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A paired spherical bacterium with hairs (pili) on the surface

Illustrations by Marta Pucci

Reading time: 7 min

Gonorrhea 101

Top things to know:

  • Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae
  • Gonorrhea is often asymptomatic, meaning that many people don’t know they have it
  • Untreated, it can lead to pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, and/or infertility in women and people with female reproductive tracts
  • Gonorrhea infections must be treated with two antibiotic medications

What is gonorrhea?

Gonorrhea infections are caused by the bacteria Neisseria gonorrhoeae and are spread through sexual contact (1). A person can contract a gonorrhea infection through mucous membranes (where your outer skin meets soft, moist, inner tissue) (2). These include the female reproductive tract, the anus, the inside of your eyelids, the urethra, and the throat (2).

What are the symptoms of gonorrhea?

Like chlamydia infections, gonorrhea can infect people of all genders. Gonorrhea is often asymptomatic in women and people with female reproductive tracts—this means that people often do not experience any discomfort or notice any changes once infected (3).

Without any symptoms, people may not suspect that they have an STI. Some may have very mild or vague symptoms, which can be confused with a urinary tract infection or vaginal infection (4). In women and people with female reproductive tracts, these symptoms can include increased [vaginal discharge]( "What is "normal" vaginal discharge?"), frequent painful urination, spotting/bleeding between periods or after vaginal intercourse; or pain, bleeding, or discharge in the rectum (4).

Infections of gonorrhea in the throat are also often asymptomatic, though some people may have a sore throat and enlarged tonsils (5).

How does one get gonorrhea?

Gonorrhea is spread through sexual contact with an infected partner. It can be spread through any type of unprotected sex, including penis in vagina sex, anal sex, and oral sex (2). A gonorrhea infection can develop in the genital tract, anus, and urethra for penis-in-vagina sex or anal sex. Having oral sex can spread a gonorrhea infection from the genitals to the throat.

A person can also be re-infected with gonorrhea after having been treated previously. People don’t become immune to gonorrhea after they’ve had it once (2).

What are the potential complications of gonorrhea?

A sexually transmitted infection of gonorrhea can cause an infection of the cervix, urethra, and fallopian tubes in people with female reproductive organs (4,6). Like an untreated chlamydia infection, an untreated gonorrhea infection can lead to the development of pelvic inflammatory disease (PID).

PID can result in irreversible and serious outcomes in women and people with female reproductive tracts, like ectopic pregnancy, infertility, or chronic pelvic pain (1,4). Gonorrhea bacteria travel up the reproductive tract from the vagina through the cervix to the uterus, ovaries, and fallopian tubes, causing inflammation and infection. Once inside, the bacteria damage the fallopian tubes, and can cause scarring (7). This can have long term effects including infertility, as scar tissue can block the fallopian tubes, preventing sperm from fertilizing an egg. Ectopic pregnancies (where a pregnancy implants outside of the uterus) are also more common, as a fertilized egg may get stuck in the damaged fallopian tube—which can be life threatening.

Chronic pelvic pain is also a possible long term consequence of untreated gonorrhea infections, and is a symptom of PID (8).

Another long term, though rare, consequence of an untreated gonorrhea infection is disseminated gonococcal infection (2,4). This is when a gonorrhea infection spreads to the blood and causes symptoms around the body including joint pain, inflamed tendons, and/or skin disorders, and can be fatal if left untreated (2,6).

In people with male reproductive organs, gonorrhea can cause an infection of the urethra and epididymis, the tube that collects and store sperm from the testicles (2).

How common is gonorrhea?

In 2016 in the United States, gonorrhea was the second most common sexually transmitted infection reported to the Centers for Disease Control (CDC) (1). In that year, almost half a million (468,524) cases of gonorrhea were reported in the US. Like chlamydia, syphilis, and many other STIs, rates of gonorrhea within the US are continuing to rise, especially within the last couple of years (1).

Reported rates of gonorrhea within the US are higher among men than women. These differences in rates are likely to do higher rates of gonorrhea among men who have sex with men (MSM) (1). Among women, younger women reported higher rates of gonorrhea infection compared to older women, with 19-year-olds having the highest rate of gonorrhea infection (1).

It is difficult to estimate the burden of gonorrhea infections across the entire world, since many regions may not have the healthcare services capable to diagnose and report cases of gonorrhea and other STIs. The World Health Organization (WHO) estimates that the total number of cases per year across the world in 2008 was 106.1 million gonorrhea infections (9). This estimate is almost 20 million incidences higher than the WHO’s 2005 estimate, which they suspect could be due to many social and health factors surrounding the spreading of STIs, including an increased number of youths becoming part of the sexually active population (9). More access to healthcare, STI reporting, and research is needed.

How can I prevent contracting gonorrhea?

Being sexually active puts you at risk for contracting an STI. Using condoms every time you have sex can greatly reduce the risk of contracting gonorrhea (and many other STIs). Condoms should be used not just during ejaculation, but before any genital or sexual contact starts. If you are having oral-vaginal sex, use a dental dam to stay protected.

Ask a partner whether they’ve been tested recently for STIs before starting sexual contact. If a partner has sex with multiple people, ask about their other partners STI status and encourage them to also get tested. Limiting the number of sexual partners you are exposed to will also decrease your risk of contracting gonorrhea.

For people with female reproductive organs, a yearly gynecologic visit is recommended, even for those in a monogamous long-term relationship. Yearly gonorrhea screenings are recommended for sexually active women who are 25 years old and under, and also for anyone who is at increased risk for acquiring a gonorrhea infection (people who’ve had sex with a new partner, who have sex with multiple partners, or have had sex with a partner who with and STI) (3). The screening can easily be performed with a cervical swab as part of a pelvic exam (4). To detect gonorrhea infections of the throat or anus, a swab can also be performed at the infected area.

Speak to your healthcare provider to discuss if screening for gonorrhea and other STIs is right for you.

How is gonorrhea treated?

Gonorrhea can be treated with antibiotics to kill the bacteria. A person will need two separate antibiotic medications to eliminate a gonorrhea infection (3,4). The reason for needing two antibiotics is due to the increasing problem of antimicrobial resistance among gonorrhea infections (3).

After getting a diagnosis, it is recommended that any partner that you have had sexual contact with in the last 60 days, and/or your last sexual partner, be tested (3).

It is possible to transmit gonorrhea even while being treated with antibiotics. Stay away from sexual contact until seven days after completion of the full course of antibiotic medication—even if symptoms have already gone away. Three months after treatment, you should get re-tested for gonorrhea (3).

Special cases/additional information: conjunctivitis and HIV

Gonorrhea, like chlamydia, can also be transmitted from mother to child during the delivery. Babies born to mothers with untreated gonorrhea infections may develop a gonorrheal conjunctivitis (infection in the eye), though this is not very common (1). For this reason, gonorrhea testing should be routine during pregnancy.

Having an STI, like gonorrhea, can also increase your chances of contracting HIV if you are exposed to it, or spreading HIV if you are already infected (10,11). If you think you have gonorrhea, or any STI, it is important for you to seek help immediately from your healthcare provider or an STI clinic. Many clinics provide free or low-cost STI testing. This will all help keep you, your sexual partners, and your community healthy.

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