Gonorrhoea

Gonorrhoea is caused by bacteria called Neisseria gonorrhoeae. It can live in the cervix, the urethra (tube where urine comes out), the rectum (back passage) and occasionally, the eyes. 

Anyone who is sexually active can get gonorrhoea and pass it on, even if you don’t have lots of sexual partners.

About half of people who have a vulva and 1 in 10 people with a penis who have genital gonorrhoea do not have any obvious signs or symptoms.  Symptoms may show up between 2 and 14 days after coming into contact with gonorrhoea, months later or not until the infection has spread to other parts of the body.

If you do notice symptoms they can include the following:

If you have a penis it can cause:

• An unusual discharge from the tip of the penis which may be yellowish, white or green
• A burning feeling, especially when urinating
• Swelling of the foreskin.
• Rarely, pain or tenderness in the testicles

If you have a vulva/vagina/front hole it can cause:

• An unusual or changed discharge which may be thin or watery, yellow or green
• A burning feeling when urinating
• Rarely, bleeding between periods or heavier periods (including those using hormonal contraception)
• Lower abdominal pain or tenderness

Gonorrhoea in the throat is mostly symptom-free.

Gonorrhoea in the rectum often has no symptoms but there might be pain or discomfort and a discharge.

Gonorrhoea in the eyes (conjunctivitis) may cause pain, irritation, swelling of the eyelids and surrounding area and a discharge.

Gonorrhoea is usually passed from one person to another when having sex. You can be infected if you come into contact with the semen or vaginal/frontal fluids of someone who has gonorrhoea. 

Gonorrhoea is most commonly spread by

• Vaginal/frontal or anal sex without using condoms. 

• Sharing sex toys that are not washed or covered with a condom each time they are used with a different person.
• Oral sex, when a condom or dental dam is not used to cover the vulva/front hole or penis.

It may be possible for gonorrhoea to be spread by transferring infected semen or vaginal/frontal fluids to another person’s genitals on the fingers or through rubbing vulvas together. 

It’s possible for gonorrhoea to spread from vaginal/frontal discharge to the rectum. You don’t have to have anal sex for this to happen.

Using a condom (external or internal condom) cuts the risk, but doesn't eliminate it entirely, as fluids containing the bacteria may be passed on fingers.

Gonorrhoea can be passed on by oral sex, so the advice is to use flavoured condoms or dental dams to do as much as you can to protect yourself. 

It's possible for an adult to get conjunctivitis as a result of their eye coming into contact with gonorrhoea bacteria, but this is rare.

Some studies suggest that gonorrhoea in the throat can be passed on by deep kissing or by using saliva as a lubricant, but this needs to be studied further. You cannot get gonorrhoea from normal social contact or from using public facilities like lavatories. Gonorrhoea can also be passed from a parent to baby during childbirth, which can cause conjunctivitis in the baby’s eyes. Antibiotics can be taken to treat gonorrhoea during pregnancy or while breastfeeding. The antibiotics won’t harm the baby but do tell the doctor or nurse if you are pregnant or breastfeeding.

Help protect yourself against most STIs such as gonorrhoea:

• Use internal or external condoms, which help prevent you coming into contact with bodily fluids containing the bacteria, every time you have vaginal/frontal or anal sex.
• Avoid sharing sex toys without using a new condom for each person. Wash sex toys well after you have used them. Some people use sterilising fluid that’s used to clean baby feeding bottles.
• It is also advised that if you want to be as sure as you can be of not getting gonorrhoea via oral sex that a condom is used to cover the penis, or a latex or plastic ‘dam’ is used to cover the vulva or anus.

Other types of contraception, such as the contraceptive pill, or HIV prevention tools such as PrEP (pre-exposure prophylaxis) offer no protection against STIs.

If a person with HIV is not taking HIV treatment (usually because they have not tested and do not know they have HIV), having untreated gonorrhoea may make them more infectious and liable to pass on HIV because untreated STIs can increase the amount of HIV present in semen and vaginal/frontal fluid.  

However, if the person with HIV is taking effective HIV treatment and has an undetectable viral load (the level of HIV in the body is so low that tests cannot detect it) they cannot pass on HIV. Gonorrhoea will not make a difference to this.

If an HIV negative person has a gonorrhoea infection, it is more likely that they could acquire HIV if they are exposed to the virus. 

It’s important not to delay going for a test if you think you might have gonorrhoea. A test will be carried out right away, and you will be advised to test again two weeks later to ensure that the treatment has worked. 

There are a number of services that do gonorrhoea testing, so choose the one you feel most comfortable with. 

Most people get tested and treated for infections such as gonorrhoea at a sexual health or GUM (genitourinary medicine) clinics. It’s free and confidential, so no-one else, including your GP, will be told about your visit. 

GP surgeries, contraception clinics, young people’s clinics and some pharmacies also test for and treat these infections.

Gonorrhoea tests are simple and painless.

A sample of cells can be collected for testing in two ways:

• if you have a penis you may be asked to provide a sample of urine (you will be advised not to pee for one to two hours before the sample is taken)
• gently wiping a swab (small cotton bud) over the area that might be infected. If you have oral and/or anal sex make sure that swabs are taken from those areas as well as the vulva/vagina/front hole or penis. A swab may be taken from the eye if conjunctivitis is present.

