Gonorrhoea

Gonorrhoea is a sexually transmitted infection (STI) caused by bacteria called Neisseria gonorrhoeae or gonococcus. It used to be known as 'the clap'.

The bacteria are found mainly in discharge from the penis and vaginal fluid from infected men and women. Gonorrhoea is easily passed between people through:

• unprotected vaginal, oral or anal sex, and
• sharing vibrators or other sex aids, that have not been washed or covered with a new condom each time they are used.

It can also be passed from a pregnant woman to her baby.

Typical symptoms are an unusual discharge from the vagina or penis and pain when urinating.

How common is it?

Gonorrhoea is a less common STI in the UK than chlamydia, genital warts or genital herpes, but over 16,500 new cases of gonorrhoea were reported in 2008. Young men and women aged 16-24 are the most affected: in 2008, they accounted for 47% of new gonorrhoea diagnoses.

Who is at risk?

Anyone who is sexually active can contract gonorrhoea, especially people who change partners frequently or do not use a barrier method of contraception, such as a condom, when having sexual intercourse.

Previous successful treatment for gonorrhoea does not make you immune from catching the infection again.

Outlook

Gonorrhoea can be easily diagnosed through a simple swab test and treated with antibiotics. If left untreated, gonorrhoea can lead to more serious long-term health problems and infertility.

Symptoms of gonorrhoea 

Symptoms of gonorrhoea usually show up after 1-14 days after you are infected. But sometimes symptoms may not appear until many months later, or until the infection has spread to other parts of your body.

About one in 10 infected men and half of infected women will not experience any obvious symptoms after contracting gonorrhoea, which means it can go untreated for some time.

Women

In women, symptoms of gonorrhoea can include:

• an unusual discharge from the vagina, which may be thick, and green or yellow in colour,
• pain when passing urine,
• pain or tenderness in the lower abdominal area (this is less common), and
• bleeding between periods or heavier periods (this is less common).

Men

Nine out of 10 men who contract gonorrhoea experience symptoms after they are infected, which can include:

• an unusual discharge from the tip of the penis, which may be white, yellow or green,
• pain or a burning sensation when urinating,
• inflammation (swelling) of the foreskin, and
• pain or tenderness in the testicles or prostate gland (this is rare).

Men and women

Both men and women can also catch gonorrhoea at other sites of the body, these include:

• infection in the rectum which may cause pain, discomfort or discharge,
• infection in the throat, this does not usually have any symptoms,
• infection in the eyes, which can cause pain, swelling, irritation and discharge (conjunctivitis).

Babies

Gonorrhoea can be passed from a mother to her baby during childbirth. Newborn babies normally show symptoms in their eyes during the first 1-14 days. The eyes become red and swollen, and have a thick pus-like discharge (conjunctivitis).

Gonorrhoea can be treated with antibiotics when you are pregnant or when you are breastfeeding. The antibiotics will not harm your baby.

Causes of gonorrhoea 

Gonorrhoea is a sexually transmitted infection (STI) caused by the  Neisseria gonorrhoeae bacteria. The bacteria are usually found in discharge from the penis and vaginal fluid of infected men and women, and are easily passed from one person to another through sexual contact.

During sex, the bacteria can infect the vagina or penis, as well as other places that come into contact with infected semen or vaginal fluid. The gonorrhoea bacteria can live inside the cells of the cervix (entrance to the womb), the urethra (tube where urine comes out), the rectum, the throat and, very occassionally, the eyes.

The infection is most commonly spread through:

• unprotected vaginal, anal or oral sex, and
• sharing sex toys if you do not wash them or cover them with a new condom after each use.
• If you are a woman, it is possible for gonorrhoea to spread from your vaginal secretions to your anus - you do not need to have had anal sex for this to happen.
• If you are pregnant, gonorrhoea can be passed from you to your baby during birth. This can lead to your newborn baby having an infection of the eyes (conjunctivitis), which can lead to blindness if not treated.

It is not clear if gonorrhoea can be spread by transferring the bacteria to another person on the fingers, or by female to female genital contact.

Testing for gonorrhoea

The only way to be certain that you have gonorrhoea is to be tested. If you suspect that you have gonorrhoea, or any other sexually transmitted infection (STI), it is important not to delay getting tested.

It is possible to do a gonorrhoea test within a few days of having sex, but you may be advised to wait up to two weeks after having sex before being tested. You can be tested even if you do not have any symptoms.
Early diagnosis and treatment of gonorrhoea will reduce the risk of any complications developing, such as pelvic inflammatory disease or infection in the testicles. Complications that arise from long-term infection are much more difficult to treat.

How you are tested

There are different ways to test for gonorrhoea:

Women

A doctor or nurse may take a swab to collect a sample from the cervix or vagina during an internal examination.

You may be asked to use a swab or tampon yourself to collect a sample from inside your vagina.
Cervical smear tests and routine blood tests do not check for gonorrhoea. If you are not sure if you have been tested for the presence of gonorrhoea, ask your nurse or doctor.

Men

You may be asked to provide a urine sample and will usually be asked not to pass urine for 1-2 hours beforehand.

Men and women

A doctor or nurse may take a swab to collect a sample from the entrance of the urethra (where urine is passed out).

If you have had anal or oral sex the doctor or nurse may need to take a swab from the rectum or throat.
If you have symptoms of conjunctivitis, such as red inflamed eyes with discharge, a sample of the discharge may be collected from your eye.

A swab looks a bit like a cotton bud but is smaller and rounded. It is wiped over parts of the body that may be infected, to pick up samples of discharge. Having a swab only takes a few seconds and is not painful, although it may be uncomfortable for a moment.

