What is gonorrhea? Common signs and symptoms

Gonorrhea often has no symptoms, but it can cause health complications when left untreated. If you think you may have gonorrhea or want to learn more about sexually transmitted infections (STIs), this article will explain what gonorrhea is, cover how signs of infection can show up differently in different parts of the body, discuss treatment methods and provide information about reducing the risk of contracting and spreading gonorrhea.

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What is gonorrhea?

Gonorrhea is a treatable sexually transmitted infection (STI) caused by a strain of bacteria called Neisseria gonorrhoeae. While it mostly affects young people, anyone who engages in vaginal, anal or oral sex can get gonorrhea. The infection affects the genitals, rectum and throat and is the second most common STI in the United States. Gonorrhea has been around for hundreds of years, well before the development of antibiotics. Experts believe the increase in worldwide prevalence rates is due to a growing number of antibiotic-resistant cases.

Causes of gonorrhea

Neisseria gonorrhoeae bacteria can be spread through anal, oral or vaginal sex with a person who has a gonorrhea infection. In adults, infection most often occurs in the anus, cervix, throat or urethra.

Transfer can also occur through the use of penetrative sex toys without a condom or if toys are not cleaned between use. Gonorrhea can also be spread through direct contact with infected genital fluids. A person could develop an eye infection if they were to rub their eye after touching infected penile or vaginal fluid with their hand.

Gonorrhea can also be spread during childbirth. Newborn babies can become infected after exposure to the bacteria in the cervix of a pregnant person. First signs of illness usually show up within two to five days following birth.

What doesn’t cause gonorrhea

Not all forms of physical contact cause gonorrhea. People cannot get gonorrhea through hugging or holding hands. The bacteria cannot be transferred by sitting on toilet seats, exchanging towels or swimming in public pools. There is also no risk of infection through sharing eating utensils. Because gonorrhea is not airborne, sneezing does not cause infection.

Risk factors

“Most cases of gonorrhea are spread through sexual contact. This includes vaginal, anal and oral intercourse,” explains board-certified internal medicine physician Dr. Brennan Kruszewski.

Gonorrhea can be spread through sexual contact with people of the same sex or opposite sex. Condomless sex and having multiple sexual partners are also risk factors. People who have had STIs before may be at higher risk for gonorrhea. Cases are most often seen among young people, with individuals between the ages of 15 and 24 most affected.

Symptoms of gonorrhea

Symptoms of gonorrhea can vary based on the site of infection. Common genital symptoms include pain or a burning sensation with urination.

If the anus or rectum is infected, a person may experience itching, discharge or pain when passing stool. A gonorrhea infection in the eyes may produce symptoms of discharge, itching, light sensitivity (also known as photophobia) or pain. People who develop the infection in the throat may experience a sore throat or swelling in the neck glands. If gonorrhea spreads to the joints, the area may become red, painful, swollen or warm to the touch. In many cases, people develop no symptoms whatsoever.

Symptoms in men

In men or people assigned male at birth (AMAB), gonorrhea often affects the urethra. While some patients may be asymptomatic, common signs of genital infection include the following:

• Pain or burning during urination (dysuria).
• Pain or swelling in the testes. This symptom tends to be less common.
• Penile discharge (green, white or yellow). Discharge may be minimal and mucus-like or heavier and pus-like.
• Redness or swelling at the tip of the penis.

Symptoms in women

For women or people assigned female at birth (AFAB), gonorrhea usually causes no symptoms. Research shows that less than 50 percent of women with gonorrhea report symptoms.

Infection commonly occurs in the cervix, and if signs do develop, they are often similar to a bladder infection or urinary tract infection (UTI). Patients with symptoms may experience the following:

• Greater amounts of vaginal discharge than normal
• Pain in the pelvic or abdominal region
• Pain or burning when urinating (dysuria)
• Spotting between periods
• Unusual vaginal discharge

When symptoms appear

Gonorrhea has an incubation period of approximately 1 to 14 days, so it may take this amount of time before a person starts experiencing symptoms. In some cases, it may be months before signs of gonorrhea develop.

Complications

Gonorrhea does not resolve on its own. If left untreated, the infection can lead to serious complications in people of any gender.

For women and people AFAB, this can include pelvic inflammatory disease, an increased risk of ectopic pregnancy, and long-term pelvic and abdominal pain. Men and people AMAB may develop prostatitis or epididymitis, a condition that causes pain and inflammation in the tube behind the testicle that stores and carries sperm.

Untreated gonorrhea may also cause infertility and disseminated gonococcal infection, and it may make a person of any gender more susceptible to HIV. Newborns who are exposed to gonorrhea during childbirth may develop an eye infection that increases the risk of blindness.

Disseminated gonococcal infection (DGI)

In severe cases, untreated gonorrhea can develop into disseminated gonococcal infection (DGI). This occurs when the infection has traveled through the bloodstream to other parts of the body.

DGI can lead to fever, heart valve inflammation, joint infection, rash, meningitis and more. The condition is rare, with one study showing that between 2015 and 2019, rates of DGI among residents of California and Georgia were 0.13 per every 100,000 people. While uncommon, the spread of bacterial infection can be life threatening.

Infertility

In about 15 percent of women diagnosed with PID, the condition progresses into tubal factor infertility (TFI). This occurs when pathogens like Neisseria gonorrhoeae bacteria damage the cells of the fallopian tubes.