If you have a vagina/vulva/front hole the doctor or nurse may ask if it’s ok if they carry out an internal examination and they may swab the cervix, if you have one, to test for infection.

Swabs only take a few seconds and don’t hurt – they may be slightly uncomfortable for a moment or two. A doctor or nurse may take the sample, or you can ask to do the swabs yourself. A swab looks a bit like a smaller more rounded cotton bud, although sometimes it has a plastic loop rather than a cotton tip. 

You may also be able to get free gonorrhoea testing kits to do at home, depending where you live.

You can also buy tests to do at home but the accuracy of these tests varies so it’s best to visit a sexual health clinic, GP or pharmacy to get tested. 

Gonorrhoea is treated with antibiotics. The most common treatment is:

• a single dose of azithromycin

A strain of so-called super gonorrhoea has recently been on the rise in England. This strain is resistant to azithromycin and so another antibiotic used – called ceftriaxone – will be prescribed as it currently works for the majority of azithromycin resistant cases.

Because of this, it’s important to test again after two weeks to check that it has worked. If it hasn’t worked, you will be given the other antibiotic to treat it. 

The doctor or nurse may also advise you to have other tests, mainly to check if you have acquired gonorrhoea again. They will also suggest further testing if the symptoms haven’t gone away, if you had gonorrhoea of the throat or if a test was negative but you have developed symptoms. They will advise you which tests to take and when you can take them after your treatment. If you have any doubts or questions don’t hesitate to discuss them with the doctor or nurse.

You will notice an improvement in your symptoms quite quickly after having treatment. 

• Discharge and pain when you urinate should lessen within 2 or 3 days.
• Discharge and discomfort in the rectum (back passage) should lessen in 2 or 3 days. 
• Bleeding between periods or heavier periods should lessen by your next period. 
• Pelvic pain and pain in the testicles should lessen quickly, although they may take up to two weeks to go away completely.

If you continue to have pelvic pain or painful sex that doesn’t improve, see your doctor or nurse as it may be necessary to have further treatment or investigate other possible causes of the pain. 

When can I have sex again?

Don’t have vaginal/frontal, oral or anal sex, or share sex toys, even with a condom, until you and your partner(s) have finished the treatment and the symptoms have gone as you could pass on the infection if you have sex before treatment has finished. To prevent re-infection or passing the infection on, wait 7 days after your treatment has finished to have sex.

Even if you are given a single dose of antibiotics, you need to wait 7 days to have sex with other people.

Telling your partner/s

If your test shows that you have gonorrhoea it is important that people you have had sex with recently are also tested and treated as they may have the infection without knowing it.

You may be given a contact slip to send or give to your partner(s) or with your permission the clinic can contact them if you don’t want to. This will inform them that they may have been infected with an STI and suggest that they go for a check-up. This information may be sent by text rather than by a paper slip. The staff at the clinic can discuss with you which of your partners may need to be informed and tested. 

Whichever way the information is sent to your partner(s) it will not have your name on it or identify you in any way, so your confidentiality is protected. 

If you feel angry or upset that you have gonorrhoea and find it difficult to talk with a partner or friends about it, please don’t be afraid to discuss how you feel with the staff at the clinic or general practice (GPs). 

If gonorrhoea is not treated it can spread to other parts of the body. The more times you have gonorrhoea the more likely you are to get complications from the infection.

If you have a vulva/vagina/front hole, gonorrhoea can spread and cause PID (pelvic inflammatory disease) which may lead to long term pelvic pain, blocked fallopian tubes, infertility and ectopic pregnancy, where the pregnancy develops outside of the womb.

If you have a penis, gonorrhoea can lead to painful infection in the testicles and may reduce fertility.

In rare cases, gonorrhoea can cause pain and inflammation of the joints and tendons, known as SARA (sexually acquired reactive arthritis) which sometimes also affects the eyes and causes skin lesions.

Anyone can get gonorrhoea and you can only be certain you have gonorrhoea if you have a test, so regular STI tests are both a good idea and important for your sexual wellbeing. This is true for everyone although it’s especially the case if you: 

• are starting a new relationship
• want to stop using condoms with your partner 
• have multiple partners
• don’t use condoms consistently.

It’s best to test if:

• You or a sexual partner think either of you may have symptoms
• You’ve recently had sex without a condom with a new sexual partner
• You, or a partner, have had sex without a condom with other sexual partners
• During a vaginal/frontal exam, your doctor or nurse says that the cervix is inflamed and/or there is an unusual discharge
• A sexual partner tells you they have an STI
• You have another STI such as chlamydia

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There is no reason to be embarrassed or guilty about getting an STI, in fact we know that these feelings actually stop people from getting tested and treated, making it more likely that STIs will impact on your sexual health and are passed on to your partners.

Terrence Higgins Trust can provide emotional support if you are worried about your sexual health or have concerns about living with HIV. We can help you access services local to you across the UK, whether provided by us or by someone else.

Call THT Direct on 0808 802 1221 for support, advice and information or email info@tht.org.uk

Visit tht.org.uk for the latest HIV and sexual health information.