Gonorrhea

British Columbia Specific Information

Gonorrhea is a sexually transmitted infection (STI) caused by bacteria. Gonorrhea is passed from one person to another by contact with body fluids containing the bacteria during unprotected oral, anal, and vaginal sex. For more information about gonorrhea, see HealthLinkBC File #08a Gonorrhea, or visit Smart Sex Resource and Options for Sexual Health.

If you have concerns about an STI or want additional information, speak with your health care provider, or call HealthLink BC at 8-1-1. You can call 8-1-1 and speak to a registered nurse anonymously anytime, every day of the year.

Topic Overview

What is gonorrhea?

Gonorrhea is an infection spread through sexual contact. In men, it most often infects the urethra. In women, it usually infects the urethra, cervix, or both. It also can infect the rectum, anus, throat, and pelvic organs. In rare cases, it can infect the eyes.

Gonorrhea does not cause problems if you treat it right away. But if it's left untreated, it can lead to serious problems.

For a woman, untreated gonorrhea can move into the uterus, fallopian tubes, and ovaries. This can cause painful scar tissue and inflammation, known as pelvic inflammatory disease (PID). PID can cause infertility or ectopic pregnancy.

Sometimes gonorrhea is called the clap, drip, or GC.

What causes gonorrhea?

A certain kind of bacteria causes gonorrhea. Gonorrhea is a sexually transmitted infection, or STI. This means it can spread from one partner to another during vaginal, anal, or oral sex.

A woman who is pregnant can pass the infection to her newborn during delivery.

What are the symptoms?

Many people have no symptoms, so they can pass gonorrhea to their sex partners without knowing it.

If there are symptoms, they may include:

Pain when you urinate.
Abnormal discharge from the penis or vagina.

Gonorrhea infection in the throat may cause a sore throat, but it usually does not cause symptoms.

Symptoms in men usually are easier to notice than symptoms in women. But some men have mild or no symptoms.

In women, the early symptoms may be so mild that they are mistaken for a bladder infection or a vaginal infection. When an untreated infection moves into a woman's pelvic organs, symptoms can include lower belly pain, pain during sex, vaginal bleeding, and a fever.

The time from exposure to gonorrhea until symptoms begin usually is 2 to 5 days. But it may take as long as 30 days before symptoms start.

You can spread gonorrhea even if you don't have symptoms. You are contagious until you have been treated.

How is gonorrhea diagnosed?

Your doctor will ask you questions about your past health and your sexual history, such as how many partners you have. Your doctor may also do a physical examination to look for signs of infection.

Urine or fluid from the infected area will be tested for gonorrhea. You may also be tested for other sexually transmitted infections (STIs) at the same time. Testing can be done with a Pap test.

As soon as you find out you have gonorrhea, be sure to let your sex partners know. Experts recommend that you notify everyone you've had sex with in the past 60 days. If you have not had sex in the past 60 days, contact the last person you had sex with.

How is it treated?

Antibiotics are used to treat gonorrhea. It's important to take all of the medicine as directed. Otherwise the medicine may not work. Both sex partners need treatment to keep from passing the infection back and forth.

Getting treatment as soon as possible helps prevent the spread of the infection and lowers your risk for other problems, such as pelvic inflammatory disease.

Many people who have gonorrhea also have chlamydia, another STI. If you have gonorrhea and chlamydia, you will get medicine that treats both infections.

Avoid all sexual contact while you are being treated for an STI. If your treatment is a single dose of medicine, you should not have any sexual contact for 7 days after treatment so the medicine will have time to work.

Having a gonorrhea infection that was cured does not protect you from getting it again. If you are treated and your sex partner is not, you probably will get it again.

Finding out that you have an STI may make you feel bad about yourself or about sex. Counselling or a support group may help you feel better.

How can you prevent gonorrhea?

It's easier to prevent an STI like gonorrhea than it is to treat it.

Use a condom every time you have sex. Latex and polyurethane condoms keep out the viruses and bacteria that cause STIs.
Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you. Every time you add a new sex partner, you are being exposed to all of the diseases that all of that person's partners may have.
Be responsible. Don't have sex if you have symptoms of an infection or if you are being treated for an STI.
Wait to have sex with a new partner until both of you have been tested for STIs.

Cause

Gonorrhea is caused by the bacteria Neisseria gonorrhoeae.

Gonorrhea is spread during vaginal, anal, or oral sex with an infected partner. A pregnant woman may pass the infection to her newborn during delivery.

