Topic Resources
Gonorrhea is usually spread through sexual contact.
People usually have a discharge from the penis or vagina and may need to urinate more frequently and urgently.
Culture or tests of the bacteria's genetic material using a sample of urine or of discharge from the genitals, rectum, or throat can detect the infection.
Antibiotics can cure the infection, but resistance to the antibiotics used to treat gonorrhea is becoming more common.
Using condoms during sex can help prevent passing gonorrhea and other sexually transmitted infections (STIs) from one person to another.
(See also Overview of Sexually Transmitted Infections.)
Gonorrhea is a very common sexually transmitted infection (STI). The Centers for Disease Control and Prevention (CDC) estimates that more than 1.5 million new infections occur in the United States each year.
Gonorrhea is almost always spread through vaginal, oral, or anal sexual contact. After one episode of vaginal intercourse without a condom, the chance of spread from an infected woman to a man is about 22%. The chance of spread from an infected man to a woman and from a man to a man may be higher.
If a pregnant person is infected, the bacteria can spread to the eyes of the newborn during labor and delivery, causing conjunctivitis in the newborn.
Children who have been sexually abused may become infected with gonorrhea.
People with gonorrhea are at increased risk of other STIs, such as chlamydia, syphilis, and human immunodeficiency virus (HIV) infection.
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Symptoms of Gonorrhea
Usually, gonorrhea causes symptoms only at the sites of initial infection, most commonly the cervix, penis, urethra, or throat. In a few people, infection spreads through the bloodstream to other parts of the body, especially to the skin, joints, or both.
The majority of infected men have no symptoms. They begin within 2 to 14 days after infection. Men feel mild discomfort in the urethra (the tube that runs through the penis and drains urine from the bladder out of the body). This discomfort is followed a short time later by mild to severe pain when urinating, a yellow-green discharge of pus from the penis, and a frequent urge to urinate. The opening at the tip of the penis may become red and swollen. The bacteria sometimes spread to the epididymis (the coiled tube on top of each testis), causing the scrotum to swell and feel painful and tender to the touch on one side.
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
Most infected women have no symptoms. Thus, gonorrhea may be detected only during routine screening or after diagnosis of the infection in a sex partner. Symptoms typically begin 10 days after infection. Symptoms may include mild discomfort in the genital area, a yellow or green vaginal discharge, and pain during sexual intercourse. When the urethra (the tube that drains urine from the bladder out of the body) is also infected, additional symptoms may include pain during urination or a frequent urge to urinate.
The infection may spread up the reproductive tract and infect the uterus, the tubes that connect the ovaries to the uterus (fallopian tubes), and sometimes the area around the ovaries. In some women, the infection spreads to the lining of the pelvis and abdominal cavity (peritoneum), causing peritonitis. These complications together are called pelvic inflammatory disease (PID) and cause severe lower abdominal pain and sometimes fever. Sometimes infection is concentrated in the area around the liver, in the upper right part of the abdomen, causing pain, fever, and vomiting (called Fitz-Hugh-Curtis syndrome).
Gonorrhea of the rectum (gonococcal proctitis) may develop after unprotected anal sex with an infected partner. This infection usually causes no symptoms, but it may cause constipation, itching, bleeding, and a cloudy discharge from the rectum. The area around the anus may become red and raw, and stool may be coated with mucus and pus. A doctor may examine the rectum with a viewing tube (anoscope) to look for mucus and pus on the wall of the rectum.
Gonorrhea of the throat (gonococcal pharyngitis) may develop after unprotected oral sex with an infected partner. Usually, this infection causes no symptoms, but the throat may be sore.
Gonorrhea of the eyes (gonococcal conjunctivitis) may develop if infected fluids come into contact with the eyes. This infection causes swelling of the eyelids and a discharge of pus from the eyes. In adults, often only one eye is infected. In newborns, usually both eyes are infected (see Conjunctivitis in the Newborn). Blindness may result if the infection is not treated early.
Disseminated gonococcal infection (also called arthritis-dermatitis syndrome, or gonorrhea of the skin and joints) is a rare complication of gonorrhea. It occurs when the infection spreads through the bloodstream to other parts of the body, especially the skin and joints. People typically have a fever and generally feel ill. Joints become painful, swollen, and tender (arthritis). The skin over infected joints may be red and warm. Small, red spots may appear on the skin (dermatitis), usually on the arms and legs. The spots are slightly painful and may be filled with pus. Rarely, the infection spreads to the heart or the nervous system and brain.
Image courtesy of Dr. S. E. Thompson and J. Pledger via the Public Health Image Library of the Centers for Disease Control and Prevention.
Gonococcal septic arthritis is a form of disseminated gonococcal infection that causes painful arthritis and an abnormal amount of fluid to accumulate within the affected joints. Usually, it affects 1 or 2 large joints, such as the knees, ankles, wrists, or elbows. Symptoms often begin suddenly. People usually have a fever, severe joint pain, and limited movement. The skin over the infected joints may be warm and red.
In children, gonorrhea is usually a sign of sexual abuse. In girls, the genital area (vulva) may be irritated, red, and swollen, and they may have a discharge from the vagina. If the urethra is infected, children, mainly boys, may have pain when urinating.
Diagnosis of Gonorrhea
Usually, nucleic acid amplification testing (NAAT) of a sample of discharge from the cervix, vagina, penis, throat, or rectum or of a sample of urine
Sometimes culture of a sample from the urethra, cervix, rectum, or joint or of blood
To diagnose gonorrhea, doctors collect a sample of discharge and send it to a laboratory. NAATs are highly sensitive tests that can detect the unique genetic material, the DNA or RNA, of gonococci and of chlamydiae (which are often also present). Laboratories can test for both infections in a single sample. Because NAAT makes the organisms easier to detect, urine samples can be used. Thus, these NAATs are convenient for screening people who have no symptoms or who do not want to have samples taken from their genitals.
