Factsheet Gonorrhoea

Gonorrhoea is a common sexually transmitted infection. Gay men and young heterosexual men and women are the groups most affected by gonorrhoea in the UK. The number of infections has gone down in gay men in recent years, but it was still the most common sexually transmitted infection diagnosed in gay men in 2016.

Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae. Gonorrhoea can live in the anus, cervix, urethra, throat and, occasionally, the eyes.

You can become infected with gonorrhoea if you come into contact with infected semen or infected discharge from the vagina, throat or rectum. It can be passed on during anal, vaginal and oral sex, and by mouth-to-anus contact (rimming), if no condom is used (unprotected sex). It can also be passed on by sharing sex toys if they are not washed or covered by a new condom each time they are used. Infection in women can spread from the vagina to the rectum via vaginal fluids. 

"A general sexual health check-up includes testing for gonorrhoea."

In a person with HIV who is not taking HIV treatment, untreated gonorrhoea may make them more infectious. This is because untreated sexually transmitted infections can increase HIV viral load in genital fluids. However, if the person with HIV is taking effective HIV treatment and has an undetectable viral load, they will not pass HIV on. Gonorrhoea will not make a difference to this.

In an HIV-negative person, having gonorrhoea can make it more likely that they will be infected with HIV if they are exposed to the virus.

If you are pregnant, gonorrhoea can cause miscarriage or early labour. It can be passed on from mother to baby during childbirth, infecting the baby’s eyes. This can cause discharge and swelling, and may result in blindness. If you are pregnant and may have gonorrhoea, it is important you are tested and treated before your baby is born.

Using a condom for anal or vaginal sex, or a condom or dental dam (a sheet of latex) for oral sex, is an effective way of avoiding transmission of gonorrhoea.

Also, don’t share sex toys. If you do, wash them or cover them with a new condom before anyone else uses them.  

People who are sexually active are advised to have regular sexual health check-ups, especially if you have recently had a new partner. It is recommended that people with HIV have a sexual health check at least once a year. There you will be tested for gonorrhoea and other sexually transmitted infections. In some situations, having a check-up more often may be recommended, such as if you are having unprotected sex with new or casual partners. Gay men having unprotected sex – including oral sex – with new or casual partners are advised to have a sexual health check every three months. If you are thinking about becoming pregnant, it is advised you are tested for gonorrhoea.

Most HIV treatment centres have an associated sexual health clinic. These offer confidential and free treatment. You don't need to be referred by your GP or your HIV doctor.

Symptoms of gonorrhoea usually appear between two and ten days after infection. However, for many people, especially women, there may only be very mild symptoms, no symptoms for many months, or none until the infection spreads to other parts of the body.  

In men, symptoms usually consist of a white, yellow or green discharge from the penis and burning when passing urine. More rarely, your testicles may hurt and swell. 

Symptoms in women can include a burning sensation when passing urine, a thin or watery discharge, which might be yellow or green, from the vagina. Less commonly, there may be pain or tenderness in the lower abdomen and bleeding between periods or heavier periods.

If the infection is rectal, there may be no symptoms or, for both men and women, there may be a discharge from the anus and pain or discomfort in the anus. 

Gonorrhoea in the throat usually causes no symptoms.

Infection in the eyes can cause pain, swelling, irritation and discharge (conjunctivitis).

If left untreated, gonorrhoea can cause more serious health problems. This includes pelvic inflammatory disease (PID) in women, which can cause long-term pelvic pain, infertility and ectopic pregnancy, and testicular problems in men, potentially reducing fertility.

If untreated, gonorrhoea can affect the joints, causing arthritic-like pain and swelling or skin rashes. It can eventually spread to the bloodstream, leading to serious infection (septicaemia), which can be life-threatening.

A general sexual health check-up includes testing for gonorrhoea. You can also have a test at your GP (family doctor) surgery. You can buy kits to test yourself at home, but these are not always very accurate. 

For women with symptoms, it is best if a swab is taken from the cervix by a doctor or nurse during an internal examination. If there are no symptoms, you can take a swab yourself from the entrance to the vagina. 

For men experiencing discharge, a doctor or nurse will take a swab from the tip of the penis. If you do not have any symptoms, a urine sample will be tested.

Sometimes, swabs will also be taken from the throat, rectum and eye. 

Some results for gonorrhoea may be available immediately from examining the urine sample or swabs. Other results will take longer and you will be told when to contact the clinic for the outcome. It is important to do so, so you can be treated if gonorrhoea is diagnosed.

Gonorrhoea can be easily treated with a single dose combination of antibiotics.

The recommended first-line treatment is now a single dose of ceftriaxone – given by injection – and a single dose of azithromycin given as a tablet.

Occasionally a second course of antibiotics is needed if your symptoms do not go away or you are found to have a strain of gonorrhoea resistant to those drugs. There are substantial levels of resistance to a number of antibiotics (including penicillin, tetracyclines and ciprofloxacin) in some strains of gonorrhoea present in the UK. Advice is to avoid infection if possible, by following guidance on protected sex, testing and treatment.

It is very important not to have any sort of anal, oral or vaginal sex during this period as you may be re-infected with gonorrhoea, or pass the infection to your partner.

It is possible to become infected with gonorrhoea again after being successfully treated. To avoid this, make sure any of your sexual partners have also been treated. Condoms, used properly and consistently, can prevent infection with gonorrhoea and many other sexually transmitted infections.