gonorrhea
Gonorrhoea is a sexually transmitted infection caused by the bacteria, Neisseria gonorrhoea. Infections affecting the urethra (tube that allows the urine to leave the body) and cervix (body found between the vagina and uterus) which causes irritation, inflammation and discharge. In slang, it is known as ‘the clap’.
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According to the European Centre for Disease Prevention and Control, in 2019 a total of 117, 881 confirmed cases of gonorrhoea were reported by 28 EU member states [1]
In 2019, more than 70,000 people were diagnosed with gonorrhoea in England, with most cases affecting gay, bisexual and other men who have sex with men. [2]
Approximately 87 million new infections occur among the ages 15-49
The likelihood of transmission of Gonorrhea from women in men (22%) is higher than men to women after vaginal intercourse
Gonorrhoea, and chlamydia can exist at the same time in 15-25% of infected heterosexual men and 35% of women [3]
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Bacterium Neisseria Gonorrhoeae
Spread through sexual contact with an infected person via the:
Penis
Vagina
Mouth
Anus
Spread from mother to baby during childbirth [5]
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Medical Students
Organism: Neisseria gonorrhoeae – gram-negative, intracellular, aerobic diplococcus.
Entry and Attachment:
Transmitted via sexual contact or vertical transmission at birth.
Targets columnar or cuboidal epithelium (e.g., cervix, urethra, rectum, pharynx, conjunctiva).
Pili and Opa (opacity-associated) proteins enable adhesion to mucosal surfaces.
Invasion and Host Response:
Bacteria invade subepithelial space after attachment.
Trigger acute inflammatory response: neutrophil infiltration, epithelial cell damage, microabscess formation.
Leads to epithelial sloughing and mucosal ulceration.
Chronic Progression:
If untreated, immune response shifts to macrophage and lymphocyte infiltration.
Certain strains may remain asymptomatic, allowing for undetected chronic infection and carrier states.
Virulence & Resistance:
Porin channels assist in immune evasion.
Plasmids and genetic mutations contribute to antibiotic resistance (e.g., penicillin, tetracycline).
Ascending Infection:
Gonococci can grow anaerobically, allowing invasion from lower genital tract to upper structures.
Patients
Gonorrhoea is caused by a type of bacteria called Neisseria gonorrhoeae.
Spread through sexual contact or passed from mother to baby during birth.
Affects thin, delicate linings inside the body such as the:
Cervix (in females)
Urethra (urine passage)
Rectum (bottom)
Throat
Eyes (in newborns)
The bacteria use tiny hair-like structures to attach to these body surfaces.
After attaching, the bacteria move deeper into the tissue.
This causes the body to react with:
Swelling and redness
Damage to the lining
Tiny areas of pus (small pockets of infection)
Over time, the body’s immune response changes, but the infection can continue.
Some people may not notice any symptoms and can unknowingly spread the infection. [4]
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Medical Students
Organism: Neisseria gonorrhoeae – gram-negative, intracellular, aerobic diplococcus.
Entry and Attachment:
Transmitted via sexual contact or vertical transmission at birth.
Targets columnar or cuboidal epithelium (e.g., cervix, urethra, rectum, pharynx, conjunctiva).
Pili and Opa (opacity-associated) proteins enable adhesion to mucosal surfaces.
Invasion and Host Response:
Bacteria invade subepithelial space after attachment.
Trigger acute inflammatory response: neutrophil infiltration, epithelial cell damage, microabscess formation.
Leads to epithelial sloughing and mucosal ulceration.
Chronic Progression:
If untreated, immune response shifts to macrophage and lymphocyte infiltration.
Certain strains may remain asymptomatic, allowing for undetected chronic infection and carrier states.
Virulence & Resistance:
Porin channels assist in immune evasion.
Plasmids and genetic mutations contribute to antibiotic resistance (e.g., penicillin, tetracycline).
Ascending Infection:
Gonococci can grow anaerobically, allowing invasion from lower genital tract to upper structures.
Patients
Gonorrhoea is caused by a type of bacteria called Neisseria gonorrhoeae.
Spread through sexual contact or passed from mother to baby during birth.
Affects thin, delicate linings inside the body such as the:
Cervix (in females)
Urethra (urine passage)
Rectum (bottom)
Throat
Eyes (in newborns)
The bacteria use tiny hair-like structures to attach to these body surfaces.
After attaching, the bacteria move deeper into the tissue.
This causes the body to react with:
Swelling and redness
Damage to the lining
Tiny areas of pus (small pockets of infection)
Over time, the body’s immune response changes, but the infection can continue.
Some people may not notice any symptoms and can unknowingly spread the infection.
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Younger age (15-24 years)
More than one sexual partner
Protection not being used regularly
MSM (men who have sex with men)
History of a sexually transmitted infection
Social history of sexual or physical abuse
Deprivation
Being born by an infected person [6,7]
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Men:
Discomfort in the urethra
Tenderness in the penis
Pain when urinating and urinary frequency/urgency
Discharge (usually yellow-green colour)
Inflammation
Pain on the scrotum on one side (unilateral) (epididymitis)
Women:
Dysuria
Vaginal discharge
Redness of the cervix
Inflammation of the urethra
Pelvic inflammatory disease
Inflammation of the fallopian tubes
Pelvic lumps (abscesses)
Lower abdominal pain (usually on both sides- bilateral)
Fitz-Hugh-Curtis syndrome is the inflammation of the liver that causes right upper quadrant abdominal pain, fever, nausea, and vomiting
Rectal gonorrhoea is usually asymptomatic but can include:
Rectal itching
Rectal discharge
Bleeding
Constipation
Sore throat caused by gonorrhoea affecting the pharynx (tube inside the neck that extends from the nose and open into the oesophagus)
Arthritis-dermatitis syndrome- Seen as a fever, migratory pain or joint swelling (polyarthritis), and pustular skin lesions. [3]
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Take a history including sexual activity, number and sex of sexual partners, protection used during sexual activity, and history of previous sexually transmitted infections.
