Everything You Need to Know About Gonorrhoea

What Is Gonorrhoea?

Gonorrhoea is a bacterial sexually transmitted infection caused by *Neisseria gonorrhoeae*. It's one of the most common STIs in the UK, with over 80,000 diagnoses annually – and rising.

The infection can affect the genitals, rectum, throat, and eyes. It's highly contagious but completely curable with appropriate antibiotics.

How Is Gonorrhoea Transmitted?

Gonorrhoea spreads through:

Sexual Contact

• Unprotected vaginal sex
• Unprotected anal sex
• Unprotected oral sex (giving or receiving)
• Sharing sex toys without proper cleaning or condom use

During Childbirth

• Mother to baby during delivery
• Can cause serious eye infections in newborns

What Doesn't Transmit Gonorrhoea

• Toilet seats
• Swimming pools
• Sharing towels or cutlery
• Kissing (though emerging research suggests deep kissing may rarely transmit throat gonorrhoea)
• Casual contact

Symptoms of Gonorrhoea

Symptoms vary by infection site and sex.

In Men (Genital Infection)

Symptoms are more common in men and may include:

• Unusual discharge from the penis (white, yellow, or green)
• Pain or burning when urinating
• Pain or swelling in the testicles (less common)
• Increased urinary frequency

About 10% of men have no symptoms.

In Women (Genital Infection)

Women are more likely to be asymptomatic:

• Unusual vaginal discharge (may be thin, watery, yellow, or green)
• Pain or burning when urinating
• Bleeding between periods or after sex
• Lower abdominal or pelvic pain
• Pain during sex

About 50% of women have no symptoms.

Throat Infection (Pharyngeal)

• Usually no symptoms
• Occasionally: sore throat, redness, swollen glands
• Easily mistaken for other causes of sore throat

Rectal Infection

• Often no symptoms
• When present: discharge, itching, soreness, bleeding, pain during bowel movements

Eye Infection (Conjunctivitis)

• Redness, irritation, discharge from the eye
• Can occur through hand-to-eye contact with infected secretions
• Serious if untreated – can threaten vision

Complications of Untreated Gonorrhoea

Without treatment, gonorrhoea can cause serious problems:

In Women

• Pelvic inflammatory disease (PID): Infection spreading to uterus, fallopian tubes, ovaries
• Chronic pelvic pain
• Ectopic pregnancy: Life-threatening pregnancy outside the uterus
• Infertility: From scarring of fallopian tubes

In Men

• Epididymitis: Painful infection of the tubes next to the testicles
• Infertility (rare but possible)
• Urethral stricture: Narrowing of the urethra

In Both Sexes

• Disseminated gonococcal infection (DGI): Bacteria spread through bloodstream
• Causes fever, joint pain, skin lesions
• Can affect heart valves (rare)
• Increased HIV risk: Having gonorrhoea makes you more susceptible to HIV

In Pregnancy

• Premature birth
• Low birth weight
• Infection passed to baby during delivery
• Eye infection (ophthalmia neonatorum) in newborns – can cause blindness

Testing for Gonorrhoea

How It's Tested

• Urine sample (for genital infection, particularly in men)
• Swab tests:
• Vaginal or cervical swab (women)
• Urethral swab (men) – less common now
• Throat swab (if oral sex history)
• Rectal swab (if anal sex history)

Testing Uses NAAT

• Nucleic acid amplification tests (NAAT) detect bacterial DNA
• Highly accurate
• Results typically within a few days

When to Get Tested

• 2 weeks after potential exposure
• If you have symptoms
• If a partner has been diagnosed
• As part of regular sexual health screening

Where to Get Tested

• Sexual health clinics (free and confidential)
• GP surgery
• Online testing services
• Private clinics

Treatment for Gonorrhoea

Current UK Treatment

The recommended treatment in the UK is:

• Ceftriaxone 1g intramuscular injection (single dose)

This is the same treatment regardless of infection site (genital, throat, or rectal).

Why Injection?

• Ensures you receive the full dose
• No compliance issues with tablets
• Most effective against resistant strains

After Treatment

• Avoid sex for 7 days after you and your partner(s) have completed treatment
• Test of cure recommended 2 weeks after treatment
• Particularly important for throat infections (harder to cure)
• Confirms the infection has cleared
• Partner notification: Sexual partners need testing and treatment

What About Over-the-Counter Treatment?

There is no over-the-counter treatment for gonorrhoea. You need a prescription from a healthcare provider, and injection treatment requires a clinic visit.

The Antibiotic Resistance Crisis

Gonorrhoea is becoming increasingly difficult to treat due to antibiotic resistance.

Historical Treatments Now Ineffective

Gonorrhoea has developed resistance to:

• Penicillin
• Tetracyclines
• Fluoroquinolones (ciprofloxacin)
• Azithromycin (increasingly)
• Cefixime (oral cephalosporin)

Current Concerns

• Resistance to ceftriaxone is emerging globally
• Some "super-gonorrhoea" cases have been difficult to treat
• The UK has reported cases resistant to multiple antibiotics

Why This Happens

• Bacteria naturally evolve resistance over time
• Incomplete treatment (not finishing courses)
• The throat is a reservoir where resistance develops
• Global spread through travel

What This Means for You

• Complete any prescribed treatment
• Attend test of cure appointments
• Don't share or stockpile antibiotics
• Use protection to prevent infection in the first place

Partner Notification

If you're diagnosed with gonorrhoea:

Who Needs to Know

• All sexual partners from the past 2 weeks (or your last partner if longer)
• They need testing and treatment even if they have no symptoms

How to Notify

• Tell them yourself – direct and honest
• Use clinic partner notification services (can be anonymous)
• Some online tools allow anonymous notification

Why It Matters

• Prevents re-infection (ping-pong effect)
• Protects partners from complications
• Reduces community transmission

Prevention

Condoms

• Highly effective at preventing gonorrhoea
• Use for vaginal, anal, and oral sex
• Use correctly every time with new or casual partners

Regular Testing

• Get tested between partners
• Regular screening if you have multiple partners
• Include throat and rectal swabs if relevant

Communication

• Discuss STI status with partners
• Get tested together before stopping condom use
• No shame in asking about testing history

Vaccination

• There's no gonorrhoea vaccine currently
• Research is ongoing
• Interestingly, meningococcal vaccines may provide some cross-protection

Key Takeaways

1. Gonorrhoea is extremely common – and rising in the UK
2. Most infections cause no symptoms – especially in women and throat/rectal sites
3. Testing is simple and accessible – don't let embarrassment stop you
4. Treatment works – but requires proper antibiotics and follow-up
5. Antibiotic resistance is a real threat – complete treatment and attend test of cure
6. Partners need treating – to prevent re-infection and onward transmission
7. Condoms prevent gonorrhoea – use them consistently

Get Tested Today

Whether you have symptoms, a concerned partner, or just want routine screening, gonorrhoea testing is quick and confidential. Don't wait for complications – book your test now.