What Is Gonorrhoea? Symptoms, Testing and Treatment

Gonorrhoea (gonorrhea in American English, and sometimes called 'the clap') spreads easily and often silently, particularly from the throat and rectum, where it rarely causes symptoms. This guide covers what it is, how it spreads, the symptoms in different parts of the body, what happens if it isn't treated, and how testing and treatment work. If you want to test now, Ovio's gonorrhoea test is done at home in Bangkok.

What Is Neisseria Gonorrhoeae?

Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae. Under a microscope it appears as pairs of bean-shaped cells (a Gram-negative diplococcus). It lives on the moist lining of the body: the urethra, cervix, rectum and throat, and less often the eyes. Proteins on its surface help it cling to those cells and dodge the immune system, which is one reason infection doesn't make you immune: you can catch it again.

How Common Is Gonorrhoea?

The World Health Organization estimates there were 82.4 million new gonorrhoea infections among adults aged 15 to 49 worldwide in 2020. It's one of the most common bacterial STIs, and in Thailand young people aged 15 to 24 account for a large share of reported cases. You can see the national figures in our Thailand STI statistics report.

Three things keep it a public-health problem:

• Silent infections. Many people have no symptoms and pass it on without knowing.
• Late diagnosis. Without symptoms, people often test late, sometimes only after a complication.
• Antibiotic resistance. The bacterium has become resistant to several antibiotics that used to cure it, and WHO treats this as a serious and growing threat.

How Is Gonorrhoea Transmitted?

• Vaginal, anal and oral sex without a condom with someone who has gonorrhoea. It passes from one mucous membrane to another through semen, pre-cum and vaginal fluid, with or without ejaculation.
• From mother to baby during birth, which can cause a serious eye infection in the newborn.
• To the eyes, occasionally, from infected fluid on the hands.

People without symptoms are just as able to pass it on. Gonorrhoea isn't spread by casual contact: not by hugging, toilet seats, swimming pools, or sharing cups, cutlery or towels. Oral sex is a common route to the throat; see STIs from oral sex.

Gonorrhoea Incubation Period

When gonorrhoea causes symptoms, they usually begin 1 to 14 days after sex with an infected partner, according to WHO. Men with an infection of the urethra tend to notice within days. Many women, and most people infected in the throat or rectum, never get symptoms at all, so the absence of symptoms tells you nothing about whether you have it.

Gonorrhoea Symptoms in Men and Women

Men

• Burning or pain when passing urine
• White, yellow or green discharge from the tip of the penis
• Pain or swelling in one or both testicles
• Sometimes no symptoms at all

Women

• Often no symptoms
• Increased or unusual vaginal discharge, which may be yellow or green
• Pain or burning when passing urine
• Bleeding between periods or after sex
• Pain in the lower tummy, or pain during sex

Women's symptoms are often mild and easy to mistake for thrush, bacterial vaginosis or a urine infection.

Rectum

Usually silent, especially after receptive anal sex. When there are symptoms: discharge, itching, pain or discomfort when opening the bowels, or a little blood on the toilet paper.

Throat

Throat gonorrhoea almost never causes symptoms. Occasionally there's a sore throat, redness or swollen glands in the neck, which look like any other throat infection.

Eyes and joints

Uncommonly, gonorrhoea infects the eye, causing pain, redness, sensitivity to light and a thick discharge. Rarely, it spreads through the blood and causes painful, hot, swollen joints (see disseminated infection below). Both need prompt medical care.

Complications If Gonorrhoea Isn't Treated

In women

• Pelvic inflammatory disease (PID): infection spreading to the womb, fallopian tubes and ovaries.
• Long-term pelvic pain from scarring.
• Ectopic pregnancy and infertility, if the fallopian tubes are damaged.

In men

Epididymitis, a painful swelling of the tube at the back of the testicle. Rarely, scarring from long-standing infection affects fertility.

Disseminated gonococcal infection

Rarely, the bacteria get into the bloodstream. This can cause fever, joint pain and swelling, inflamed tendons and small skin spots or pustules. It's a serious illness that needs hospital treatment with intravenous antibiotics.

In pregnancy

Gonorrhoea can pass to the baby during birth and cause a severe eye infection that, untreated, can damage the baby's sight. Testing and treatment in pregnancy protect both mother and baby.

How Is Gonorrhoea Tested?

The recommended test is a NAAT (nucleic acid amplification test, often called PCR). It detects the bacterium's genetic material and is very sensitive. The key point is that the sample has to come from each site that could be infected:

For first-catch urine, collect the first part of the stream, not midstream, ideally at least an hour after you last passed urine. If you're unsure which samples you need, STI blood test vs urine test vs swab explains the differences.

When to test

Test from 2 weeks after the sex you're worried about. If you have symptoms, test straight away. A negative result from earlier than 2 weeks may need repeating. Work out your dates with the STI test window calculator.

Gonorrhoea and chlamydia often occur together, and one PCR test on the same sample can check for both. How the two differ is covered in chlamydia vs gonorrhoea.

Gonorrhoea Treatment

Gonorrhoea is curable. Current guidelines treat uncomplicated infection with a single injection of the antibiotic ceftriaxone. If chlamydia hasn't been ruled out, a doctor may add a week of doxycycline tablets.

• Don't self-treat. Leftover tablets or antibiotics bought over the counter may not work and help resistance spread.
• Avoid sex until you and your partners have finished treatment and for 7 days afterwards.
• Test of cure: after a throat infection, a repeat test 7 to 14 days after treatment is advised, because throat gonorrhoea is harder to clear.
• Retest at about 3 months, whatever the site, because reinfection is common. See STI retesting after treatment.
• Symptoms that don't settle need a check-up, usually with a culture to test the bacteria's antibiotic sensitivity. Other infections, such as Mycoplasma genitalium, can cause similar symptoms.

Telling and Treating Partners

Anyone you've had sex with in the two months before your symptoms started or your diagnosis should be tested and treated, even if they feel fine. If they aren't, the infection passes straight back. In some countries a doctor can give you medicine or a prescription to pass to a partner, but in Thailand partners are usually advised to see a doctor themselves. If you're the partner, read what to do if your partner tested positive for an STI.

Gonorrhoea Testing in Bangkok

Gonorrhoea testing is available at hospitals, clinics and sexual health centres across Bangkok. Ask for a PCR test, and for throat and rectal swabs if they apply to you.

If you'd prefer private testing, Ovio's at-home STI testing brings a doctor to your home, condo, hotel or office at a time you choose, for Thai and international clients. The gonorrhoea PCR test is ฿2,990, or ฿3,990 for chlamydia and gonorrhoea together on one sample, with urine and swabs from the sites that match the sex you've had. Not sure what else to include? See which STI tests should I get?

Frequently Asked Questions

Can gonorrhoea go away on its own?

You shouldn't rely on it. Symptoms can fade while the infection stays, and untreated gonorrhoea can still be passed on and cause complications such as PID. A course of the right antibiotic cures it.

How soon after sex can I test for gonorrhoea?

From 2 weeks after the sex you're worried about. If you have symptoms, test now. A negative test taken earlier may need repeating.

Will a urine test pick up throat gonorrhoea?

No. Urine only checks the urethra. After oral sex you need a throat swab, and after receptive anal sex a rectal swab.

Can I catch gonorrhoea again after treatment?

Yes. Having had it doesn't make you immune, and reinfection from an untreated partner is common. That's why partners need treating and a retest at about 3 months is advised.

Is gonorrhoea the same as chlamydia?

No. They're different bacteria with different treatments, though they spread the same way, cause similar symptoms and are often tested together. See chlamydia vs gonorrhoea.