If you suspect that you have gonorrhoea, see a doctor even if symptoms go without treatment. An antibiotic usually clears the infection. Your sexual partner or partners should also be tested and treated, even if they have no symptoms. You should not have sex until you have finished treatment.
What is gonorrhoea?
Gonorrhoea is a sexually transmitted infection (STI) caused by a germ (bacterium) called the gonococcus.
How do you get gonorrhoea?
It is passed on if you have sex with an infected person. This can be due to vaginal, anal or oral sex. It can therefore be passed during sex between men and women or sex between men and men. In men, the infection usually affects the urethra (the tube between the bladder and the end of the penis) but can cause infection of the mouth or anus or both sexes. Vaginal liquid can be a source of infection so in theory it could be passed on during sex between women but this is very uncommon.
What are the symptoms of gonorrhoea?
Possible symptoms in women with gonorrhoea
- About 1 in 2 women develop an increase or change in vaginal discharge.
- About 1 in 4 women develop pain in the lower part of the stomach.
- Rarely, women may notice bleeding between periods, or heavy periods.
- Pain when passing urine can sometimes mimic a urine infection.
- Infection of the rectum or back of the throat (pharynx) can develop. Such infections do not usually cause symptoms, although occasionally rectal itching or a sore throat may be noticed.
Possible symptoms in men with gonorrhoea
Infection of the urethra (urethritis) is the typical infection in men. This commonly develops 5-7 days after having sex with an affected person. Symptoms include:
- Fluid (discharge) from the penis. This may stain underpants.
- Pain or burning when passing urine.
- Irritation inside the penis, or a feeling of wanting to pass urine frequently.
- Redness at the opening of the urethra at the end of the penis.
Gonorrhoea is believed to cause symptoms in most infected men (about 9 in 10 affected). However, about 1 in 2 women with gonorrhoea do not get any symptoms.
The symptoms may clear over time, even without treatment. This may take up to six months but can be just a couple of weeks or so. However, without treatment, some germs (bacteria) usually remain in the urethra. It is just that the symptoms may go.
Therefore, even if symptoms go or are not present, there is a good chance that you can pass on the infection if you do not have treatment.
Do I need tests?
You will normally be advised to have tests if gonorrhoea is suspected - even if symptoms go. You may be referred to a local genitourinary medicine (GUM) clinic for this. You can also go to the local GUM clinic without a referral from your GP. (See later for details.)
A urine sample and/or a sample (swab) of the discharge will be taken to try to identify the germ (bacterium) that causes gonorrhoea. In men, the swab will be taken from the urethra. In women, a swab is taken from high up in the vagina. Another swab is taken from the inside the neck of the womb (the endocervix) at the womb's entrance. You may also be advised to have tests for other sexually transmitted infections.
Are there any possible complications from gonorrhoea?
- Infection can spread to the womb (uterus) to cause pelvic inflammatory disease. This can cause long-standing (chronic) pelvic pain and can lead to infertility.
- Pregnancy can be complicated by premature labour, ectopic pregnancy or miscarriage.
- Infection present during pregnancy can lead to infection spreading to the eyes of a newborn baby. This is called ophthalmia neonatorum.
- Pelvic infection can spread to the liver.
- Abscesses can develop in the Bartholin's glands on either side of the lower part of the vaginal opening.
- In a small number of cases the infection travels up the urethra to the prostate. Rarely, a narrowing (stricture) of the urethra may develop.
- Spread in the bloodstream to other parts of the body is rare.
- Men who have sex with men can get infections of the back passage (anus) and throat.
What is the treatment for gonorrhoea?
The usual treatment is a single injection of an antibiotic medicine plus a single large dose of a different antibiotic taken by mouth. However, sometimes other treatment regimes and schedules are used. For example, if you have an allergy to the usual antibiotic, or if you have another infection at the same time.
Does my sexual partner need treatment?
Yes. They should be tested for infection, even if they have no symptoms. Treatment with antibiotics is usually advised for sexual partners, even if the tests are negative, because:
- Germs (bacteria) that cause gonorrhoea are often passed on during sex. Tests for bacteria are not foolproof. Treatment with antibiotics helps to make sure that any possible infection is cleared.
- If a sexual partner is infected and not treated, infection can be passed back to you.
- If you have gonorrhoea without symptoms then you may have had it for some time. In this situation any sexual partners within the previous three months should be tested and treated.
A doctor or healthcare professional will normally want to know that treatment has worked. It is usual to be reviewed soon after you finish treatment. This is to check that symptoms have gone and to do a test to check that the infection has gone. Sometimes further treatment (perhaps with a different antibiotic) is needed if the infection has persisted despite treatment.
You should not have sex until both you and your sexual partner have finished treatment. Note: this will normally be for at least seven days after treatment has commenced. Even if the treatment is the usual one-dose schedule of two antibiotics as described above, it takes several days for the infection to clear after taking the treatment.
Can gonorrhoea be prevented?
Wearing a condom during sex (including anal sex and oral sex) helps to prevent the spread of sexually transmitted infections.
The risk of sexually transmitted infections increases with the number of changes of sexual partner.
If you suspect that you have gonorrhoea or any other STI then contact your local GUM clinic or see your GP. You can go to the local GUM clinic without a referral from your GP. You can ring the local hospital or health authority and ask where the nearest clinic is, or find one on the FPA website (see below).
Further help & information
23-28 Penn Street, London, N1 5DL
4a Whitehorse Mews, Westminster Bridge Road, London, SE1 7QD
Further reading & references
- UK National Guideline on Gonorrhoea Testing; British Association for Sexual Health and HIV (2012)
- Management of gonorrhoea; British Association for Sexual Health and HIV (2011)
- Infection reports HIV-STIs, Sexually transmitted infections and chlamydia screening in England, 2013, Volume 8 Number 24; Public Health England, June 2014
- Public Health England 2013 press release: Efforts to tackle gonorrhoea treatment resistance may be working, but threatened by ongoing transmission; GOV.UK
- Walker CK, Sweet RL; Gonorrhea infection in women: prevalence, effects, screening, and management. Int J Womens Health. 2011;3:197-206. Epub 2011 Jul 19.
- Health Protection Report, Volume 5 Number 24; Health Protection Agency, June 2011
- Gonorrhoea; NICE CKS, November 2011 (UK access only)
- Cole MJ, Chisholm SA, Hoffmann S, et al; European surveillance of antimicrobial resistance in Neisseria gonorrhoeae. Sex Transm Infect. 2010 Nov;86(6):427-32.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Laurence Knott
Dr Helen Huins