What is gonorrhoea? (Overview)
Gonorrhoea (also spelled “Gonorrhea) is a contagious infection with the bacterium Neisseria gonorrhoeae that typically occurs in warm, clammy areas of the body. A sexually transmitted disease (STD), gonorrhoea is passed from person to person, mostly through unprotected, oral, anal or vaginal sex.
Areas of the body this STD commonly infects include the urethra in males (the urethra is a tube that empties urine from the urinary bladder), vagina, anus, female reproductive tract (uterus, the fallopian tubes and cervix), eyes and throat.
Those at risk of infection are individuals with multiple sexual partners, or those who don’t use protection (a condom) when having sex. Abstinence, monogamy (sex with only one partner), and proper condom usage are some of the best means of protection or prevention. Behaviours like substance abuse (drugs and alcohol), can also make a person more vulnerable to engaging in unprotected sex, and thereby at higher risk of an STD infection.
Gonorrhoea, also known as ‘the clap’ or ‘the drip,’ can also be transmitted through infected bodily fluids from mother to child (especially during childbirth). A baby with the infection commonly experiences complications with one or both eyes.
This STD affects both men and women, but in many cases, shows no symptoms of infection or illness. It is not uncommon for some infections to go completely unnoticed for a period of time. All infections must be treated by a medical doctor as soon as possible.
Some people with a gonorrhoea infection may never develop noticeable symptoms (non-symptomatic carrier), while others will notice something wrong within a period of 2 to 14 days following exposure. It can take up to 30 days for an infection to develop in some people. A non-symptomatic carrier is still contagious, even without tell-tale signs of infection and can still pass on the infection.
Gonorrhoea affects the genital tract of both men and women but can also show signs in other parts of the body. These include:
- The rectum: A pus-like discharge from the rectum, anal itching and strain during bowel movements.
- The eyes: Sensitivity to light, pain or discomfort in the eyes, and a pus-like discharge from one or both eyes.
- The throat: Sore and swollen lymph nodes in the neck.
- The joints: Bacteria can infect one or more joints in the body (septic arthritis) and cause warm, red, swollen and extremely painful symptoms, especially when you move (or are mobile).
Symptoms in men
It can take up to several weeks for men to develop noticeable symptoms, but typically an infection can begin to show signs a week following its transmission.
One of the first signs a man may notice is a burning or painful sensation when urinating. This symptom is typically accompanied by any or more of the following:
- Urgency or increased frequency of urination
- Swelling or inflammation at the opening of the penis
- A white, yellow, beige or greenish pus-like discharge (‘the drip’) from the penis
- Swelling, pain or discomfort in the testicles (causing an epididymitis)
- A sore throat (persistent) or burning sensation (commonly experienced due to oral sex)
- Swollen glands in the throat (commonly experienced due to oral sex)
- Conjunctivitis (red and itchy eyes)
A gonorrhoea infection will remain in the body for several weeks after any of the abovementioned symptoms show up and undergo treatment. It is rare, but gonorrhoea can cause further damage to the urethra and testicles or spread to the prostate.
Symptoms in women
Women tend to experience mild symptoms which may be similar to those of other illnesses, such as vaginal yeast or bacterial infections. This can often make this STD more difficult to identify in the diagnosis process.
Many women don’t develop any overt symptoms, but the following noticeable signs of this STD are:
- A watery, creamy or greenish discharge from the vagina
- Burning or painful sensation when urinating
- An increased urgency to urinate (and more frequently than normal)
- Heavier menstrual periods or spotting (bleeding between periods)
- A sore throat - Swollen glands and a burning sensation in the throat (commonly experienced as a result of oral sex)
- Sexual intercourse that is painful
- Spotting after sexual intercourse
- A sharp pain in the lower abdomen or pelvis
- Swelling of the vulva (vulvitis)
- Conjunctivitis (red and itchy eyes)
Causes of gonorrhoea
Neisseria gonorrhoeae is a contagious bacterium that easily grows and multiplies in the mucus membranes of the body. Bacteria favour warmth and moist areas for growth, and thus easily infect the reproductive tract (cervix, uterus and fallopian tubes), urethra, mouth, throat and anus.
