What is gonorrhea? Gonorrhea is a sexually transmitted infection colloquially known as “the clap.” The infection can be cured, but it must first be detected because people with the infection often experience no symptoms at all.
Even today, sexually transmitted infections (or STIs) are not as rare as many people think. The World Health Organization (WHO) estimates that around one million people worldwide become infected with sexually transmitted infections (STI) every day.[1] In the United States, reports have revealed that there were approximately 1.6 million new gonorrhea infections nationwide in 2018 – and that over 50 percent of these were reported in young adults aged 15 to 24 years old.
Once gonorrhea has been detected, it is usually very treatable. But sometimes, people affected experience no gonorrhea symptoms at all, and people spread the infection without realizing it. This is precisely why condoms and regular testing play a vital role in helping prevent gonorrhea infection.
Read this article to find out answers to commonly asked questions – for example: “What is gonorrhea?”, “Who is most often affected?”, and “What does gonorrhea look like?” We will tell you how gonorrhea is diagnosed through sexual health tests, and forms of gonorrhea treatment. We will also explore reasons why antibiotic resistance is a big problem in the fight against gonorrhea.
What Is Gonorrhea?
The sexually transmitted infectious infection (STI) gonorrhea is also known by its colloquial name “the clap.” In the United States, the number of reported gonorrhea cases have increased heftily by 92 percent since 2009, equalling over 600,000 in 2019.[12]
The STI is caused by a bacterium called Neisseria gonorrhoeae, which is also called “gonococcus.” These gonococci are transmitted mainly during sexual intercourse.
Who Is Most Often Affected by Gonorrhea?
Sexually active people between 15 and 44 years of age are most frequently affected by a gonorrhea infection. Health authorities have also stated that there is a high incidence of the infection in men who have sex with men (MSM).
Furthermore, according to further reports, sex workers are affected more often than average.[2–4] Other risk groups include those with an HIV infection, people who have had sex with more than five people within the period of six months, and people who regularly have sex without a condom.
In general, men suffer from gonorrhea significantly more often than women. Nationwide, the rate of reported infections has been higher among men than women since 2013. Experts believe that this higher incidence among men could be due to a number of reasons, including a greater rate of transmission between men or a greater rate of testing among men – particularly men who have sex with men – or both.[12]
What Causes Gonorrhea: How Gonorrhea Spreads
What causes gonorrhea? Gonococci are transmitted through direct contact between mucous membranes, usually in the genital or anal area or in the throat. This usually happens through unprotected sexual intercourse. Ejaculation does not have to occur for gonorrhea to be transmitted from one person to the next.[11]
Pathogens can also reach the eyes by contact with the hands and cause purulent conjunctivitis, which, in the worst case, can lead to blindness. Even those affected who do not notice any symptoms can infect others with gonorrhea.
Gonorrhea Transmission: Can Gonorrhea Be Passed on from Mother to Child?
The gonorrhea pathogen can be transmitted to a newborn during birth, in which case, its eyes are often affected, leading to conjunctivitis. In some cases, transmission can lead to more serious consequences in a newborn, such as blindness, a joint infection, or a life-threatening blood infection.[11] In the United States, this is why precautionary pregnancy screenings for sexually transmitted illness are strongly recommended.
Gonorrhea Prevention: How Do I Prevent an Infection?
In 2018 a study looked at how STIs are prevalent among men who have sex with men in Germany. Gonorrhea and other STIs were more common among men who were taking a preventive medication against HIV, called pre-exposure prophylaxis (PrEP) – and were probably more likely to have sex without a condom. According to the study, the use of party drugs also seems to be a risk factor.[5]
Gonorrhea Symptoms: What Does Gonorrhea Look Like?
What does gonorrhea look like? Gonorrhea symptoms depend on which part of the body has been infected with the gonococci.
The genital area – especially the urethra – the rectum, and the throat are the most commonly affected areas. The incubation period – that is, the time between infection and initial gonorrhea symptoms – varies between one to 14 days, if symptoms develop at all.
A throat infection (pharyngeal gonorrhea) usually occurs without symptoms. In rare cases, those infected may experience a sore throat.[7]
What about Symptoms of Gonorrhea in Women?
