What is Gonorrhoea and How is it Spread?
- Dr Ravi Gowda
- Mar 3
- 7 min read
Gonorrhoea, a sexually transmitted bacterial infection, has a notorious reputation… and a long one too. It has been described in pre-biblical times in Ancient Chinese, Egyptian and Roman civilisations from at least 3500 years ago but the bacteria itself, Neisseria gonorrhoeae, was first isolated only in 1879.
It's the second most common Sexually Transmitted Infection (STI) after chlamydia and just like HIV, cases have been rising in the 2000s. Again, just like these other STIs, people don't always have symptoms and therefore they can spread the disease very easily.
In this article we will discuss:
How Can You Get Gonorrhoea?
You can get gonorrhoea through intimate sexual contact including oral sex. It can also be passed from a mother to the baby through the birth canal secretions.
The Symptoms of Gonorrhoea
You don't always have symptoms with gonorrhoea but if you do, they can vary slightly from men to women:
Symptoms in Men
Gonorrhoea symptoms in men include:
Penile discharge
Pain on passing urine
Redness around the opening at the end of the penis
Urine ‘threads’ – slimy, mucus identified in urine
Men who have sex with men can also have anal discharge, bleeding and itchiness
Symptoms in Women
In women, the following are common:
Vaginal discharge
Lower abdominal pain
Pain on passing urine
Bleeding after sexual intercourse
Pelvic tenderness especially after sexual intercourse
Both men and women can have infection in the throat but they don't often have symptoms. Other symptoms include swollen neck glands and conjunctivitis. Rarely, you can get an infection of the liver, skin and even your heart. So, it's vital that you get tested before serious complications appear.
How Long Does it Take for Gonorrhoea Symptoms to Show?
Remember, you won't always experience symptoms with gonorrhoea. In fact, 50 to 70% of women don't have symptoms. If you do get symptoms, they usually occur between 5 to 10 days after infection.
Why Does Gonorrhoea Often Go Undetected?
The trouble with gonorrhoea is that it’s often silent or non-specific, and therefore there’s a chance that you will pass it on to others without realising.
Here are some of the reasons why:
It’s common: The World Health Organisation estimates there are about 82 million new cases in young adults aged between 18 and 49 years and this figure has been increasing
Symptoms may not occur for 10 days after infection but you can still infect others
You might only experience non-specific symptoms, such as pain on passing urine, which may be mistaken for something like cystitis
Even if you do get symptoms, they can sometimes clear by themselves but you may still be infected but think you're cured
Screening studies in America have shown up to 2.9% of women attending various home visit services were unknowingly infected with gonorrhoea
A lack of adequate screening programmes means cases go undetected
Symptoms do not occur in:50 to 70% of women
Up to 10% of men
90% of gonorrhoeal throat infections
How Do You Test for Gonorrhoea?
The good news is that testing for gonorrhoea is very straightforward. There’s a simple urine test that can identify gonorrhoea infection as well as other STIs. You can easily book online for an STI test. Once you attend our home visit service, our nurse will collect a sample of urine. It only takes 10 minutes and the service is completely confidential. The results will be back within 1-3 working days as an email link so that you can quickly access them.
If you have symptoms or your urine test is positive then you will need additional bacterial swab tests. The type of swab will depend on your gender and where you have symptoms.
The kind of gonorrhoea swab test men can expect:
Penis
Throat
Rectal (if you have symptoms, you’ve had anal sex or you’re a man who has sex with other men)
Gonorrhoea swab tests for women:
Cervix - neck of the womb
Throat
Rectal (if you have symptoms or had anal sex)
When Should you get Tested for Gonorrhoea?
The first question should really be… ‘Should I get tested?’ We’d recommend getting tested in the following situations:
You or your sexual partner have symptoms of gonorrhoea
Your sexual partner tests positive for gonorrhoea
Every time you have sex with a partner without a condom
A regular annual test is also recommended
Get tested anyway if you have any concerns
Benefits of regular gonorrhoea testing and treatment include:
Early detection of infection and treatment to improve your wellbeing
Helps prevent severe complications of disseminated (generalised spread) gonorrhoea
Helps prevent transmission of the infection to your partner
Prevents pregnant women from transmitting gonorrhoea to the baby
If you think you might need a test, you can get a free gonorrhoea test through the NHS or alternatively, you can get a completely confidential STI screen at Vaxly. We don’t even need to tell your GP if you don’t want us to.
