Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 30, 2016

Gonorrhea is a common sexually transmitted disease (STD). It is easily spread and often has little to no symptoms in the infected person. With proper measures, gonorrhea is preventable, easily treated in most cases, and curable.


Definition & Facts

Gonorrhea is one of the oldest known sexually transmitted diseases affecting both males and females. Caused by the highly contagious bacterium, Neisseria gonorrhoeae, it is the fourth most common STD. The Centers for Disease Control cites there are over 20 million new cases of sexually transmitted infections (STI) per year in the United States. Of these cases, they estimate more than 820,000 of new infections are gonorrhea.

While all age groups and populations are at risk, sexually active adolescents and young adults are the most likely to become infected. The CDC estimates 570,000 new infections which is more than half, are acquired by people ages 15-24. Other statistically high incident groups are: urban and southern U.S. dwellers, African Americans particularly females, and drug users, particularly intravenous drug users.

Symptoms & Complaints

Many people who contract gonorrhea have mild symptoms if they have any at all, particularly in the early stages of the infection. Symptoms for women often mimic and can initially be mistaken for other illnesses, such as a yeast infection or a urinary tract infection. If the infection is located in the cervix, females may experience: frequent urination and/or painful urination, swollen genitals, red genitals, increased or abnormal vaginal discharge, possibly with a yellow or green colored tinge and bleeding in between periods.

An infection located in a male's urethra may cause: frequent urination, yellow, green or white colored discharge like pus from the penis and sore testicles. Both females and males with rectal infections may have anal soreness, anal itching, thick discharge and/or anal bleeding. If symptoms appear at all, they are more often experienced by males after infection occurs. For females, experiencing symptoms are less common.


Gonorrhea is spread through sexual contact from an infected person to their partner. It infects both males and females and is passed through vaginal sex, oral sex or anal sexual contact. It can also be spread through sharing needles while using intravenous drugs, and passed from pregnancy mother to her baby during childbirth.

A common misconception among the general public is that gonorrhea can infect others by using the same public toilet, shaking hands or touching other common surfaces, like door handles, that an infected person touched. The bacteria is not spread through common contact. It lives and grows only within warm, moist areas of the body, including the eyes, throat, penis, vagina, and anus.

It spreads through contact specifically with bodily fluids infected with the bacteria. A male does not need to ejaculate in order to spread the infection. Less commonly, an uninfected person can contract the bacteria with their hands touching infected genitals and then their eyes.

Diagnosis & Tests

Diagnosis begins with a visit to a healthcare provider. After asking questions and performing a physical examination, the doctor or nurse will run tests to determine if the bacteria, including N. gonorrhoeae, is present in the body. There are a few possible tests that may be performed to determine the infection.

A gram stain involves taking a small sample of discharge or tissue that is then examined under a microscope. It is a quick test, but may not reliably detect the bacteria. If the infection is located in the male's urethra or female's cervix, a urine test may occur in which a urine sample is taken from the patient and tested. Likewise, a swab of the infected site: the urethra, cervix, anus or throat, is sent to the laboratory to be cultured for analysis. The bacteria will be confirmed within 72 hours.

Increasingly, despite being costlier than the other methods, DNA tests are being used. Urine samples, rather than the more invasive swab samples can be used in DNA tests, and the results are faster and more accurate. The patient may also be tested and treated for other STDs in addition to gonorrhea. For instance, chlamydia is present 50% of the time when gonorrhea is diagnosed in a patient.

If the infection is diagnosed relatively quickly before it's had time to spread, a round of antibiotics is normally adequate to cure the infection. While in the past there were many effective antibiotics, lately antibiotic resistance has been building in different bacterial strains, leaving fewer effective options.

Treatment & Therapy

Currently, the recommended treatment for an uncomplicated infection is with an injection of the antibiotic ceftriaxone along with an oral antibiotic: either doxycycline or azithromycin. While being treated, it's important for patients to abstain from sexual contact. Anyone who has had recent sexual contact with the infected person should be notified for testing. A subsequent test after treatment may need to be taken to confirm the bacteria is no longer present.

When the infection is cured, it's important to note, the patient can be reinfected if exposed again to the bacteria. Having partners tested and treated is an important step, as all preventative measures to avoid reinfection should be taken. Sometimes providers will preemptively issue antibiotics for the patient's partner.

Due to the mild and non-specific nature of the symptoms, gonorrhea in women can spread undetected and become a more serious illness. Untreated STDs is a leading cause of pelvic inflammatory disease (PID), a serious infection of the female reproductive system. If PID is left untreated, scar tissue in and around the Fallopian tubes may occur which could cause difficulty getting pregnant or even infertility.

Prevention & Prophylaxis

Gonorrhea is preventable if the proper precautions are taken. Using a latex condom as recommended when engaging in any sexual activity, including oral sex, every time is vital. Regular screenings for sexual transmitted infection is necessary for individuals and their partners. The CDC recommends all sexually active people who have new or multiple sexual partners to be tested once a year.