About 50 percent of women who contract gonorrhea have an asymptomatic infection, meaning that they experience no symptoms at all.[2]
The following gonorrhea symptoms occur most frequently in women:
- More vaginal discharge, which often looks or smells unusual
- Burning when urinating and pain in the lower abdomen
- Bleeding between periods and increased menstrual bleeding (although this is less common)
Gonorrhea during pregnancy can cause many complications. Among other things, it can increase the likelihood of premature birth, miscarriages, and stillbirths. For this reason, women who want to have children should check whether they are suffering from any undetected STIs.[6]
What Are Signs of Gonorrhea in Men?
A total of 10 to 30 percent of men who become infected with gonorrhoea experience no symptoms at all.[2]
Most affected men show clear symptoms a few days after infection. The main gonorrhea symptoms are:[8]
- Purulent discharge from the urethra – usually white, yellow, or greenish in color
- Burning and difficulties when urinating
- Painful or swollen testicles (although this is less common)
Are There Any Rectal Gonorrhea Symptoms?
Rectal gonorrhea often occurs without symptoms. Undiagnosed rectal gonorrhea can lead to affected persons infecting others unknowingly.
There are, however, some possible symptoms, including:
- An itchy anus
- Inflammation of the mucous membrane in the rectum
Will Gonorrhea Go Away?
If you are given the right treatment, gonorrhea can be cured with antibiotics. More information about gonorrhea treatment can be found further down in this article.
If gonorrhea remains untreated, this could have serious health consequences. In women, it can lead to pelvic inflammatory disease, among other things, if the bacteria migrate upward. Another possible complication is that the fallopian tubes are left scarred, which can cause infertility and ectopic pregnancies – that is, pregnancies, where the egg is implanted outside the uterus.[8] In rare cases, untreated gonorrhea in men can also lead to infertility.
If an infection does not receive the treatment it requires, gonorrhea can also spread to a person’s blood and cause disseminated gonococcal infection (DGI), a life-threatening condition, which is usually characterized by arthritis, tenosynovitis, and dermatitis. Moreover, untreated gonorrhea can increase a person’s risk of becoming infected or infecting someone with HIV.[11]
Gonorrhea Screening: How Do You Diagnose Gonorrhea?
Gonorrhea pathogens can be detected in laboratory tests – whether these are performed at the doctor’s or at home with home tests. People who show typical gonorrhea symptoms, who have had other STIs such as chlamydia, syphilis, or HIV, or whose sexual partners have been infected with gonorrhea are usually examined.
Doctors usually take swabs of the affected mucous membranes if gonorrhea is suspected. If you have had sexual contact with men (regardless of your sex), samples are often taken from several parts of the body, as the bacteria can lurk in your throat or rectum, for example, without any symptoms.
If your genital area is infected, urine samples may also be taken, which are then examined in the laboratory. These samples are especially insightful for men and pregnant women, for whom urine tests are also used in STI screening.
A laboratory then determines whether the Neisseria gonorrhoeae bacterium is present in the sample, either by examining the sample under a microscope, investigating the cultural cultivation of the bacteria, or detecting nucleic acids by amplification tests.[6, 7]
The US Center for Disease Control and Prevention recommends that people who have gonorrhea should also let themselves be tested for other sexually transmitted infections, such as chlamydia, syphilis, or hepatitis C.
Do I Need to Report a Positive Result?
Health care providers in the United States are required by law to report all cases of gonorrhea. This is to ensure that patients receive the necessary follow-up treatment – previous partners who may also be infected are also supposed to found and tested for gonorrhea.[13]
Gonorrhea Treatment: Can Gonorrhea Be Cured?
As a rule, gonorrhea can be treated very well with antibiotics. Which active substances are used in which doses depends on the exact pathogen and which part of the body is affected. Usually, you only need one or two doses of the medication.
It is important to note that although an infection can be stopped with the right medication, permanent damage caused by a gonorrhea infection cannot be reversed.
After you have started antibiotic treatment, the gonococci are usually already killed after 24 hours, and you are no longer infectious. Nevertheless, experts recommend that you do not have sex until seven days after starting treatment – at the earliest. This way, you minimize the risk of infecting someone else and then re-infecting yourself later.[2]
It is also recommended that you contact sexual partners so that they can be tested and, if necessary, treated. If an infected person has experienced gonorrhea symptoms, they should contact any sexual partners they have had within the previous eight weeks. If they have not had any symptoms, they should inform their sexual contacts from the previous six months.[6] Unfortunately, once you have fully treated gonorrhea, you are not immune to gonococci and can become infected again at any time.[2]
Gonorrhea Treatment: Why Is Antibiotic Resistance Problematic?