Risk factors and complications
Those at most risk of an infection:
- Are younger in age
- Have a new sex partner
- Have a sex partner who has concurrent (or multiple) partners
- Have multiple sex partners
- Have had a gonorrhoea infection before (and been diagnosed)
- Have other STD infections
If gonorrhoea is left untreated, significant complications can occur:
- Infertility: If untreated, infection in women can spread to the uterus and fallopian tubes, causing pelvic inflammatory disease (PID). The resulting scar damage causes a blockage in the tubes and chronic pain. This process puts a woman at greater risk during pregnancy because it may cause infertility or ectopic pregnancy (a fertilized egg implants outside the uterus). PID is a serious infection and will require immediate treatment. Men are also affected by infertility complications. Untreated gonorrhoea can lead to epididymitis (the inflammation of a small, coiled tube in the rear portion of the testicles. This affects the sperm ducts located in the epididymis) or the development of a painful abscess in the interior of the penis. Gonorrhoea can also affect the prostate, causing scarring inside the urethra which can lead to difficulties with urination. It is a treatable condition but can lead to infertility problems (reduced fertility or sterility) if not attended to by a medical professional.
- Increased risk of HIV/AIDS: A gonorrhoea infection can make you more susceptible to the human immunodeficiency virus (HIV) that leads to AIDS. If infected with both, a person is able to pass both diseases more easily to others.
- Joints and other areas of the body: Neisseria gonorrhoeae can spread through the bloodstream and infect other parts of the body, including the joints. An infection can cause fever, rash, skin sores, swelling and stiffness, as well as pain in the joints. If an infection spreads to the bloodstream, both men and women can develop arthritis, heart valve damage and inflammation of the lining of the brain or spinal cord.
- Babies: If a gonorrhoea infection is passed from an infected mother to her baby during childbirth, infants are at risk of developing complications including blindness and sores on the scalp.
Treatment Procedures – Remedies and Relief
When should you see a doctor?
Any suspected signs of gonorrhoea should be diagnosed and treated by a medical doctor. If you notice any signs and symptoms, make an appointment with your general practitioner (GP) as soon as possible.
If you become aware that a sex partner has been diagnosed with gonorrhoea (whether you are showing noticeable signs of infection or not), it is also strongly advised to see your doctor as soon as possible.
If you are diagnosed with gonorrhoea and your GP notices any other concerns or complications, you may be referred to specialists.
Before your doctor’s appointment you should be prepared to:
- Discuss your symptoms in detail
- Provide a list of all medications and supplements you are currently taking
- Honestly disclose your sexual history
- Potentially provide contact information for previous sexual partners so that they can be anonymously contacted on your behalf by your doctor. You may also contact your sexual partners directly to advise testing as soon as possible.
- Ask any questions you may have and address any other concerns.
Diagnosis and tests
Your GP will likely ask you a number of questions during the initial stages of your consultation. These can include:
- What are your symptoms and how long ago did you start experiencing them?
- Have these symptoms been continuous or occasional?
- How severe are your symptoms?
- Have you ever previously been exposed to sexually transmitted infections?
Your doctor will be able to diagnose a gonorrhoea infection in several ways. To assess whether Neisseria gonorrhoeae is present in the body or not, you doctor will analyse a sample of cells. These samples may be collected by means of the following:
- Urine test: This test will help your doctor to identify the presence of any bacteria in the urethra.
- Swab of an affected area of the body (take a sample of fluid): Your doctor may take a swab of your throat, urethra, vagina, cervix, penis or rectum to try and identify any bacteria present in these areas.
Other STD infections may also be tested for by taking a blood sample, including chlamydia (which often accompanies gonorrhoea infections). Your doctor may very well recommend an HIV test, as well as for any other known STDs, depending on your risk factors.
If your doctor suspects any infection in your joints or bloodstream, a blood test (sample of drawing blood from a vein) or inserting a needle into the symptomatic joint to withdraw fluid will be done. In the laboratory, a stain will be added to the sample for examination under a microscope. If the cells react to the stain, it will show up as a gonorrhoea infection. Another way to test this is by placing the sample on a special dish which is then incubated under ideal bacterial growth conditions for a period of a few days. A colony of bacteria will grow if gonorrhoea is present.
Preliminary results for all tests may be available within 24 hours. Results can take several days (up to 3 days) to come back from the laboratory.
Treatments and medications
Gonorrhoea is a treatable infection which can be cured.
