Gonorrhea: Symptoms & Treatment
This illustration shows a computer-generated image of drug-resistant Neisseria gonorrhoeae, the bacterium that causes gonorrhea.
Credit: CDC/James Archer

Gonorrhea is the second most common sexually transmitted disease reported to the U.S. government behind chlamydia, according to the Centers for Disease Control and Prevention (CDC)

Gonorrhea, also referred to by the slang term "the clap," affects both men and women, and can cause infections in the genitals, rectum and throat. It is caused by a bacterium, Neisseria gonorrhoeae, which is typically spread when an infected person has vaginal, anal or oral sex. In addition, a pregnant woman with untreated gonorrhea can transmit the infection to her baby during childbirth. 

More than 468,000 cases of gonorrhea were reported to the CDC in 2016, although the agency estimates that about 820,000 new infections may actually occur each year in the United States. 

The number of actual cases of gonorrhea in the United States may be much higher than what gets reported to the CDC because the infection may be underdiagnosed in women, who, in about 50 percent of cases where the bacteria has infected the cervix, may not have any symptoms of the disease, said Dr. Lindley Barbee, an infectious disease specialist at Harborview Medical Center in Seattle. 

Rates of gonorrhea in the United States have been rising, partly due to changes in testing methods that are picking up more cases and also due to an increasing number of infections seen in men having sex with men, said Barbee, who is also the medical director, Public Health, Seattle & King County HIV/STD Program.

According to Barbee, the large majority of gonorrhea cases are seen primarily in young people ages 30 and under because they are more likely to have sex with multiple partners. 

In addition to sexually active teens and young adults, another vulnerable group is men who have sex with men. Higher rates of the infection might be detected in these men until age 40, Barbee said.

Neisseria gonorrhoeae can infect the mucous membranes, or the moist linings, of the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. The bacteria can also infect mucous membranes of the mouth, throat, eyes and rectum. 

According to the Mayo Clinic, these factors may increase your risk of gonorrhea infection:

  • Younger age
  • A new sex partner
  • A sex partner who has concurrent partners
  • Multiple sex partners
  • Having previous gonorrhea diagnosis
  • Having other sexually transmitted infections

The use of condoms during sexual activity work to prevent gonorrhea, Barbee said. Abstaining from sex or being in a mutually monogamous relationship with an uninfected partner are two more ways to reduce risk. Other steps to reduce the risk of infection include, not having sex with someone who may have signs or symptoms of an STD, asking a partner if he or she has been tested for STDs, or being screened regularly for gonorrhea if sexually active. 

Screening for gonorrhea

  • Sexually active women who are younger than 25, or women 25 years and older who have risk factors for gonorrhea, such as multiple partners or a partner who has an STD, should request a yearly screening for the infection, the CDC recommends. Screening for gonorrhea during pregnancy is recommended for sexually active women who are younger than 25, and in older women who are at increased risk for the infection. Screening usually occurs at the first prenatal visit.  
  • Men who have sex with men are advised to have gonorrhea screening at least once a year, the CDC recommends. But routine screening is not recommended for sexually active heterosexual men. 

In many cases of the disease, gonorrhea may not cause any symptoms or only very mild ones. When symptoms do occur, they commonly affect the genitals of men and women. These symptoms may typically begin two to seven days after a person is exposed to the infection, and symptoms may begin even later than a week afterwards. 

Men's symptoms

Genital symptoms of gonorrhea in men may include:

  • A burning sensation or pain when urinating
  • A pus-like, yellowish-white discharge from the tip of the penis
  • Pain or swelling in the testicles

Women's symptoms

The symptoms of gonorrhea in women may be easily mistaken for a urinary tract infection or a vaginal infection, according to The American College of Obstetricians and Gynecologists. These symptoms may include:

  • A yellow vaginal discharge
  • A burning sensation or pain when urinating
  • Vaginal bleeding between periods, such as after vaginal intercourse

The bacteria that cause gonorrhea can not only target cells in the genitals, they can also infect cells in other parts of the body, including the rectum, throat, eyes and joints, according to the Mayo Clinic

Additional symptoms in men and women:

  • Itching, swelling, pain, discharge or bleeding from the rectum, or bleeding after a bowel movement
  • Sore throat and swollen lymph nodes in the neck
  • Pus-like discharge from the eyes, eye pain and sensitivity to light
  • Warm, red, swollen and painful joints, especially when the joint is moved

In women, tests for gonorrhea can be done on a urine sample or on samples taken with a swab from the vagina, mouth, throat, rectum or the area around the cervix, depending on the affected area, according to The American College of Obstetricians and Gynecologists. The swab collects bacteria that can be identified in a lab. 

In men, tests for gonorrhea can be done on a urine sample or on samples taken with a swab from the mouth, throat, rectum, or a man's urethra (urine canal), depending on the affected area, according to the CDC. 

Rates of gonorrhea infection in 50 states in 2012.
Rates of gonorrhea infection in 50 states in 2012.
Credit: CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention

Gonorrhea is treated with a two-drug regimen, and both treatments are given on the same day, Barbee said. She explained that first a person receives a single shot of the antibiotic ceftriaxone, and then a person is given the antibiotic azithromycin, which is taken orally as a single set of pills.  

These medications are effective for treating gonorrhea; however, it is possible to develop the STD again if someone has sexual contact with an infected person. 

Treatment-resistant gonorrhea 

The bacteria that cause gonorrhea are increasingly developing resistance to nearly all of the drugs available to treat it. Antibiotic-resistant gonorrhea is among the three most urgent drug-resistant health threats to the United States, according to a 2013 CDC report. 

"It's a smart bug that has developed resistance to every first-line therapy since 1930," Barbee told Live Science. Experts aren't entirely sure why the bacteria continue to evolve and resist nearly every treatment used to control the infection, she said, adding that it could be because the organism is seeing certain drugs a lot or it may be obtaining the resistant mutation from other strains of bacteria.  

In 2006, the CDC had five recommended treatment options for gonorrhea, and now more than a decade later, the United States has only one treatment option remaining — a combination of the antibiotics azithromycin and ceftriaxone. 

There has already been a case in England of treatment failure, where the infection was resistant to the two antibiotics recommended as the first-choice treatment for gonorrhea, Barbee said. An eventual treatment was found, but the man needed to be hospitalized and given an antibiotic intravenously to successfully clear the infection. 

If gonorrhea is not treated, it can lead to the following serious complications and may cause permanent health problems in both women and men:

Infertility in women

In women, untreated gonorrhea can cause pelvic inflammatory disease (PID), an infection in which scar tissue forms that blocks the fallopian tubes and causes long-term pelvic and abdominal pain. PID can lead to a difficulty becoming pregnant and an ectopic pregnancy, a pregnancy that develops outside a woman's womb. 

Infertility in men

Untreated gonorrhea can cause epididymitis, a painful condition in the tubes attached to the testicles that may lead to infertility. 

Infection spreads to other areas

If untreated, the bacteria may spread to the blood or joints, where it may cause a serious condition known as disseminated gonococcal infection, which can be life threatening. Symptoms of this infection may include skin lesions, painful swelling of joints, fever, infection of the inner lining of the heart and meningitis, an inflammation of the membrane covering the brain and spinal cord. 

Increased risk of HIV/AIDS

Untreated gonorrhea may increase a person's risk of getting or giving HIV, the virus that causes AIDS. 

Infant complications 

When gonorrhea is passed on to a baby at birth, the infection most commonly affects an infant's eyes and can even lead to blindness if not treated. But babies born to a mother with gonorrhea can be given medication in their eyes soon after birth to prevent the infection from developing, according to the Mayo Clinic. 

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