Sometimes, samples are sent for culture. A culture is the process where doctors try to grow a microorganism, such as bacteria, in a laboratory until there are enough to identify.
For men, doctors may be able to rapidly diagnose gonorrhea by examining samples of discharge from the penis and identifying the bacteria (gonococci) if they have access to a facility that has the appropriate equipment and trained personnel. If a discharge is obvious, doctors touch a swab or slide to the end of the penis to collect the sample. If there is no obvious discharge, doctors insert a small swab a half inch or more into the urethra to collect a sample. Men are asked to refrain from urinating for at least 2 hours before the sample is collected.
For women, doctors do a physical examination of the pelvis. To test for gonorrhea, they usually take a sample from the cervix with a swab and do a culture or NAAT. Women who are not able to undergo a pelvic examination can provide a urine sample or use a swab to obtain a sample from their vagina themselves.
If doctors suspect infection of the throat or rectum, samples from those sites are tested with a culture or NAAT.
If people have sores on their skin, doctors take blood and samples from the urethra, cervix, and rectum and test them with a culture or NAAT.
If a joint is red and swollen, doctors draw fluid from the joint using a needle. Doctors send the fluid for culture and other tests (arthrocentesis).
Because people may have more than one STI, doctors may test samples of blood and genital fluids for other STIs, such as syphilis and human immunodeficiency virus (HIV) infection.
Screening for Gonorrhea
Certain people who have no symptoms are screened for gonorrhea because they are at increased risk of this infection.
If screening is recommended, it is done even if a person uses condoms consistently. NAAT is done using urine for vaginal samples.
Women are screened annually if they are sexually active and under age 25 or if they are 25 years or older, sexually active, and have one or more of the following risk factors:
A previous STI
High-risk sexual activities (such as having many sex partners or multiple sex partners, using condoms inconsistently when not in a mutually monogamous relationship, or engaging in sex work)
Have a sex partner who has an STI or has other sex partners
Pregnant people who are under age 25 or who are 25 years or older with one or more risk factors are screened during their first prenatal visit and again during their third trimester if they are still at high risk. Pregnant people with gonorrhea that has been treated should be retested within 3 months.
Men who have sex with men are screened as follows:
If they are sexually active: At least once a year
If they are at increased risk (for example, those with HIV infection, multiple sex partners, or a partner who has multiple partners): Every 3 to 6 months
People who are transgender and gender diverse are screened if they are sexually active on the basis of sexual practices and anatomy. For example, all people with a cervix who are under age 25 are screened annually. If they are 25 years or older, people with a cervix should be screened annually if at increased risk. NAAT is done using a sample from the rectum in transgender and gender diverse people based on reported sexual behaviors and exposure.
Men who are not included in the categories above are not routinely screened, but screening is available if a person requests it and is often offered to all men who are in or have been to a place where the spread of gonorrhea is high (such as adolescent clinics, STI clinics, and correctional facilities).
Treatment of Gonorrhea
An antibiotic
Simultaneous testing and treatment of sex partners
Doctors usually give people with gonorrhea a single injection of the antibiotic ceftriaxone into a muscle. Pregnant people are treated with the same antibiotic. Alternative antibiotics are given to people who are allergic to Doctors usually give people with gonorrhea a single injection of the antibiotic ceftriaxone into a muscle. Pregnant people are treated with the same antibiotic. Alternative antibiotics are given to people who are allergic toceftriaxone.
If gonorrhea has spread to the skin, joints, or other parts of the body through the bloodstream, people are usually treated in the hospital and given antibiotics intravenously or by injection into a muscle. Accumulations of fluid are drained from the joints.
If symptoms return or do not go away after treatment, doctors may take samples for culture to determine whether people are cured and may do tests to determine whether the gonococci are resistant to the antibiotics used.
If doctors think people also have gonorrhea and chlamydia, chlamydia is treated at the same time, usually with the antibiotic ceftriaxone. Such treatment is needed because the symptoms of the two infections are similar and it is common to have both infections at the same time., chlamydia is treated at the same time, usually with the antibiotic ceftriaxone. Such treatment is needed because the symptoms of the two infections are similar and it is common to have both infections at the same time.
People with gonorrhea should abstain from sexual activity until treatment is completed to avoid infecting sex partners.
Sex partners
All sex partners who have had sexual contact with infected people in the past 60 days should be tested for gonorrhea and other STIs and, if the tests are positive, should be treated. If sex partners were exposed to gonorrhea within the past 2 weeks, they are treated for it without waiting for test results.
Expedited partner therapy is an option doctors sometimes use to make it easier for sex partners to be treated. This approach involves giving a person with an STI a prescription or medications to give to their sex partners. Thus, the sex partners are treated, even if they have not yet seen a doctor. Seeing a doctor is better because then the doctor can check for allergies to medications and for other STIs. However, if the sex partners are unlikely to see a doctor, expedited partner therapy is useful.
Prevention of Gonorrhea
People can do the following to help reduce their risk of gonorrhea, and other STIs:
Practice safer sex, including using a condom every time for oral, anal, or genital sex.
Reduce the number of sex partners and not have high-risk sex partners (people with many sex partners or who do not practice safer sex).
Practice mutual monogamy or abstinence.
Vaccinate (available for some STIs).
Seek prompt diagnosis and treatment to prevent spread to other people.
Identify sexual contacts if infected with an STI for the purposes of counseling and treatment.
More Information
The following English-language resource may be useful. Please note that The Manual is not responsible for the content of this resource.
Centers for Disease Control and Prevention (CDC): About Gonorrhea
Drugs Mentioned In This Article
