What you need to know about gonorrhoea

Gonorrhoea is one of the most common sexually transmitted infections (STIs) in the UK. It is caused by infection with bacteria called Neisseria gonorrhoeae, and while it often affects the genitals, it can affect other areas of your body too. 

As gonorrhoea does not always cause symptoms, it is important to get tested if you’re concerned that you may be infected.  

Here, we will explore how gonorrhoea is spread and the symptoms it can cause, as well as what diagnosis, treatment and prevention involve. 

Gonorrhoea vs chlamydia

Before exploring gonorrhoea, it is worth noting that gonorrhoea is not the same as chlamydia. Both are STIs and often produce no symptoms but they are caused by different bacteria. 

Chlamydia is caused by the bacteria Chlamydia trachomatis and is the most common STI in the UK. Unlike gonorrhoea, the discharge caused by chlamydia tends to have a strong, foul smell. 

Symptoms of gonorrhoea

Gonorrhoea often causes no symptoms. When symptoms do occur, they usually develop within two weeks of infection, although it is possible to develop symptoms several months later. 

Your symptoms will depend on which part of your body is infected with the bacteria. Gonorrhoea can affect your genitals, as well as any part of your body that comes into contact with infected semen or vaginal discharge, such as your eyes, mouth, throat and back passage (rectum). 

Genital gonorrhoea symptoms

Genital gonorrhoea in women can cause a painful and/or burning sensation when urinating, lower abdominal pain, especially after sexual intercourse, and white, yellow or green vaginal discharge. In rare cases, women may experience bleeding between periods or after sex. 

Genital gonorrhoea in men can also cause a painful and/or burning sensation when urinating, as well as white, yellow or green discharge from the penis, and sore, swollen testicles. 

Gonorrhoea symptoms in other parts of the body

If your eyes become infected with gonorrhoea, they can become red, itchy, sore and sensitive to light; you may also notice a white, yellow or green discharge.

If your rectum becomes infected, you may notice a white, yellow or green anal discharge, itchiness around your anus and anal pain. 

If your throat becomes infected, it can become sore, itchy and dry. The glands in your throat may swell and you may find it harder to swallow comfortably. 

How gonorrhoea is spread

Gonorrhoea is spread through sexual activity. This includes oral, anal and vaginal sex as well as contact with vaginal discharge and semen, such as through the use of sex toys or close genital contact without penetration. 

There is growing evidence that oral gonorrhoea can be spread through kissing using the tongue; however, it is unknown how common this form of transmission is. 

Gonorrhea cannot be spread by sharing cooking or dining utensils or food, using the same toilet, coughing or sneezing.

Your risk of becoming infected with gonorrhoea is higher if you do not use barrier protection (eg condoms and/or dental dams) during sex, have previously had an STI and/or have a sexual partner(s) who has not recently tested negative for gonorrhoea. 

As gonorrhoea does not always cause symptoms, it is important to have regular sexual health testing if you are having unprotected sex and/or sex with multiple partners. 

Getting a diagnosis

If you’re concerned that you may have gonorrhoea, you can get tested at your local genitourinary medicine (GUM) clinic or you can use a self-test kit. Self-test kits are available at GUM clinics and certain pharmacies.

If you visit a GUM clinic and you have symptoms, you will be asked about your symptoms and sexual partners, and the affected area (eg your genitals) may be examined. Next, you will be given a cotton swab to collect a sample of fluid from the affected area or a nurse will do this for you. 

You may also need to provide a urine sample. These samples will be sent to a lab for testing. 

If you do not have any symptoms, samples can still be collected for testing. 

A self-test kit works in the same way as in-person testing at a GUM clinic ie you will need to swab the fluid from the affected area and/or provide a urine sample. You will then need to send these samples in the post to a lab for testing. 

It will take several days for your results to come back. 

When to contact sexual partners

Left untreated, gonorrhoea can spread and cause serious and sometimes long-term health problems. 

It can spread to the joints, causing gonococcal arthritis, and to the liver, causing liver inflammation. In rare cases, it can spread to the heart valves, causing gonococcal endocarditis, or brain, causing gonococcal meningitis, both of which are life-threatening. 

In women, gonorrhoea can also spread to the uterus and fallopian tubes, leading to pelvic inflammatory disease (PID). PID can, in turn, cause scarring of the fallopian tubes and ultimately infertility or ectopic pregnancy. 

In men, gonorrhoea can spread to the prostate and testicles, causing inflammation and pain. It can also spread to the urethra (the tube through which urine leaves the body), causing scarring that narrows the urethra and makes it difficult to urinate. 

If gonorrhoea spreads to the tube that sits behind each testicle (epididymis), which carries, stores and helps mature sperm, it can cause epididymitis, which can lead to permanent tissue damage and infertility.

Gonorrhoea treatment

Gonorrhoea will not get better on its own. Even if your symptoms ease, without treatment, your symptoms will return and you will continue to risk infecting others if you engage in sexual activity. 

Given the serious health consequences of not treating gonorrhoea, it is important to start treatment as soon as possible. If your symptoms suggest that you have gonorrhoea, your doctor can prescribe treatment before your test results come back. 

Treatment involves a single dose of antibiotics via injection or taken as tablets. Around one week after treatment, you will need to be tested again for gonorrhoea. Only once your test results come back negative can you engage in sexual activity again. 

Gonorrhoea and pregnancy

If you have gonorrhoea while pregnant, there is a greater risk of premature labour and your baby having a low birth weight; the latter is linked to several poor health outcomes for the baby. 

If you have a vaginal delivery, there is also the risk that your baby will become infected. It can infect your baby’s eyes, causing gonococcal conjunctivitis, which needs treatment with antibiotics to prevent blindness. 

Given the risks, if you are pregnant and have gonorrhoea, it is important to seek treatment and inform your GP and/or midwife. You can be successfully treated with antibiotics for gonorrhoea while pregnant. 

How to prevent gonorrhoea

To reduce your risk of becoming infected with gonorrhoea, make sure you always use barrier contraception during anal, oral or vaginal sex, and clean any sex toys with hot, soapy water. 

Avoid having sex with anyone who has symptoms of gonorrhoea and make sure you have honest conversations with your sexual partners about their sexual health, including whether or not they have recently been tested for gonorrhoea. 

As gonorrhoea can sometimes produce no symptoms, it is important to be regularly tested if you have multiple sexual partners and/or have unprotected sex.