and forth to each other.

You should not have sex for seven days after treatment, and you should refrain from having sex with partners who have not been treated for gonorrhea until after they have been tested and, if necessary, treated.

Alternative and Complementary Therapies

Gonorrhea is curable with antibiotics, provided the medications are taken as prescribed; there aren’t any alternative therapies that have been proven to cure the disease.

There does appear to be potential for the mouthwash Listerine to help with gonorrhea control. In one small study, researchers instructed men with pharyngeal gonorrhea (gonorrhea of the throat) to gargle with Listerine for one minute.

 A control group of men gargled with a saline solution. Five minutes after gargling, the men received pharyngeal swabs to see what effect, if any, the Listerine had had on the amount of N. gonorrhoeae bacteria in their throats. The researchers found that men who’d gargled with Listerine were significantly less likely to have positive tests than the men who’d gargled with saline. Even so, all the men in the study were then treated with antibiotics to cure their gonorrhea.

While the Listerine study raises intriguing possibilities, it does not prove that Listerine cures gonorrhea. People who test positive for gonorrhea should still be treated with antibiotics. In addition, Listerine is not intended to be used in body cavities other than the mouth.

Prevention of Gonorrhea

The only way to keep yourself absolutely safe from catching gonorrhea is to avoid having vaginal, anal, or oral sex. However, since many people wish to have sex at some point in their lives, that may be unrealistic.

But there are ways you can lower your risk of getting the disease while still being sexually active, such as the following:

  • Using a condom during vaginal or anal sex
  • Using a condom (for men) or a dental dam (for women) during oral sex
  • Thoroughly washing sex toys — or changing the condom on them — before a new person uses them
  • Not having sex with anyone until you’ve finished your treatment (if you are currently being treated for gonorrhea)

Also, having sex with fewer partners can help reduce your chances of getting gonorrhea.

Preventing Gonorrhea in Infants

Gonorrhea in a pregnant woman can increase the risk for miscarriage or premature birth.

A pregnant woman with gonorrhea can also pass it to her baby during childbirth, which can cause a severe eye infection possibly leading to blindness, a joint infection, or a deadly blood infection in her infant.

For these reasons, it’s recommended that women get screened for gonorrhea at their first prenatal visit, so they can be treated as soon as possible if they have it.

If gonorrhea is detected in an infant after birth, it’s treatable with ceftriaxone.

Complications of Gonorrhea

Women with untreated gonorrhea are at risk for pelvic inflammatory disease (PID), which may cause no symptoms or may cause pain in the pelvis, lower abdomen, or lower back. If left untreated, PID can lead to:

  • Chronic pelvic pain
  • Infertility
  • Ectopic pregnancy, in which the fertilized egg implants outside the uterus, possibly leading to internal bleeding or a ruptured fallopian tube
Complications of gonorrhea in men may include epididymitis, an inflammation of the epididymis, a long coiled tube at the back of the testicles that stores sperm and carries it between the testicles and the vas deferens, which conveys it to the urethra. Epididymitis can cause testicular or scrotal pain, and, if left untreated, infertility.

Disseminated Gonococcal Infection

Gonorrhea can also spread throughout the body, in a condition called systemic, or disseminated, gonococcal infection (DGI).

Symptoms of DGI commonly include joint or tendon pain, a skin rash, and fever. More advanced stages of DGI cause septic, or infectious, arthritis, in which the bacteria directly invade the joint space.

If gonorrhea spreads to the joints, it can cause a type of arthritis known as gonococcal arthritis, which is typically experienced in the knees, wrists, or ankles. Gonococcal arthritis is treatable with antibiotics.

Research and Statistics: How Many People Have Gonorrhea?

The number of reported cases of gonorrhea can depend on many factors that go beyond the actual occurrence of the infection, including things like differences in screening practices in different locations or the use of different kinds of tests. Nonetheless, reported cases can be a useful way to track the disease and identify areas where the infection is on the rise or in decline.

In 2018, there were a total of 583,405 cases of gonorrhea, an increase of about 5 percent over the number reported in 2017.

At that time, over 90 percent of reported gonorrhea cases were in people between the ages of 15 and 44, with the highest percentage in the 20- to 24-year-old age group for both men and women.

Black and Hispanic Americans and Gonorrhea

Disparities exist in the rates of STDs among white Americans and racial minority groups. There are several factors that could be contributing to these disparities, including unequal access to healthcare, and specifically to sexual health services.

In 2018, the rate of reported cases of gonorrhea in Black Americans was 7.7 times the rate among white Americans.