A growing problem in gonorrhea treatment is that some strains of the bacterium are developing resistance to some common antibiotics. This has rendered previously effective antibiotics ineffective. In 2019 it was reported that over 50 percent of infections in the United States were estimated to be resistant to at least one antibiotic. This is why it is important to switch to other antibiotics and the keep monitoring resistance to antibiotics during gonorrhea treatment.
What Is Gonorrhea – at a Glance
What Is Gonorrhea?
Gonorrhea (also called the clap) is a sexually transmitted infectious disease. It is caused by the bacterium Neisseria gonorrhoeae (gonococcus).
People usually become infected through unprotected sexual intercourse. In addition to the mucous membranes in the genital area, the throat and rectum can also be affected.
Who Is Most Affected by Gonorrhea?
Gonorrhea occurs most frequently in young people between 15 and 44. Men are affected significantly more often, especially men who have sex with men (MSM).
What Are Typical Gonorrhea Symptoms?
Many gonorrhoea sufferers have no symptoms at all – in about 50 percent of women and 10 to 30 percent of men, the infection is asymptomatic.
Typical gonorrhea symptoms in women are an unusual-looking and odd-smelling discharge, burning when urinating, and, more rarely, menstrual cramps.
Typical symptoms in men are discharge from the urethra, burning and pain when urinating, and, in rare cases, swollen and painful testicles.
If the rectum is affected, those affected may experience an itchy anus.
How Is Gonorrhea Treated?
In most cases, gonorrhea can be treated well with antibiotics. Doctors will choose your medication depending on the exact pathogen and which part of the body is affected.
After treatment, you should not have sex for seven days to make sure you do not infect anyone else. You should also inform your sexual partners of the last weeks and months.
Sources
[1] “Sexually transmitted infections (STIs),” available at https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis), accessed on July 14, 2021.
[2] Robert-Koch-Institut, “Gonorrhö (Tripper) RKI-Ratgeber,” available at www.rki.de. https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Gonorrhoe.html, accessed on July 12, 2021.
[3]. Kirkcaldy R. D., Weston E., Segurado A. C., Hughes G. “Epidemiology of Gonorrhea: A Global Perspective,” Sex Health, vol. 16(5), pp. 401–411, September 2019, doi: 10.1071/SH19061.
[4] B. für G. BAG, „Gonorrhoe (Tripper),” available at https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberblick/gonorrhoe.html, accessed on July 15, 2021.
[5] Jansen K. et al. “STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany,” BMC Infectious Diseases, vol. 20(1), pp. 110, February 2020, doi: 10.1186/s12879-020-4831-4.
[6] Deutsche STI-Gesellschaft e.V. (DSTIG) - Gesellschaft zur Förderung der Sexuellen Gesundheit, “S2k-Leitlinie Diagnostik und Therapie der Gonorrhoe, 2018,” available at https://www.awmf.org/uploads/tx_szleitlinien/059-004l_S2k_Gonorrhoe-Diagnostik-Therapie_2019-03.pdf, accessed on July 12, 2021.
[7] Fifer H., Saunders, J., Soni S., Sadiq S. T., FitzGerald M. “2018 UK national guideline for the management of infection with Neisseria gonorrhoeae,” Int J STD AIDS, vol. 31(1), pp. 4–15, January 2020, doi: 10.1177/0956462419886775.
[8] “STD Facts - Gonorrhea,” October 22, 2019, available at https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm, accessed on July 12, 2021.
[9] Selb R., Bremer V., Buder S., Heuer D. “Einführung einer Meldepflicht für N. gonorrhoeae mit verminderter Empfindlichkeit gegenüber Azithromycin, Cefixim oder Ceftriaxon,” Epid Bull, vol. 10, March 2020, doi: 10.25646/6526.
[10] Bremer V., Dudareva-Vizule, S., Buder S., an der Heiden M., und Jansen K. “Sexuell übertragbare Infektionen in Deutschland,” Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, vol. 60(9), 2017, doi: 10.1007/s00103-017-2590-1.
[11] Centers for Disease Control and Prevention, “Gonorrhea – CDC Fact Sheet (Detailed Version),” available at https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm, accessed on October 12, 2021.
[12] Centers for Disease Control and Prevention, “National Overview - Sexually Transmitted Disease Surveillance, 2019,” available at https://www.cdc.gov/std/statistics/2019/overview.htm#Gonorrhea, accessed on October 12, 2021.
[13] Medline Plus, “Gonorrhea,” available at https://medlineplus.gov/ency/article/007267.htm, accessed on October 12, 2021.