Some clinics may be able to carry out rapid diagnostic tests, when the doctor can view the sample through a microscope and give you your test results straight away. Otherwise, you will have to wait up to two weeks to get the results.

Who should get tested

You can only be certain you have gonorrhoea if you have a test. It is recommended you get tested if:

• you or your partner think you have symptoms of gonorrhoea,
• you have had unprotected sex with a new partner,
• you or your partner have had unprotected sex with other people,
• you have another STI,
• a sexual partner tells you that they have an STI,
• during a vaginal examination your nurse or doctor tells you that the cells of your cervix are inflamed or there is discharge, or
• you are pregnant or planning a pregnancy.

Where to get tested

There are a number of different places you can go to be tested for gonorrhoea:

• a genitourinary medicine (GUM) or sexual health clinic,
• your GP surgery,
• a contraceptive and young people’s clinic, or
• a private clinic.

It is possible to buy a gonorrhoea test from a pharmacy to do yourself at home. However, these tests vary in how accurate they are. It is recommended that you go to your local sexual health service. 

You can find details of your nearest sexual health or GUM clinic in the phone book, or by using the local health service search. You can attend these clinics at any age, even if you are under 16 years of age (the age of consent for sex). All results are treated confidentially.

All tests are free through the NHS, although if you choose to go to a private clinic you will have to pay. If you go to your GP practice, you may have to pay a prescription charge for any treatment.

Treating gonorrhoea 

It is important to receive treatment for gonorrhoea as quickly as possible. It is unlikely the infection will go away without treatment and, if you delay treatment, you risk the infection causing complications and more serious health problems. You may also pass the infection onto someone else.
Gonorrhoea is treated with a single dose of antibiotics, usually:

• ceftriaxone,
• cefiximine, or
• spectinomycin.

The antibiotics are either given orally (as a pill) or as an injection.

Recently, it has become apparent that some strains of gonorrhoea are becoming resistant to some antibiotics - particularly antibiotics that have been used heavily in the past, like penicillin - so these tend not to be used.
If there is a high chance that you have gonorrhoea, you may be given treatment before you get your results back. You will always be offered treatment if your partner is found to have gonorrhoea.

You should avoid sexual intercourse and intimate contact with other partners until you (and your partner) have both finished the course of treatment. This is to prevent reinfection or passing the infection onto anyone else.
Babies who display signs of a gonorrhoea infection at birth (such as inflammation of the eyes) or who are at increased risk of infection, because the mother has been diagnosed with gonorrhoea, will usually be given antibiotics immediately after birth. This is to prevent blindness and other complications developing and does not harm the baby.

Follow up

Treatment is at least 95% effective and you should only have to go back for a follow-up test if:

• the signs and symptoms do not go away,
• you had unprotected sex with your partner in the week following treatment,
• you think you have come into contact with gonorrhoea again,
• you had gonorrhoea of the throat, or
• your test was negative but you develop symptoms of gonorrhoea.

In these situations, you may need a repeat test.

Recovery

If the antibiotics have been effective, you should soon notice an improvement in your symptoms:

• pain and discharge when you urinate should improve within two to three days,
• pain and discharge in your rectum should improve within two to three days,
• bleeding between periods, or extra heavy periods, should improve by the time of your next period, and
• pain in your pelvis or testicles should start to improve quickly but could take up to two weeks to go away.

If you have pelvic pain or experience pain during sex that does not go away after treatment, you should see your doctor or nurse. You may need further treatment, or it may be necessary to investigate other possible causes of pain

Sexual partners

Gonorrhoea is easily passed on through intimate sexual contact. If you are diagnosed with the infection, anyone you have recently had sex with may also have it. It is important that your current partner and any other recent sexual partners are tested and treated.

Your local genitourinary medicine (GUM) or sexual health clinic may be able to help by notifying any of your previous partners on your behalf. A contact slip can be sent to them explaining that they may have been exposed to a sexually transmitted infection (STI) and suggesting that they go for a check up. The slip sometimes notes what the infection is but will not have your name on it, so your confidentiality is protected.
If you or your current partner is diagnosed with gonorrhoea, you should not have sex until you have both finished your course of treatment.

Complications of gonorrhoea 

If treated early, gonorrhoea is unlikely to lead to any complications or long-term problems. However, without treatment gonorrhoea can spread to other parts of your body and cause serious problems. The more times that you have gonorrhoea, the more likely you are to get complications:

• In women, gonorrhoea can spread to the reproductive organs and cause pelvic inflammatory disease (PID). PID can lead to long-term pelvic pain, ectopic pregnancy and infertility.
• In men, gonorrhoea can cause painful infection in the testicles and prostate gland, which can lead to reduced fertility.
• In rare cases, when gonorrhoea has been left untreated, it can spread through the bloodstream to cause infections in other parts of your body. In both men and women, this can cause:
• inflammation (swelling) of the joints and tendons,
• skin lesions (rash), and
• inflammation around the brain and spinal cord (meningitis), and the heart which can be fatal

Gonorrhoea can be successfully prevented by:

• using condoms (male or female) every time you have vaginal or anal sex,
• using a condom to cover the penis, or latex or plastic square (dam) to cover the female genitals if you have oral sex, and
• not sharing sex toys, (if you do share them wash them and cover them with a new condom before anyone else uses them).

These measures can also protect you from other sexually transmitted infections (STIs), such as genital herpes and chlamydia.

If you are worried you may be at risk of having an STI or have any of the symptoms mentioned in the symptoms section, you should visit your local sexual health or genitourinary medicine (GUM) clinic to have them checked out.