Gonorrhoea
Gonorrhoea is a bacterial infection of the mucous membranes that is passed on during sex. It settles in the urethra and the neck of the womb, in the rectum…
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Medicines commonly prescribed for Gonorrhoea
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 500 mgActive substance: azithromycinManufacturer: Aristo Pharma GmbhPrescription requiredDosage form: TABLET, 500 mgActive substance: azithromycinManufacturer: Pfizer S.L.Prescription requiredDosage form: INJECTABLE, 1 g ceftriaxone disodiumActive substance: ceftriaxoneManufacturer: Fresenius Kabi España, S.A.U.Prescription required
Gonorrhoea is a bacterial infection of the mucous membranes that is passed on during sex. It settles in the urethra and the neck of the womb, in the rectum, in the throat and, occasionally, in the eye. It clears quickly and almost always without lasting harm, on one condition: that somebody looks for it. That is where the difficulty starts, because usually there is no reason to look. Most women and a good share of men feel nothing at all. While the person carries on believing they are well, the bacterium travels upwards and has time to do damage that cannot always be undone.
How it spreads and why it goes unnoticed
The gonococcus cannot survive outside the human body. It is not passed on by towels, swimming pools, toilet seats or shared cutlery, so that particular worry can be set aside straight away. Infection happens through vaginal, anal and oral sex, and also from the genitals to the eye by way of the hands. A baby can catch it from the mother during birth, on the way through the birth canal.
Penetration is not always needed: contact between mucous membranes and an exchange of fluids is enough. Shared sex toys that are not washed and given a fresh condom carry the infection in the same way.
Having no symptoms is not the exception here but the ordinary course of events. The infection is especially quiet in the throat and the rectum, where there is almost never anything to feel. That is why gonorrhoea is found not through how somebody feels but through a test, either because a partner has been diagnosed or because the person decides to check.
The signs, when there are any
They usually show up within a few days, or one to two weeks after infection, and in some people later than that.
- burning or stinging when passing urine;
- in men, discharge from the urethra, most often thick and yellowish or greenish, along with needing to go more often;
- in women, discharge that is not the usual one, a dragging ache low in the abdomen, spotting between periods or after sex;
- pain and swelling on one side of the scrotum, which is how inflammation of the epididymis announces itself;
- itching, pain, mucus or blood when opening the bowels, if the rectum is affected;
- a scratchy, sore throat, sometimes with swollen glands in the neck;
- a red eye with swollen lids and heavy pus-like discharge.
Not one of these signs belongs to gonorrhoea alone. Chlamydia, trichomoniasis and urethritis of other kinds look exactly the same, and each is treated differently. This is why taking an antibiotic on the strength of symptoms is a bad idea: half of those attempts miss the target, and the other half blur the picture so thoroughly that the laboratory can no longer find the infection either.
How testing works
The main method looks for the organism's DNA in a sample from the mucous membrane. In men this is usually the first part of the urine stream; in women, a vaginal swab, which they can take themselves without any loss of accuracy. If there has been anal or oral sex, separate samples are taken from the rectum and the throat: a urine test does not cover those sites and the infection would simply stay hidden there.
Testing immediately after a risky encounter achieves little, because there are still too few bacteria to detect. Waiting about two weeks makes sense, though anyone with symptoms should go at once. Alongside gonorrhoea it is worth checking for chlamydia, syphilis and HIV: they travel together more often than they travel alone.
Reasons to be tested even when nothing hurts: sex without a condom with a new partner, news that a partner has been diagnosed, planning a pregnancy and pregnancy itself, and a yearly check whenever partners change.
Treatment, and why one tablet is not the end of it
Gonorrhoea is treated with an antibiotic, and in most cases a single injection into the muscle is enough. The choice is the doctor's: the list of antibiotics that still work has shrunk noticeably in recent years, and what did the job a decade ago no longer does so in many parts of the world.
Resistance deserves a paragraph of its own, because it is the defining feature of this particular infection. The gonococcus has worked its way around one family of antibiotics after another, and strains have already been described against which very little is left. Two practical conclusions follow. First, treating yourself with what is left over in the medicine cabinet is a direct contribution to the problem. Second, a follow-up test after treatment is needed, usually a couple of weeks later, and it matters most when the infection was in the throat, which is the hardest place to clear.
Sex is put on hold during treatment, for both of you, until each partner has finished the course and at least a week has passed. Otherwise the two of you simply hand the infection back and forth, each convinced of having caught it elsewhere.
What happens if it is left alone
It does not go away by itself. The infection climbs the genital tract, and then comes the part that makes testing worth the trouble.
- In women, inflammation of the womb, tubes and ovaries. It can run quietly, but it leaves scarring in the tubes, which means tubal infertility and a raised risk of ectopic pregnancy. Long-term pelvic pain comes from the same place.
- In men, inflammation of the epididymis and the prostate and, less often, narrowing of the urethra.
- In anyone, an uncommon but serious turn in which the gonococcus enters the bloodstream. Fever follows, with a scattering of small pustules or spots on the hands and feet, inflamed tendons and one or two large joints affected. Such a hot, swollen joint is easily mistaken for something else, and by that stage treatment happens in hospital.
- Eye infection in an adult moves fast and can damage the cornea within days.
Pregnancy deserves a line of its own. Untreated gonorrhoea raises the risk of premature labour and of a baby born small, and during birth it passes to the child. In a newborn it appears as a pus-filled eye infection in the first days of life and, left untreated, leads to blindness. This is why the infection is looked for and cleared during pregnancy, and why a red, discharging eye in a small baby means seeing a doctor straight away rather than waiting until morning.
Partners
Treating one person almost never settles the matter. Everyone who has been a sexual partner in recent months needs testing and treatment, including those who feel perfectly well, since they are most often the source.
It is an awkward conversation and plenty of people put it off. It helps to know that clinics generally lend a hand: they suggest how to word it, and in some places they can notify the partner themselves without giving your name. Nobody is obliged to explain themselves to all comers, but telling people is worth it: one sentence can spare someone infertility five years down the line.
What lowers the risk
- Condoms for vaginal and anal sex; for oral sex, a condom or a latex square. The protection is not absolute, but it cuts the chance of infection several times over.
- Regular checks whenever partners change: yearly, and more often if changes are frequent. For men who have sex with men, the check includes throat and rectum.
- No shared sex toys without washing them and fitting a new condom.
- Finishing the treatment, yours and your partner's, and having the follow-up test.
Having had gonorrhoea leaves no protection behind: you can catch it as many times as you are exposed, including a month after being cured. There is evidence that the vaccine against meningococcus group B partly reduces the risk of gonococcal infection, and some countries offer it to people at high risk; whether that option is open to you is a question for your doctor locally.
Online consultation
A remote appointment is a comfortable way to take the first step, the one so many people postpone out of embarrassment. The doctor goes through whether there was a risk and what kind, says how many days must pass before a test will be reliable, and which sites need sampling: urine only, or throat and rectum as well. Once the result is in hand, an online conversation is the place to work out what it means, how to raise the subject with a partner, when the follow-up test is due and why a course is never stopped halfway. Prescribing an antibiotic without seeing a test result is not something a doctor can do, and rightly so. And with a high fever alongside a rash and a swollen joint, with severe pain in the scrotum, or with a discharging eye, nobody waits for an appointment: that is a reason to seek care the same day.
This material is for information only and does not replace medical advice.
Consult with a doctor about Gonorrhoea
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Online doctors for Gonorrhoea
Discuss your symptoms and possible next steps for Gonorrhoea with a doctor online.