- Treatment for adults: Uncomplicated gonorrhoea can be treated with prescribed antibiotics, given as an injection (in the buttocks) or in combination with those that can be taken orally (dual therapy). If you have been diagnosed with gonorrhoea and are undergoing treatment, your sex partner should also be tested and treated for the infection (even if no signs or symptoms are noticeable). Your partner will likely receive the same treatment as you are. You can be re-infected, even after treatment, if your partner is not treated. Treatment with antibiotics should bring relief within a few days. A full course may be prescribed for a period of 7 days, given once or twice a day. It is important to take the full course of prescribed antibiotics, even if you begin to feel better (to prevent you from developing a resistance to the antibiotic or incomplete treatment). It is also important to only take your own prescription and not anyone else’s medication. Your doctor may strongly recommend that you do not have sex until you have completed your course of prescribed antibiotics (for up to 7 days), as well as to always use protective measures such as condoms when having sexual intercourse. Your doctor will likely request a follow-up one to two weeks after the completion of your antibiotics to assess whether your gonorrhoea has completely cleared or not. You will only then be able to resume sexual activity once your gonorrhoea is completely cleared (as well as that of your partner).
- Treatment for babies: Infants born to mothers with gonorrhoea are often treated soon after birth with medications preventing infection symptoms in the eyes (as this can lead to blindness). If an eye infection does develop, babies can be treated with antibiotics.
Can I get gonorrhoea from a toilet seat?
It is highly unlikely that you will get a gonorrhoea infection from sitting on a toilet seat that an infected person has used. Neisseria gonorrhoeae bacteria does not typically survive very long outside of the human body. The infection is transmitted through bodily fluids from person to person in order for gonorrhoea to be passed on.
Can gonorrhoea be cured?
Yes, gonorrhoea is completely treatable and can be cured.
How does gonorrhoea affect pregnancy and childbirth?
The infected mother will pass on the infection to her baby through the birth canal during delivery. Complications can include premature delivery or a spontaneous abortion (miscarriage). An infection transmitted through childbirth can lead to blindness, joint infection or even a life-threatening blood infection in the baby.
The sooner a gonorrhoea infection is detected, diagnosed and treated in a pregnant woman, the lesser the risk of complications. All cases of gonorrhoea must be diagnosed and treated by a medical professional as soon as possible.
How can I prevent gonorrhoea?
Although curable, prevention is best. You can reduce your risk by:
- Using a condom if you choose to have sex: Abstinence is the surest means of prevention, but if you choose to have sex, a condom during any type of sexual contact (anal, oral or vaginal) must be used (and used correctly).
- Limit your number of sex partners: It is also highly advisable not to go back and forth between partners.
- Regular testing for sexually transmitted infections: You and your partner/s can be tested for infections on a frequent basis if you are both sexually active. There is no shame in asking a new partner whether he or she has had or would be willing to have themselves tested for any STD infection. You can also consider regular gonorrhoea screening. Annual screening is generally recommended for all sexually active women under 25 years of age or older women at a higher risk of infection (those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner with a known STD infection). Men who are sexually active with other men, as well as their partners are also encouraged to have regular screening.
- Don’t have sex with anyone who has unusual symptoms: If it appears that your partner is experiencing any signs or symptoms of a sexually transmitted infection, such as a genital rash, or burning sensation during urination, avoid having sex with that person.
Why is gonorrhoea called ‘the clap’?
One reason gonorrhoea is often referred to as ‘the clap’ is because of the old French term ‘clapier’ or ‘clapier bubo’, meaning ‘brothel’. ‘Clapier’ was also used to refer to a rabbit’s nest or hutch. There was a period, dating back to the 1580s when gonorrhoea was easily spread via brothels (prostitutes) and not sufficiently treated. A ‘bubo’ referred to an inflamed lymph node or infection in the groin area. ‘Clapier bubo’ was the term typically associated with those having visited a brothel.
The second theory relates to a rather nasty form of ‘treatment’ that involved clapping hard on both sides of a man’s penis (simultaneously) as a means of ridding the urethra of pus-like discharge. A third theory comes from an old English word ‘clappan’ which means ‘to beat’ or ‘to throb’ (both common ways to describe symptoms of burning, painful urination and throbbing sensations caused by inflammation).