Overview

Gonorrhoea is a sexually transmitted infection (STI) caused by bacteria called Neisseria gonorrhoeae or gonococcus. It used to be known as "the clap".

How gonorrhoea is spread

The bacteria that cause gonorrhoea are mainly found in discharge from the penis and in vaginal fluid.

Gonorrhoea is easily passed between people through:

• unprotected vaginal, oral or anal sex
• sharing vibrators or other sex toys that have not been washed or covered with a new condom each time they're used

The bacteria can infect the entrance to the womb (cervix), the tube that  passes urine out of the body (urethra), the rectum and, less commonly, the throat or eyes.

The infection can also be passed from a pregnant woman to her baby. If you're pregnant and may have gonorrhoea, it's important to get tested and treated before your baby is born.

Without treatment, gonorrhoea can cause permanent blindness in a newborn baby.

Gonorrhoea is not spread by kissing, hugging, swimming pools, toilet seats, or sharing baths, towels, cups, plates or cutlery. The bacteria cannot survive outside the human body for long.

Symptoms of gonorrhoea

Typical symptoms of gonorrhoea include a thick green or yellow discharge from the vagina or penis, pain when peeing and, in women, bleeding between periods.

But around 1 in 10 infected men and almost half of infected women do not experience any symptoms.

Getting tested

If you have any of the symptoms of gonorrhoea or you're worried you may have an STI, you should visit a sexual health clinic for a sexual health test.

Find a sexual health clinic

Gonorrhoea can be easily diagnosed by testing a sample of discharge picked up using a swab. In men, testing a sample of urine can also diagnose the condition.

It's important to get tested as soon as possible because gonorrhoea can lead to more serious long-term health problems if it's not treated including pelvic inflammatory disease (PID) in women or infertility.

Treating gonorrhoea

Gonorrhoea is usually treated with a single antibiotic injection (usually in the buttocks or thigh). With effective treatment, most of your symptoms should improve within a few days.

It's usually recommended you attend a follow-up appointment a week or 2 after treatment so another test can be carried out to see if you're clear of infection.

You should avoid having sex until you have been told you no longer have the infection.

Previous successful treatment for gonorrhoea does not make you immune to catching it again.

Who's affected

Anyone who's sexually active can catch gonorrhoea, particularly people who change partners frequently or do not use a barrier method of contraception, such as a condom, when having sex.

Gonorrhoea is the second most common bacterial STI in the UK after chlamydia.

Preventing gonorrhoea

Gonorrhoea and other STIs can be successfully prevented by using appropriate contraception and taking other precautions, such as:

• using male condoms or female condoms every time you have vaginal sex, or male condoms during anal sex
• using a condom to cover the penis or a latex or plastic square (dam) to cover the female genitals, if you have oral sex
• not sharing sex toys, or washing them and covering them with a new condom before anyone else uses them

If you're worried you may have an STI, visit a sexual health clinic for advice.

Symptoms

Symptoms of gonorrhoea usually develop within about 2  weeks of being infected, although they sometimes do not appear until many months later.

About 1 in 10 infected men and 5 in 10 infected women will not experience any obvious symptoms, which means the condition can go untreated for some time.

Symptoms in women

In women, symptoms of gonorrhoea can include:

• an unusual vaginal discharge, which may be thin or watery and green or yellow in colour
• pain or a burning sensation when passing urine
• pain or tenderness in the lower abdominal area (this is less common)
• bleeding between periods, heavier periods and bleeding after sex - this is less common

Symptoms in men

In men, symptoms of gonorrhoea can include:

• an unusual discharge from the tip of the penis, which may be white, yellow or green
• pain or a burning sensation when urinating
• inflammation (swelling) of the foreskin
• pain or tenderness in the testicles - this is rare

Infection in the rectum, throat or eyes

Both men and women can develop an infection in the rectum, eyes or throat by having unprotected anal or oral sex.

If infected semen or vaginal fluid comes into contact with the eyes, you can also develop conjunctivitis.

Infection in the rectum can cause discomfort, pain or discharge. Infection in the eyes can cause irritation, pain, swelling and discharge and infection in the throat usually causes no symptoms.

Getting medical advice

It's important to be tested for gonorrhoea if you think there's a chance you're infected, even if you have no obvious symptoms or the symptoms have gone away on their own.

If gonorrhoea is left undiagnosed and untreated, you can continue to spread the infection and there is a risk of potentially serious complications, including infertility.

Diagnosis

The only way to find out if you have gonorrhoea is to be tested. If you suspect gonorrhoea or any other sexually transmitted infection (STI), it's important not to delay getting tested.