Gonorrhea can be transmitted at any time by a person who is infected with the bacteria Neisseria gonorrhoeae, whether or not symptoms are present. A person who is infected with gonorrhea is always contagious until he or she has been treated.

Having a gonorrhea infection once does not protect you from getting another infection in the future. A new exposure to gonorrhea will cause reinfection, even if you were previously treated and cured.

Symptoms

It is fairly common for gonorrhea to cause no symptoms, especially in women. The incubation period, the time from exposure to the bacteria until symptoms develop, is usually 2 to 5 days. But sometimes symptoms may not develop for up to 30 days.

Gonorrhea may not cause symptoms until the infection has spread to other areas of the body.

Symptoms in women

In women, the early symptoms are sometimes so mild that they are mistaken for a bladder infection or vaginal infection. Symptoms may include:

Painful or frequent urination.
Anal itching, discomfort, bleeding, or discharge.
Abnormal vaginal discharge.
Abnormal vaginal bleeding during or after sex or between periods.
Genital itching.
Irregular menstrual bleeding.
Lower abdominal (belly) pain.
Fever and general tiredness.
Swollen and painful glands at the opening of the vagina (Bartholin glands).
Painful sexual intercourse.
Sore throat (rare).
Pink eye (conjunctivitis) (rare).

Symptoms in men

In men, symptoms are usually obvious enough that they will cause a man to seek medical treatment before complications occur. But some men have mild or no symptoms and can unknowingly transmit gonorrhea infections to their sex partners. Symptoms may include:

Abnormal discharge from the penis (clear or milky at first, and then yellow, creamy, and excessive, sometimes blood-tinged).
Painful or frequent urination or urethritis.
Anal itching, discomfort, bleeding, or discharge.
Sore throat (rare).
Pink eye (conjunctivitis) (rare).

Other symptoms

Disseminated gonococcal infection (DGI) occurs when the gonorrhea infection spreads to sites other than the genitals, such as the joints, skin, heart, or blood. Symptoms of DGI include:

Rash.
Joint pain or arthritis.
Inflamed tendons.

What Happens

Gonorrhea causes no long-term problems if it is treated early in the course of the infection before any complications develop. Left untreated, gonorrhea can lead to serious complications.

Complications in women

Women with untreated gonorrhea may have the following complications of the female reproductive system:

Pelvic inflammatory disease (PID). The risk of infertility increases with each episode of PID.
An abscess in or near the ovaries (tubo-ovarian abscess)
Inflammation of the Bartholin glands
An ectopic (tubal) pregnancy
Chronic pelvic pain
Infertility
Fitz-Hugh–Curtis syndrome (rare)

Complications in pregnant women

Problems related to untreated gonorrhea in pregnant women include:

The possibility of a miscarriage.
Preterm labour. The woman may be given medicines to prevent premature birth, which could require a stay in the hospital.
Premature rupture of the membranes (PROM), which happens before labour contractions start. The amniotic sac breaks open, causing amniotic fluid to gush out, or less commonly, to slowly leak.
Premature delivery. A premature infant has an increased risk of health problems.
Infection of the lining of the uterus (endometritis).

If a woman has gonorrhea when she gives birth, her newborn can be infected.

Women with untreated gonorrhea and infected newborns are more likely to develop long-term complications of gonorrhea.

Complications in newborns

Newborns of women with untreated gonorrhea may have any of the following complications:

Pink eye (conjunctivitis). Most newborns who have gonorrhea also get pink eye.
An infection in the bloodstream (sepsis)
Inflammation of a joint (arthritis)
Scalp infections at the site of a fetal monitoring device
Infection of the fluid and tissues that surround the brain and spinal cord (meningitis)

Complications in men

Men with untreated gonorrhea may develop:

Epididymitis, an inflammation and infection of the epididymis—the long, tightly coiled tube that lies behind each testicle and collects sperm.
An inflammation of the prostate gland (prostatitis).

Complications of untreated gonorrhea in other areas of the body

Disseminated gonococcal infection (DGI) occurs when the gonorrhea infection spreads to sites other than the genitals, such as the joints, skin, heart, or blood. Complications of DGI include:

Fever.
Skin infection (cellulitis).
An infection in the bloodstream (sepsis).
Inflammation of a joint (arthritis). It most often affects the knees and hands.
An infection and inflammation of the heart valves and the chambers of the heart (endocarditis).
An infection of the fluid and tissues that surround the brain and spinal cord (meningitis).

Because many women do not have early symptoms of gonorrhea that cause them to seek treatment, they are more likely than men to have more serious complications from gonorrhea spreading to other parts of the body.

