Introduction

Gonorrhoea is a sexually transmitted infection (STI) caused by bacteria called Neisseria gonorrhoeae or gonococcus. It used to be known as "the clap".

The bacteria are mainly found in discharge from the penis and vaginal fluid from infected men and women.

Gonorrhoea is easily passed between people through:



unprotected vaginal, oral or anal sex



sharing vibrators or other sex toys that haven't been washed or covered with a new condom each time they are used



The bacteria can infect the cervix (entrance to the womb), the urethra (tube that carries urine out of the body), the rectum and, less commonly, the throat or eyes. The infection can also be passed from a pregnant woman to her baby.

Gonorrhoea is not spread by kissing, hugging, sharing baths or towels, swimming pools, toilet seats, or sharing cups, plates and cutlery, because the bacteria can't survive outside the human body for long.

Signs and symptoms

Typical symptoms of gonorrhoea include a thick green or yellow discharge from the vagina or penis, pain when urinating and bleeding in between periods in women.

However, around 1 in 10 infected men and almost half of infected women don't experience any symptoms.

Getting tested

If you have any of the symptoms of gonorrhoea or you are worried you may have an STI, you should visit your local genitourinary medicine (GUM) or sexual health clinic for a sexual health test.

Gonorrhoea can be easily diagnosed by testing a sample of discharge picked up using a swab. Testing a sample of urine can also be used to diagnose the condition in men.

It's important to get tested as soon as possible because gonorrhoea can lead to more serious long-term health problems if it's not treated, including pelvic inflammatory disease (PID) in women, or infertility.

You can find your nearest sexual health clinic by searching by postcode or town.

For information on all sexual health services, visit the FPA website.

Treating gonorrhoea

Gonorrhoea is usually treated with a single antibiotic injection and a single antibiotic tablet. With effective treatment, most of your symptoms should improve within a few days.

It's usually recommended that you attend a follow-up appointment a week or two after treatment so another test can be carried out to see if you are clear of infection.

You should avoid having sex until you have been given the all-clear.

Who is affected?

Anyone who is sexually active can catch gonorrhoea, especially people who change partners frequently or don't use a barrier method ofcontraception such as a condom when having sex.

Gonorrhoea is the second most common bacterial STI in the UK afterchlamydia. More than 25,000 cases were reported in England during 2012, with most cases affecting young men and women under the age of 25.

Previous successful treatment for gonorrhoea doesn't make you immune from catching the infection again.

Preventing gonorrhoea

Gonorrhoea and other STIs can be successfully prevented by using appropriate contraception and taking other precautions, such as:



using male condoms or female condoms every time you have vaginal sex, or male condoms during anal sex



using a condom to cover the penis, or a latex or plastic square (dam) to cover the female genitals, if you have oral sex



not sharing sex toys, or washing them and covering them with a new condom before anyone else uses them



If you are worried you may have an STI, visit your local GUM or sexual health clinic for advice.

Symptoms of gonorrhoea 

Symptoms of gonorrhoea usually develop within about 10 days of being infected, although they sometimes may not appear until many months later.

About 1 in 10 infected men and half of infected women will not experience any obvious symptoms, which means the condition can go untreated for some time.

Symptoms in women

In women, symptoms of gonorrhoea can include:



an unusual vaginal discharge, which may be thick and green or yellow in colour



pain or a burning sensation when passing urine



pain or tenderness in the lower abdominal area (this is less common)



bleeding between periods, heavier periods and bleeding after sex (this is less common)



Symptoms in men

In men, symptoms of gonorrhoea can include:



an unusual discharge from the tip of the penis, which may be white, yellow or green



pain or a burning sensation when urinating



inflammation (swelling) of the foreskin



pain or tenderness in the testicles (this is rare)



Infection in the rectum, throat or eyes

Both men and women can also develop an infection in the rectum, eyes or throat by having unprotected anal or oral sex. If infected semen or vaginal fluid comes into contact with the eyes, you can also develop conjunctivitis.

Infection in the rectum can cause discomfort, pain or discharge. Infection in the eyes can cause irritation, pain, swelling and discharge. Infection in the throat usually causes no symptoms.

Seeking medical advice

It's important to be tested for gonorrhoea if you think there is a chance you are infected, even if you have no obvious symptoms or the symptoms have gone away on their own.

If gonorrhoea is left undiagnosed and untreated, you can continue to spread the infection and there is a risk of potentially serious complications, including infertility.

Diagnosing gonorrhoea  

The only way to find out if you have gonorrhoea is to be tested. If you suspect that you have it or any other , it's important not to delay getting tested.

It's possible to be tested within a few days of having sex, but you may be advised to wait up to two weeks. You can be tested even if you do not have any symptoms.

Early diagnosis and treatment of gonorrhoea will reduce the risk of any complications developing, such as pelvic inflammatory disease or infection in the testicles. Complications that arise from long-term infection are much more difficult to treat.