It's possible to be tested within a few days of having sex, but you may be advised to wait up to a week. You can be tested even if you don't have any symptoms.

Early diagnosis and treatment of gonorrhoea reduces the risk of complications developing, such as pelvic inflammatory disease (PID) or infection in the testicles. Complications that arise from long-term infection are much more difficult to treat.

Who should get tested

It's recommended you get tested if:

• you or your partner think you have symptoms of gonorrhoea
• you've had unprotected sex with a new partner
• you or your partner have had unprotected sex with other people
• you have another STI
• a sexual partner tells you they have an STI
• during a vaginal examination, your nurse or doctor tells you the cells of your cervix are inflamed or there's discharge
• you're pregnant or planning a pregnancy

Where to get tested

There are several different places you can go to be tested for gonorrhoea:

• a sexual health clinic
• your GP surgery
• online testing
• a private clinic

Find a sexual health clinic

It's possible to buy a gonorrhoea test from a pharmacy to do yourself at home. However, these tests vary in accuracy, so it's recommended that you go to your local sexual health service.

All tests are free through the NHS, but you'll have to pay if you go to a private clinic.

If you go to your GP practice, you may have to pay a prescription charge for any treatment.

Testing for gonorrhoea

There are a number of different ways to test for gonorrhoea. In many cases, a swab will be used to remove a sample for testing, although men may only be asked to provide a urine sample.

A swab looks a bit like a cotton bud, but it's smaller and rounded. It's wiped over parts of the body that may be infected to pick up samples of discharge. This only takes a few seconds and isn't painful, although it may be a little uncomfortable.

Testing women

For women, a doctor or nurse will usually take a swab to collect a sample from the vagina or cervix (entrance to the womb) during an internal examination. In some cases, a sample may also be taken from the urethra (the tube that carries urine out of the body).

Sometimes, you may be asked to use a swab or tampon to collect a sample from inside your vagina yourself.

Women are not usually asked to provide a urine sample to check for gonorrhoea because this is a less-accurate test for women.

Testing men

Men will normally be asked to provide a urine sample or a swab may be used to pick up a sample of discharge from the end of the penis.

If you're asked to provide a urine sample, it's important not to urinate for about 2 hours beforehand because this can wash the bacteria away and affect the results of the test.

Infections of the rectum, throat and eyes

If there's a possibility that your rectum or throat is infected, the doctor or nurse may need to use a swab to collect a sample from these areas.

If you have symptoms of conjunctivitis, such as red, inflamed eyes with discharge, a sample of the discharge may be collected from your eye.

Getting the results

Some clinics may be able to carry out rapid tests, when the doctor can view the sample through a microscope and give you your test results straight away.

Otherwise, you'll have to wait up to 2 weeks to get the results.

Young people and sexual health clinics

You can attend a sexual health clinic at any age and all results will be treated confidentially.

If you're 13 to 16 years old, nobody in your household will be contacted without your permission. However, you may be encouraged to talk to your parents, guardian or another trusted adult.

The situation is different for people under 13, because the law says that people of this age cannot consent (say yes) to sexual activity.

Treatment

Gonorrhoea is usually treated with antibiotics.

Antibiotics are usually recommended if:

• tests have shown you have gonorrhoea
• there's a high chance you have gonorrhoea, even though your test results have not come back yet
• your partner has been diagnosed with gonorrhoea

In most cases, treatment involves having an antibiotic injection (usually in the buttocks or thigh). It's sometimes possible to have an antibiotic tablet instead of an injection, if you prefer.

If you have any symptoms of gonorrhoea, these will usually improve within a few days, although it may take up to 2 weeks for any pain in your pelvis or testicles to disappear completely.

Bleeding between periods or heavy periods should improve by the time of your next period.

Attending a follow-up appointment a week or 2 after treatment is usually recommended, so another test can be carried out to see if you're clear of infection.

You should avoid having sex until you, and your partner, have been treated and given the all-clear, to prevent re-infection or passing the infection on to anyone else.

If your symptoms do not improve after treatment or you think you've been infected again, see your doctor or nurse. You may need repeat treatment or further tests to check for other problems.

Sexual partners

Gonorrhoea is easily passed on through intimate sexual contact. If you're diagnosed with it, anyone you've recently had sex with may have it too.

It's important that your current partner and any other recent sexual partners are tested and treated.

Your local genitourinary medicine (GUM) or sexual health clinic may be able to help by notifying any of your previous partners on your behalf.

A contact slip can be sent to them explaining that they may have been exposed to a sexually transmitted infection (STI) and suggesting they go for a check-up. The slip will not have your name on it, so your confidentiality is protected.

Complications