Having a gonorrhea infection once does not protect you from getting another infection in the future. A new exposure to gonorrhea will cause reinfection, even if you were previously treated and cured.

What Increases Your Risk

Risk factors for getting gonorrhea include:

Having multiple sex partners (more than one sex partner in the past year).
Having a high-risk partner (partner has other sex partners, unprotected sex, or gonorrhea-infected sex partners).
Having unprotected sexual contact (not using condoms).

Any child with gonorrhea needs to be evaluated by a doctor to find out the cause and to assess for possible sexual abuse.

When should you call your doctor?

Gonorrhea causes no long-term problems if it is treated early in the course of the infection before any complications develop. Untreated gonorrhea can lead to many complications.

In women:

Call your doctor immediately if you have the following symptoms.

Sudden, severe pain in the lower belly
Lower belly pain with vaginal bleeding or discharge and a fever of 38°C (100.4°F) or higher
Urinary burning, frequent urination, or inability to urinate and a fever of 38°C (100.4°F) or higher

Call your doctor to find out when an evaluation is needed if you have the following symptoms.

Vaginal discharge that has become yellowish, thicker, or bad-smelling
Bleeding between periods that occurs more than once when periods are usually regular
Pain during sexual intercourse
Bleeding after sexual intercourse
Sores, bumps, rashes, blisters, or warts on or around the genital or anal area
Anal itching, discomfort, bleeding, or discharge.
Burning, pain, or itching with urination or frequent urination lasting longer than 24 hours
Pelvic or lower belly pain that occurs without a known cause, such as diarrhea or menstrual cramps
Pink eye (conjunctivitis)

Call your doctor or clinic if you have unprotected sex with someone who has, or who you think may have, a sexually transmitted infection.

In men:

Call your doctor immediately if you have the following symptoms.

Discharge from the penis and a fever of 38°C (100.4°F) or higher
Urinary burning, frequent urination, or inability to urinate and a fever of 38°C (100.4°F) or higher
Pain, swelling, or tenderness in the scrotum and a fever of 38°C (100.4°F) or higher

Call your doctor to find out when an evaluation is needed if you have the following symptoms.

Sores, bumps, rashes, blisters, or warts on or around the genital or anal areas
Burning, pain, or itching with urination or frequent urination lasting longer than 24 hours
Suspected exposure to a sexually transmitted infection
Abnormal discharge from the penis
Pink eye (conjunctivitis)
Anal itching, discomfort, bleeding, or discharge.

Call your doctor or clinic if you have unprotected sex with someone who has, or who you think may have, a sexually transmitted infection.

Watchful waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate for a gonorrhea infection. Gonorrhea causes no long-term problems if it is treated early in the course of the infection before any complications develop. But untreated gonorrhea can lead to many complications. Avoid sexual contact until you have been examined by your doctor so that you will not infect someone else.

If you know you have been exposed to gonorrhea, both you and your sex partner(s) must be treated. You need treatment even if you don't have symptoms.

If you are unable to contact your sex partners or you are uncomfortable doing so, health departments and sexually transmitted infection (STI) clinics can help with this process.

Who to see

Ask your family doctor or general practitioner about diagnosing and treating gonorrhea. You may be referred to a specialist, such as a gynecologist.

Low-cost diagnosis and treatment of gonorrhea is usually available at local health units and family planning clinics.

Some people are not comfortable seeing their usual doctor for sexually transmitted infection treatment. Most provinces have confidential clinics for diagnosing and treating gonorrhea and other sexually transmitted infections.

Examinations and Tests

Diagnosis of gonorrhea includes a medical history and a physical examination. Your doctor may ask you the following questions.

Do you think you have been exposed to any sexually transmitted infections (STIs)? How do you know? Did your partner tell you?
What are your symptoms?
- Do you have any discharge? If you have discharge from your vagina or penis, it is important to note any smell or colour.
- Do you have sores in your genital area or anywhere else on your body?
- Do you have any urinary symptoms, including frequent urination, burning or stinging with urination, or urinating in small amounts?
- Do you have any unusual belly or pelvic pain?
What method of birth control do you use? Do you use a condom to protect against STIs every time you have sex?
Do you or your partner engage in certain sexual behaviours that may put you at risk, such as having multiple sex partners or having sex without using a condom (except if you're in a long-term relationship)?
Have you had an STI in the past? How was it treated?

Your doctor will ask you questions about your medical history. Then:

A woman may have a pelvic examination.
A man may have a genital examination to look for signs of urethritis and epididymitis.
You may have a urine test for gonorrhea.