For men:
Assess using inspection and palpation (feeling using hands) of the male reproductive organs for swelling or tenderness. Include the;
Testes
Epididymis
Spermatic cord (cord that suspends the testes and epididymis)
Inspect for discharge or pain in the:
Penis shaft
Head of penis (glans)
Meatus of penis
Examine the prostate with associated symptoms:
Pain in lower back and genital area
Urinary frequency/ urgency
Pain or burning on urination
For women:
Inspect the labia and clitoris
Carry out a speculum examination (using a device called a speculum that is put into the vagina) to assess the cervix and vagina to assess for discharge or bleeding
Carry out a bimanual pelvic exam (insertion of two fingers into the vagina to inspect the pelvic organs) to assess tenderness in the cervix, uterus and adnexal (fallopian tubes and ovaries)- indicates pelvic inflammatory disease
Assess for complications such as pelvic inflammatory disease and inflammation of the testes and epididymis [6]
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Men
Urethritis (inflammation of the urethra) caused by bacteria such as Chlamydia trachomatis
Short term (acute) prostatitis (inflammation of the prostate)
Genital herpes
Candida infection (fungal)
Women
Chlamydia
Candida infection
Bacterial vaginosis (infection caused by the excess of organisms such as Gardnerella Vaginalis)
Trichomoniasis (STI caused by Trichomonas vaginalis)
Pelvic inflammatory disease
Genital herpes [7]
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Medical Students
First-line treatment (uncomplicated cases):
Single IM dose of ceftriaxone
Alternative: oral cefixime
If chlamydia not excluded:
Add doxycycline
Alternative for doxycycline allergy: single dose of azithromycin
Cephalosporin allergy:
Use gentamicin + azithromycin
Disseminated gonococcal infection (DGI):
Initial 24–48h: IV or IM antibiotics
Followed by oral antibiotics for ≥7 days guided by susceptibility testing
Add doxycycline if chlamydia not ruled out
Gonococcal arthritis:
Joint drainage and immobilisation
Passive ROM exercises initially; active exercises after pain subsides
Consider NSAIDs for inflammation
Monitoring and follow-up:
Post-treatment cultures not needed if symptoms resolve
If symptoms persist >7 days: culture and test for sensitivity
Sexual health measures:
Abstain from sex until treatment is completed
Notify and test/treat all sexual partners within past 60 days
Presumptive treatment for partners from the past 14 days
Expedited Partner Therapy (EPT): prescription/meds given to patient for partner
In-person visit preferred to screen for STIs and allergies
Patients
Usually with a single antibiotic injection (ceftriaxone)
Or a similar antibiotic tablet (cefixime)
What if I might also have chlamydia?
You’ll get an extra antibiotic called doxycycline
If allergic to doxycycline, you may get azithromycin instead
What if I’m allergic to the usual antibiotics?
You might be given gentamicin and azithromycin
What if the infection spreads (into the blood or joints)?
You’ll start with injections or IV antibiotics for 1–2 days
Then take antibiotics by mouth for at least a week
Joint infections may need fluid removal and gentle movement exercises
Painkillers (like ibuprofen) may help with joint pain
Do I need tests after treatment?
If you feel better, more tests aren’t usually needed
If symptoms last more than a week, you’ll need more tests to check which antibiotic works best
What about my partner(s)?
Don’t have sex until treatment is finished
Anyone you had sex with in the past 60 days should be tested and treated
If you had sex with someone in the past 2 weeks, they should be treated right away even if they have no symptoms
You may be given medicine or a prescription to give to your partner (called Expedited Partner Therapy)
It's better if your partner sees a doctor to get checked for other STIs and allergies [3]
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Pelvic inflammatory disease (estimated in 10-20% of cases of untreated gonorrhoea)
Ectopic pregnancy
Infertility (in men and women)
During pregnancy can cause miscarriage, premature labour/birth and conjunctivits in newborns
In rare cases, can cause sepsis (life-threatening reaction to infection) if left untreated [2]
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You can catch the infection from public toilets
Vaginal/anal sex is the only way you can spread gonorrhea
Gonorrhoea always produced symptoms
Gonorrhoea is not treatable
You can gonorrhoea once
Gonorrhoea can self resolve [8,9]
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Will I present with symptoms if I am diagnosed with gonorrhea eventually?
How long does treatment take to work?
What can I do to prevent re-infection or the infection of others?
How can I tell if I start developing complications? and who can I contact?
How can I tell my partner(s)?
Are there specific foods I should eat to help recovery?
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STD Centre NY
SH:24
Terrance Higgins Trust
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[2] https://www.nhs.uk/conditions/gonorrhoea/
[4] https://emedicine.medscape.com/article/218059-overview#a3
[5] https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm#:~:text=Gonorrhea
[6] https://cks.nice.org.uk/topics/gonorrhoea/background-information/risk-factors/
[8] https://www.bergen-aesthetics.com/blog/myths-and-facts-about-gonorrhea
Source: DermNetNZ.org
Gonorrhoea
Redness and lesion clusters on the wrist
Source: Waikato District Health Board; DermNetNZ
Gonorrhoea
Lesions found on the lower legs