Please bear in mind we can’t confidently exclude gonococcal infection immediately after sexual contact. We’d therefore advise repeat testing at least 2 weeks from the sexual encounter, even if you don’t have symptoms.
How Long Do Test Results Take?
NHS services usually take 1-2 weeks to come back and are usually a text message. With Vaxly, the results are usually back within 1-3 working days and we’ll send you a confidential email with a link to access your results.
Gonorrhoea Treatment
Gonorrhoea treatment is very simple with a single intra-muscular injection of an antibiotic called ceftriaxone. If you’re afraid of needles, oral antibiotic tablets (Cefixime and Azithromycin) can be given but this can also be completed all in one day.
Ok. The treatment is simple but can I have sex straightaway? No. You/your partner should not have sexual contact or oral sex until at least 7 days after you’ve received treatment.
What about another test to make sure that the infection is clear? If you’ve had the swabs and you’ve received intramuscular ceftriaxone, then this isn’t usually needed.
The British Association for Sexual Health and HIV(BASHH) recommend a Test of Cure if you:
have not had intramuscular ceftriaxone as treatment
have not had swabs to make sure the bacteria is not resistant to antibiotics
have had a pharyngeal (throat) infection
are pregnant
have persistent symptoms or signs
Why Does Gonorrhoea Sometimes Recur Even After Successful Treatment?
Gonorrhoea, if managed and treated properly, should not recur. If you’ve had a recurrence, it could be because:
treatment courses have not been completed
swabs have not been taken to check if the bacteria is resistant to the antibiotics
tests of cure have not been done when appropriate to do so (see above)
sexual contact/oral sex within 7 days of treatment
you may have simply got re-infected from someone else through further unprotected sexual intercourse
Can You Cure Gonorrhoea?
Absolutely. It’s easily treatable (see above) but if you don’t get treatment, things get much worse and more difficult to treat (see complications). So it’s vital that you get regular testing at least once a year or every time you have a new sexual partner. This is free through the NHS, or Vaxly can offer a private and confidential gonorrhoea and STI testing service.
How to Prevent Gonorrhoea Spreading
With the rapid rise in gonorrhoea cases since Covid, especially antibiotic resistant cases, preventing the spread of gonorrhoea is more important than ever.
Here’s what you can do:
Use condoms when having vaginal or anal sex
Use condoms to cover the penis or a plastic square (dam) to cover the vagina when having oral sex
Regular testing (eg at Vaxly) at least once a year or with every new partner
Making sure you and your partner complete any antibiotic course prescribed
Frequently Asked Questions about Gonorrhoea
Why is early diagnosis of gonorrhoea crucial for long-term health?
Early diagnosis and treatment can prevent the spread, severe disease and long-term complications of gonorrhoea. If you get tested within 2 weeks of a sexual contact, we can’t always exclude infection in the early stages so we recommend a repeat test after 2 weeks.
What are the complications of untreated gonorrhoea?
Left untreated, gonorrhoea can ‘disseminate’ or spread. Complications can include:
Disseminated gonococcal infection (spread through the blood stream causing sepsis and joint infections)
Endocarditis (infection of the heart valves)
Meningitis (inflammation of the lining of the brain)
Ocular infections (scarring of the eyes potentially leading to visual problems, especially in babies born to mothers with infection during pregnancy)
Pelvic inflammatory disease which may lead to infertility
What are the key differences between gonorrhoea and chlamydia symptoms?
There are, in fact, more similarities than differences. Gonorrhoea tends to cause more severe symptoms over a shorter period of time (1 week vs 2 weeks) and causes thicker, greenish discharge. Learn more about chlamydia symptoms, testing and treatment in our recent article.
What should I do if I think I've been exposed to gonorrhoea?
If you think you’ve been affected, then get tested early for prompt treatment, and let the health care professional know of who your sexual contacts have been.
Can I get a free gonorrhoea test?
You can get a free NHS gonorrhoea test at an NHS sexual health home visit service or alternatively book a test online at Vaxly:
What is the global prevalence of antibiotic-resistant gonorrhoea strains?
Antibiotic resistant gonorrhoea strains are a real concern worldwide. From 2022 to 2024, the WHO reported worrying increases in resistance for the two major antibiotics used:
0.8% to 5% for ceftriaxone
1.7% to 11% for cefixime
Accurate testing, early treatment with appropriate antibiotics, and partner tracing and testing are now more important than ever.
References
Written and Approved by:
Consultant Physician in General Internal Medicine
MBBS, MRCP(UK), DTM&H, MRCGP, DCH, DRCOG, DFFP