Several gonorrhea tests can be used to detect or confirm an infection. Your doctor will collect a sample of body fluid or urine to be tested for gonorrhea bacteria ( Neisseria gonorrhoeae). Most tests give results within a few days.

Other sexually transmitted infections may be present with a gonorrhea infection. Your doctor may recommend testing for:

Chlamydia, a bacterial infection of the urethra in men, and the urethra, the cervix, or the upper reproductive organs (or all three) in women.
Syphilis, a bacterial infection in which the most common symptom is a painless sore called a chancre (say "SHANK-er") that develops on the genitals.
Hepatitis B, a viral infection that causes the liver to become swollen and tender (inflamed).
Human immunodeficiency virus (HIV), a virus that attacks the immune system, making it difficult for the body to fight off infection and some diseases.

Your doctor must report to the local health unit that you have gonorrhea.

Early detection

The Public Health Agency of Canada recommends gonorrhea screening for all sexually active people age 25 and younger. The PHAC also recommends screening for people older than 25 who have risk factors for gonorrhea.

You may want to consider being tested once a year for gonorrhea even though you don't have symptoms if you have increased risks for STIs. These include having multiple sex partners or having sex without using a condom (except if you're in a long-term relationship). Testing will allow gonorrhea to be quickly diagnosed and treated. This helps reduce the risk of transmitting gonorrhea and avoid complications of the infection.

It's generally recommended that all pregnant women are screened during their first prenatal visit.^{footnote 1} If a pregnant woman is at high risk for gonorrhea, she may be tested again during the second and third trimester before delivery, to prevent transmitting the infection to her newborn.

Treatment Overview

Gonorrhea causes no long-term problems if it is treated early in the course of the infection before any complications develop. Untreated gonorrhea can lead to many complications.

Initial treatment

Gonorrhea is treated with antibiotics. Treatment is recommended for:

A person who has a positive gonorrhea test.
Anyone who has had sexual contact in the past 60 days with a person diagnosed with gonorrhea, whether or not they have symptoms or used condoms.
A newborn whose mother has gonorrhea at the time of delivery.

If you are prescribed more than one dose of an antibiotic, be sure to take your antibiotic exactly as directed. If you miss doses or don't take the full course of medicine, the gonorrhea infection may not be cured.

Do not have sexual contact with anyone:

While you are being treated.
Until both you and your partner(s) have been tested and treated. If you are treated for gonorrhea and your sex partner is not, you will probably become infected again.

If your treatment is a single dose of antibiotic, wait at least 7 days after taking the dose before having any sexual contact.

Always use a condom when you have sex. This helps protect you from sexually transmitted infections.

Treatment if the condition does not get better

Symptoms that do not go away after treatment may be caused by another gonorrhea infection or treatment failure.

Certain strains of the gonorrhea bacteria have become resistant to some antibiotics and sulfa drugs. When bacteria become resistant to an antibiotic, they no longer can be killed by that medicine.

If you have been treated for gonorrhea and don't get better, you may be retested with a gonorrhea culture to see if there is bacterial resistance to the antibiotic you were taking. If there is bacterial resistance, you will need another antibiotic to cure the infection.

What to think about

To prevent reinfection, don't have sex until any partner that might be infected is tested and treated.

Some people who have gonorrhea also have chlamydia. The Public Health Agency of Canada recommends that drug treatment for gonorrhea also include antibiotics that are effective in treating chlamydia. For more information, see the topic Chlamydia.

Pelvic inflammatory disease (PID) is a serious complication of gonorrhea that can lead to infertility, chronic pelvic pain, and ectopic pregnancy. To prevent PID, prompt treatment of gonorrhea is important. For more information, see the topic Pelvic Inflammatory Disease (PID).

Disseminated gonococcal infection (DGI) occurs when the gonorrhea infection spreads to sites other than the genitals, such as the joints, skin, heart, or blood. Treatment of DGI usually requires hospitalization and antibiotic treatment given intravenously (IV) or into a muscle (intramuscularly, IM).

Your doctor must report to the local health unit that you have gonorrhea.

Prevention

You can take measures to reduce your risk of becoming infected with gonorrhea or another sexually transmitted infection (STI). You can also reduce the risk of transmitting gonorrhea to your sex partner(s).

Practice safer sex

Preventing a sexually transmitted infection (STI) is easier than treating an infection after it occurs.

