What is gonorrhoea?

Gonorrhoea is a common sexually transmitted disease (STD). Gonorrhoea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus. Therefore, it can be transmitted from oral, vaginal and anal sex.

How common is gonorrhoea?

Gonorrhoea is a very common infectious disease. CDC estimates that more than 700,000 persons in the U.S. get new gonorrhoeal infections each year. Less than half of these infections are reported to CDC. It is even more common in developing countries where antibiotic resistance has emerged.

How do people get gonorrhoea?

Gonorrhoea is spread through contact with body fluid from the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhoea to be transmitted or acquired. It can also be transmitted by unprotect oral sex. Gonorrhoea can also be spread from mother to baby during delivery.

People who have had gonorrhoea and received treatment may get infected again if they have sexual contact with a person infected with gonorrhoea. The body does not develop immunity to it.

Who is at risk for gonorrhoea?

Any sexually active person can be infected with gonorrhoea. From our local data, the most common places people acquire gonorrhoea are from developing countries like China, Philippines, Thailand, Vietnam. More people catch gonorrhoea from unprotected oral sex than vaginal intercourse as more people have oral sex unprotected.

What are the signs and symptoms of gonorrhoea?

Although some men with gonorrhoea do not have any symptom, most men have signs or symptoms that appear one to fourteen days after infection. Symptoms from vaginal or anal contact tend to appear earlier compared to after oral sex. Symptoms and signs include a burning sensation when urinating, and/or a white/yellow, or greenish discharge from the penis. Sometimes men with gonorrhoea get painful or swollen testicles after the bacteria had travelled up the urinary track.

Although some men with gonorrhoea do not have any symptom, most men have signs or symptoms that appear one to fourteen days after infection.

Symptoms from vaginal or anal contact tend to appear earlier compared to after oral sex.

Symptoms and signs of Men

1. burning sensation when urinating
2. a white/yellow, or greenish discharge from the penis
3. painful or swollen testicles 

In women, the symptoms of gonorrhoea are often mild, however most infected women have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection and being treated as an UTI.

The initial symptoms and signs in women

1. a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods.
2. at risk of developing serious complications, such as pelvic inflammatory disease, fallopian tube infection and abscess, ectopic pregnancy and infertility

Symptoms of rectal infection in both men and women
1. discharge, anal itching, soreness, bleeding, or painful bowel movements. 2. Rectal infection also may cause no symptoms.
3. Infections in the throat may cause a sore throat, enlarged lymph glands in the neck and tonsillitis, but in majority of cases, there is no symptom.

Untreated gonorrhoea can cause serious and permanent health problems in both women and men.

Pelvic inflammatory disease (PID) is the most common complication after gonorrhoea infection. The symptoms range from mild lower abdominal/pelvic pain to very severe including fever.
PID can lead to internal abscesses (pus-filled “pockets” that are hard to cure) in the pelvis which can lead to long-lasting, chronic pelvic pain. PID can damage the fallopian tubes and permanent blockage that leads to infertility or increase the risk of ectopic pregnancy.

Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube. It can lead to rupture of the fallopian tube which can result in massive internal bleeding.

In men, gonorrhoea can cause epididymitis and orchitis, a painful condition of the ducts attached to the testicles or the testes itself. It causes severe pain and may lead to infertility if left untreated.

Gonorrhoea can spread to the blood or joints. This condition can be life threatening or causing damage to heart valves. In addition, people with gonorrhoea are more susceptible to HIV, the virus that causes AIDS. HIV-infected people with gonorrhoea can transmit HIV more easily to someone else than if they did not have gonorrhoea.

If a pregnant woman has gonorrhoea, she may give the infection to her baby through vaginal delivery. The infection can cause blindness, joint infection, or a life-threatening blood infection in the baby. Treatment of gonorrhoea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult sexual health provider for appropriate examination, testing, and treatment.

There are laboratory tests to diagnose gonorrhoea. The most accurate test for gonorrhoea is gonorrhoea DNA test which test for the presence of bacteria in the specific site.

It is most commonly performed using urine. Specifically urine should be held for two hours and using the first part of urine. DNA test can detect gonorrhoea in very small quantity usually from 3 days after an exposure.

It can also be performed using specimen collected from other sites such as oral cavity, cervix/vagina or rectum depending on the exposure. In our centre, some samples can be mixed after collection to determine the presence of infection.

A quick laboratory test for gonorrhoea in men with symptoms that can be done in some clinics or doctor’s offices is a Gram stain or an antigen rapid test. A Gram stain of a sample from a urethra allows the doctor to see the gonorrhoea bacterium under a microscope. An antigen test detects the presence of bacteria in urethral discharge and result can be obtained in 10 minutes.

Antibiotics can successfully cure gonorrhoea in adolescents and adults.

However, drug-resistant strains of gonorrhoea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhoea is becoming more difficult. CDC now recommends dual therapy (i.e. using two drugs) for the treatment of gonorrhoea, usually with azithromycin and ceftriaxone. Persons with gonorrhoea should be tested for other STDs.

Although medication will cure the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhoea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhoea. If symptoms continue even after completing antibiotics, he or she should return for reevaluation.