 Past research has suggested that racial disparities in household income are associated with racial disparities in gonorrhea rates, although why that is remains unknown.

In Hispanic Americans, the rate of gonorrhea was 1.6 times higher than in white Americans in 2018.

 Lack of insurance may prove an obstacle to care for STDs; Hispanic Americans had the lowest rate of health insurance coverage in the United States in 2017.

Related Conditions

Gonorrhea is one of many diseases transmitted through sexual contact, and it shares symptoms with certain other infections of the bladder, vagina, and penis.

 Tests for gonorrhea administered by your healthcare provider can help to rule out other potential infections.

Chlamydia Causes Similar Symptoms

While gonorrhea and chlamydia are both sexually transmitted bacterial infections, they are caused by different bacteria. Still, the two diseases have many similarities: They each can affect reproductive organs in men and women, as well as the urethra, throat, and rectum. Also, both infections are spread the same way, have symptoms that resemble each other, and are treated with antibiotics.

 Using condoms correctly each time you have sex can help to prevent both gonorrhea and chlamydia.

HIV Risk Rises With Untreated Gonorrhea

If gonorrhea goes untreated, it may increase a person’s chances of getting or transmitting HIV, the virus that causes AIDS.

 Treating gonorrhea helps reduce that risk and protect your overall health, but by itself will not prevent a person from contracting HIV. Practicing safer sex and limiting your number of sexual partners can help reduce the risk of contracting HIV.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Gonorrhea — CDC Detailed Fact Sheet. Centers for Disease Control and Prevention.
  2. 2018 STD Surveillance Report. Centers for Disease Control and Prevention.
  3. What Are the Symptoms of Gonorrhea? Planned Parenthood.
  4. Gonorrhea: Symptoms and Causes. Mayo Clinic.
  5. Gonorrhea Test. Testing.com.
  6. Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources. Centers for Disease Control and Prevention.
  7. Gonorrhea — CDC Basic Fact Sheet. Centers for Disease Control and Prevention.
  8. Gonorrhea: Diagnosis and Treatment. Mayo Clinic.
  9. Drug-Resistant Gonorrhea. Centers for Disease Control and Prevention.
  10. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. Centers for Disease Control and Prevention.
  11. Antiseptic Mouthwash Against Pharyngeal Neisseria Gonorrhoeae: A Randomised Controlled Trial and an In Vitro Study. Sexually Transmitted Infections.
  12. How Do I Prevent Gonorrhea? Planned Parenthood.
  13. Gonorrhea in Pregnancy. American Pregnancy Association.
  14. Gonococcal Infections Among Adolescents and Adults. Centers for Disease Control and Prevention.
  15. Gonorrhea. Merck Manual.
  16. What Is Gonococcal Arthritis? These Are the Signs You Could Have It. CreakyJoints.
  17. STD Health Equity. Centers for Disease Control and Prevention.
  18. The Association Between Racial Disparity in Income and Reported Sexually Transmitted Infections. American Journal of Public Health.
  19. Chlamydia and Gonorrhea. American College of Nurse-Midwives.
  20. STDs and HIV — CDC Basic Fact Sheet. Centers for Disease Control and Prevention.

Resources

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Natalia Johnsen, MD

Medical Reviewer

Natalia Johnsen, MD, practices internal medicine and lifestyle medicine. She works as an internist for the Vancouver Clinic in Vancouver, Washington.

Johnsen trained and worked as ob-gyn in Russia before coming to the United States in 2000. Subsequently, she interned in internal medicine at the University of Nevada and completed her residency at a Stanford-affiliated program in Santa Clara, California. After that she worked as a general internist for two years before to switching to full-time hospital work.

Johnsen has always been fascinated by the effects that lifestyle can have on physical and mental health, and she fell in love with the concept of lifestyle medicine as a specialty after seeing patients struggle with issues that could have been prevented had they known more about a healthy lifestyle. To make an impact on her patients through lifestyle interventions, she launched her own lifestyle medicine clinic, Vivalso Health and Longevity.

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Joseph Bennington-Castro

Author

Joseph Bennington-Castro is a science writer based in Hawaii. He has written well over a thousand articles for the general public on a wide range topics, including health, astronomy, archaeology, renewable energy, biomaterials, conservation, history, animal behavior, artificial intelligence, and many others.

In addition to writing for Everyday Health, Bennington-Castro has also written for publications such as Scientific American, National Geographic online, USA Today, Materials Research Society, Wired UK, Men's Journal, Live Science, Space.com, NBC News Mach, NOAA Fisheries, io9.com, and Discover.

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