Talk with your partner about STIs before beginning a sexual relationship. Find out whether he or she is at risk for an STI. Remember that it is quite possible to be infected with an STI without knowing it. Some STIs, such as HIV, can take up to 6 months before they can be detected in the blood.
Be responsible.
- Avoid sexual contact if you have symptoms of an STI or are being treated for an STI.
- Avoid sexual contact with anyone who has symptoms of an STI or who may have been exposed to an STI.
Don't have more than one sexual relationship at a time. Your risk for an STI increases if you have several sex partners at the same time.

If you or your partner have had several sex partners within the past year, or you are a man who has unprotected sex with men, talk to your doctor about screening for gonorrhea and other STIs even if you don't have symptoms.

Condom use

Condom use reduces the risk of becoming infected with an STI, especially gonorrhea, chlamydia, and HIV. Condoms must be in place before beginning any sexual contact. Use condoms with a new partner every time you have sex, until you know from test results that he or she does not have an STI. You can use either male or female condoms.

Even if you are using another birth control method to prevent pregnancy, you can use condoms to reduce your risk of getting an STI. Female condoms are available for women whose male partners do not have or will not use a male condom.

Home Treatment

There is no home treatment for gonorrhea. It requires medicine prescribed by a doctor.

Prescription antibiotic medicine normally cures gonorrhea infections. Gonorrhea does not cause long-term problems if it is treated before any complications develop. But gonorrhea can lead to many complications if it is not treated.

If you have been diagnosed with gonorrhea:

Take the full course of antibiotics as prescribed by your doctor. If you skip doses or do not complete the treatment, the infection may not be cured.
Do not have sexual contact with anyone while you are being treated. If your treatment is a single dose of antibiotics, wait at least 7 days after taking the dose before having any sexual contact.
Make sure your partner knows that he or she needs to be treated even if there are no symptoms. You can spread the infection to others even if you do not have symptoms.
Call your doctor if your symptoms continue or reappear after treatment or if new symptoms develop. You may need a different antibiotic medicine or further tests.

Finding out that you have gonorrhea may cause you to have negative thoughts or feelings about yourself or about sex. Talking to a counsellor or joining a support group for people who have sexually transmitted infections (STIs) may be helpful.

Medications

Antibiotics, if taken exactly as directed, normally cure gonorrhea infections. If antibiotics are not taken properly, the infection will not be cured. Prompt antibiotic treatment also prevents the spread of the infection and decreases complications, such as pelvic inflammatory disease (PID).

Avoid all sexual contact while you are being treated for a sexually transmitted infection (STI). People taking a single dose of medicine should not have any sexual contact for 7 days after treatment to give the medicine time to work. Exposed sex partners need treatment whether they have symptoms or not.

What to think about

There is an increasing number of strains of gonorrhea that can't be killed by (are resistant to) certain antibiotics. If your doctor finds that your gonorrhea is resistant to the drug you are taking, he or she might prescribe another antibiotic to cure the infection. If you continue to have symptoms after you have been treated for gonorrhea, you will need to be retested with a gonorrhea culture to find out whether there is bacterial resistance to the antibiotic you were taking.

Call your doctor if symptoms continue or new symptoms develop 3 to 4 weeks after treatment.

Treatment in a hospital with intravenous (IV) medicines may be needed for women who have pelvic inflammatory disease (PID) and men who have epididymitis. In many cases, these conditions can be treated outside of the hospital with oral antibiotics and close follow-up by your doctor. For more information, see the topic Pelvic Inflammatory Disease.

References

Citations

Expert Working Group on Canadian Guidelines for Sexually Transmitted Infections (2013). Canadian guidelines on sexually transmitted infections: Section 6—Specific populations. Public Health Agency of Canada. http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/section-6-4-eng.php. Accessed June 3, 2016

Other Works Consulted

Abramowicz M (2010). Drugs for sexually transmitted infections. Treatment Guidelines From The Medical Letter, 8(95): 53–60.

Centers for Disease Control and Prevention (2012). Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections. MMRW, 61(31) 590-594. Available online:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6131a3.htm?s_cid=mm6131a3_w.

Centers for Disease Control and Prevention (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR, 64(RR-03): 1–137. http://www.cdc.gov/std/tg2015. Accessed July 2, 2015. [Erratum in MMWR, 64(33): 924. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a9.htm?s_cid=mm6433a9_w. Accessed January 25, 2016.]

Ison C, et al. (2010). Gonorrhea. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 4th ed., pp. 24–39. Philadelphia: Saunders.

Credits

Current as of: November 17, 2021

Author: Healthwise Staff
Medical Review:
Sarah Marshall MD - Family Medicine
Brian D. O'Brien MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Peter Shalit MD, PhD - Internal Medicine
Kevin C. Kiley MD - Obstetrics and Gynecology