This hinders the fallopian tubes’ ability to transport the ovum for fertilization within the tubes and implantation in the uterus. In rare cases, gonorrhea may also cause infertility in men if infection develops in the testicles and prostate.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) occurs when an infection causes the upper genital tract to become inflamed. The condition affects women and people with uteruses. Reproductive organs, such as the fallopian tubes, ovaries and uterus, can become infected.

In 85% of cases, PID is caused by sexually transmitted bacteria. Of the offending agents, gonorrhea or chlamydia are the most common pathogens.

Gonorrhea infection can produce more severe cases of PID. People with the condition may develop adhesions, fallopian tube obstruction, persistent pelvic pain and scarring. PID can also increase the risk of infertility and ectopic pregnancy, in which a fertilized egg implants and grows outside the main cavity of the uterus.

Diagnosis and tests

People can discuss with a health care provider if testing for STIs would be recommended for them based on their personal medical history and risk factors. It is recommended that sexually active women, including pregnant persons, screen for gonorrhea if they are 24 years or younger or are 25 years or older and at an increased risk for infection.

Treatment and management

Gonorrhea can currently be treated with antibiotics. However, some strains of the bacteria that cause gonorrhea have grown resistant to antibiotic treatment. Here’s what you need to know about completing antibiotic treatment for gonorrhea, and how experts are managing drug resistance.

Antibiotics

Gonorrhea is typically treated with oral antibiotics. These medications prevent the infection from spreading and reduce the risk of complications. While antibiotics can treat gonorrhea, they cannot treat permanent damage done from the infection.

Patients will need to finish all medication as directed, and it should not be given to anyone other than the person it is prescribed to. Patients are advised to speak with their health care provider about when they can return to having sex and when they should be tested again. It is possible to contract gonorrhea more than once. Seek medical care if symptoms do not resolve after treatment.

Management of antibiotic-resistant gonorrhea

Some strains of gonorrhea are antibiotic resistant. The most resistant strains are sometimes referred to as “super gonorrhea.” This means that traditional drug treatment methods are no longer able to effectively treat the bacteria. The current class of antibiotics used to treat gonorrhea in the United States remains an effective treatment method.

The U.S. Centers for Disease Control and Prevention (CDC) actively monitors for the development of drug-resistant gonorrhea throughout the country. In addition to enhanced worldwide surveillance and continued research, controlling the spread of gonorrhea is one way to manage antibiotic resistance.

Prevention

The only way to completely avoid STIs is to not have anal, oral or vaginal sex. Having sex with a latex condom can help prevent the spread of infection. Some prescription medications may also help prevent gonorrhea or other STIs. Regular sexually transmitted disease (STD) and STI testing can help detect gonorrhea and other common sexually transmitted infections as early as possible.

At-home test kits for gonorrhea

Testing is an important tool in the prevention and treatment of STIs. Research shows that social stigma around STIs can impact a person’s decision to seek testing services. Home STI and STD testing kits have been shown to increase testing rates among individuals who are considered higher risk and people who face barriers to health care access.

Some types of gonorrhea tests can be done with an at-home STD test kit. If you have questions or concerns about STD and STI testing, speak to a health care provider about whether at-home testing may be an alternate option.

Frequently asked questions

What is gonorrhea caused by?

Gonorrhea is a common STI that is caused by the spread of Neisseria gonorrhoeae bacteria through sexual contact. The infection can develop in the genitals, rectum and throat.

Is gonorrhea curable?

Gonorrhea is currently treatable with antibiotic treatment. These medications cannot cure permanent damage to other parts of the body due to infection.

How is gonorrhea transmitted?

Gonorrhea is transmitted through anal, oral and vaginal sex with a person who has a gonorrhea infection. The STI can also be spread through direct contact with genital fluids and childbirth. Using sex toys without a condom or sex toys that have not been cleaned between uses can also increase the risk of contracting gonorrhea.

What is ‘super gonorrhea’?

“Super gonorrhea” is a term for gonorrhea bacteria that have evolved to be highly resistant to multiple treatment drugs. This includes antibiotics like azithromycin, penicillin and more.

What are the signs of gonorrhea?

Many people do not experience any signs of gonorrhea. In symptomatic cases, signs may be different depending on where in the body the infection develops.

Symptoms of genital infection may include burning sensations during urination or discharge from the vagina or penis. Women or people with vaginas may also experience vaginal bleeding between periods or pelvic or abdominal pain. In rare cases, men or people AMAB may experience swelling and discomfort in the testicles.

Signs of rectal infection may include bleeding, itching, soreness, or pain during bowel movements. A sore throat and neck gland swelling are associated with throat infections., discharge, itching, light sensitivity or pain can be signs of an eye infection.

Can someone get gonorrhea with a condom?

Condomless sex can increase the risk of gonorrhea. Using a latex condom during sex or when using sex toys can significantly lower the risk of infection. Not engaging in anal, oral or vaginal sex is the most effective way to prevent gonorrhea. 

What is the difference between gonorrhea and chlamydia?

Gonorrhea and chlamydia are the two most commonly reported STIs around the world. The majority of cases are asymptomatic.

People who have gonorrhea or chlamydia may experience similar symptoms. This includes inflammation of the outer cervix, rectum, testes or urethra.

Gonorrhea and chlamydia are caused by two different types of bacteria. Symptoms of gonorrhea usually appear within 1 to 14 days. Symptoms of chlamydia can take anywhere from 7 to 21 days to develop.

Can someone get gonorrhea from kissing? 

Gonorrhea is an infection transferred primarily through anal, oral or vaginal sex. Some research indicates that kissing may increase the risk of gonorrhea infections of the throat. More research is still needed regarding kissing and gonorrhea.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.