Who should get tested

It is recommended you get tested if:



you or your partner think you have symptoms of gonorrhoea



you have had unprotected sex with a new partner



you or your partner have had unprotected sex with other people



you have another STI



a sexual partner tells you that they have an STI



during a vaginal examination your nurse or doctor tells you that the cells of your cervix are inflamed or there is discharge



you are pregnant or planning a pregnancy



Where to get tested

There are several different places you can go to be tested for gonorrhoea:



a genitourinary medicine (GUM) or sexual health clinic



your GP surgery



a contraceptive and young people's clinic



a private clinic



It is possible to buy a gonorrhoea test from a pharmacy to do yourself at home. However, these tests vary in accuracy so it is recommended that you go to your local sexual health service.

You can find details of your nearest sexual health or GUM clinic in the phone book, or find your nearest sexual health clinic by searching by postcode or town. You can attend these clinics at any age and all results are treated confidentially.

If you go to your GP practice, you may have to pay a prescription charge for any treatment.

Testing for gonorrhoea

There are a number of different ways to test for gonorrhoea. In many cases a swab will be used to remove a sample for testing, although men may only be asked to provide a urine sample.

A swab looks a bit like a cotton bud, but it's smaller and rounded. It is wiped over parts of the body that may be infected to pick up samples of discharge. This only takes a few seconds and is not painful, although it may be a little uncomfortable.

The different tests that may be used to detect gonorrhoea in men and women are described below.

Women

For women, a doctor or nurse will usually take a swab to collect a sample from the vagina or cervix (entrance to the womb) during an internal examination. In some cases, a sample may also be taken from the urethra (tube that carries urine out of the body).

Sometimes you may be asked to use a swab or tampon to collect a sample from inside your vagina yourself.

Women are not usually asked to provide a urine sample to check for gonorrhoea because this is a less accurate test in women.

Men

Men will normally be asked to provide a urine sample, or a swab may be used to remove a sample of discharge from the end of the penis.

If you are asked to provide a urine sample, it's important not to urinate for about two hours beforehand because this can wash the bacteria away and affect the results of the test.

Infections of the rectum, throat and eyes

If there is a possibility that your rectum or throat is infected, the doctor or nurse may need to use a swab to collect a sample from these areas.

If you have symptoms of conjunctivitis, such as red, inflamed eyes with discharge, a sample of the discharge may be collected from your eye.

Getting the results

Some clinics may be able to carry out rapid tests, when the doctor can view the sample through a microscope and give you your test results straight away. Otherwise, you will have to wait up to two weeks to get the results.

Treating gonorrhoea 

Gonorrhoea is usually treated with a short course of antibiotics.

Treatment is recommended if:



tests have shown that you have gonorrhoea (see diagnosing gonorrhoea for more information)



there is a high chance that you have gonorrhoea, even though your test results haven't come back yet



your partner is found to have gonorrhoea



In most cases, treatment will involve having a single antibiotic injection (usually in the buttocks or thigh) followed by one antibiotic tablet. It is sometimes possible to have another antibiotic tablet instead of an injection if you prefer.

If you have any symptoms of gonorrhoea, these will usually improve within a few days, although it may take up to two weeks for any pain in your pelvis or testicles to go away completely. Bleeding betweenperiods or heavy periods should improve by the time of your next period.

Attending a follow-up appointment a week or two after treatment is usually recommended so that another test can be carried out to see if you are clear of infection.

You should avoid having sex until you (and your partner) have been treated and given the all-clear to prevent re-infection or passing the infection on to anyone else.

If your symptoms do not improve after treatment or you think you have been infected again, see your doctor or nurse. Treatment may need to be repeated, or you may need further tests to check for other problems.

Sexual partners

Gonorrhoea is easily passed on through intimate sexual contact. If you are diagnosed with it, anyone you have recently had sex with may have it too. It is important that your current partner and any other recent sexual partners are tested and treated.

Your local genitourinary medicine (GUM) or sexual health clinic may be able to help by notifying any of your previous partners on your behalf.

A contact slip can be sent to them explaining that they may have been exposed to a sexually transmitted infection (STI) and suggesting that they go for a check-up. The slip will not have your name on it, so your confidentiality is protected.

Complications of gonorrhoea 

If treated early, gonorrhoea is unlikely to lead to any complications or long-term problems. However, without treatment it can spread to other parts of your body and cause serious problems.

The more times you have gonorrhoea, the more likely you are to get complications.

In women, gonorrhoea can spread to the reproductive organs and cause pelvic inflammatory disease (PID), which is estimated to occur in 10-20% cases of untreated gonorrhoea. PID can lead to long-term pelvic pain, ectopic pregnancy and infertility.

During pregnancy, gonorrhoea can cause miscarriage, premature labour and the baby being born with conjunctivitis (inflammation of the eye). If the baby is not treated with antibiotics promptly, there is a risk of progressive and permanent damage of their vision.

In men, gonorrhoea can cause painful infection in the testicles and prostate gland, which may lead to reduced fertility in a small number of cases.

In rare cases, when gonorrhoea has been left untreated it can spread through the bloodstream to cause infections in other parts of your body. In both men and women this can cause:



inflammation and swelling of the joints and tendons



skin irritation and redness



inflammation around the brain and spinal cord (meningitis) or the heart, which can be life threatening





Gonorrhoea