It’s unsettling but true: You can have gonorrhea without knowing it. This sexually transmitted infection often doesn’t cause any symptoms. And if symptoms do appear, they can easily be confused for another health issue.
Before the COVID-19 pandemic, gonorrhea was on the rise; cases had increased 92 percent since 2009. While social distancing and stay-at-home orders may have prevented some new cases in 2020, people were also less likely to get tested, leading to more undocumented infections and potentially more complications from prolonged infections, says Philip Deibel, MD, an OB-GYN who delivers babies at UNC Rex Healthcare.
That’s why testing for gonorrhea is more important now than ever, Dr. Deibel says.
Signs and Symptoms of Gonorrhea
Gonorrhea is caused by infection with the Neisseria gonorrhoeae bacterium. It is very contagious, and it can be transmitted by sexual contact with the penis, vagina, mouth or anus. It can also cause infections in any of those locations. If you are exposed, symptoms can develop within a couple of days and up to two weeks later—or not at all.
“It’s crucial to know that many gonorrhea infections are asymptomatic,” Dr. Deibel says. “That means that you can have it, be contagious, and it can be doing damage to your body, all without showing any symptoms.”
In women, symptoms of a genital infection include painful or difficult urination, increased vaginal discharge, vaginal bleeding between periods, and itching or irritation.
In men, symptoms of a genital infection include painful or difficult urination, discharge from the urethra, and pain in the testicles or scrotum.
Symptoms of a rectal infection in men and women include discharge, anal itching, soreness, bleeding or painful bowel movements.
The main symptom of an oral infection in men and women is a sore throat.
Diagnosing Gonorrhea
Gonorrhea isn’t easy for people to spot on their own, either because they have no symptoms or because their symptoms could be from any number of things. If you are younger than 25, Dr. Deibel recommends annual testing for gonorrhea and other STIs, regardless of whether you suspect an infection. People older than 25 who have multiple sex partners or a new sex partner should get tested annually, too.
“Half of people who have gonorrhea are under age 25,” Dr. Deibel says, “but of course that means that half are older than 25. Testing is recommended if you are not in a long-term, monogamous sexual relationship.”
You can ask your primary care provider or gynecologist about getting tested for gonorrhea. This is typically done with urine tests or swabs of the affected area.
Complications of Gonorrhea
In women, gonorrhea can travel up the reproductive tract and infect the uterus, cervix and fallopian tubes. This can cause pelvic inflammatory disease (infection of the reproductive organs) and scarring and inflammation of the fallopian tubes, which can lead to infertility or ectopic pregnancy (when an embryo implants outside the uterus).
In men, gonorrhea can cause epididymitis, which is inflammation of the tube at the back of the testicle that stores and carries sperm. This can cause infertility if left untreated.
Gonorrhea also can spread to the blood, causing a rare but life-threatening condition called disseminated gonococcal infection. Symptoms include fever, joint pain and skin lesions.
“You are also more prone to getting or transmitting HIV if you have gonorrhea,” Dr. Deibel says. “Having an STI makes it easier for HIV to enter your body and increases your chances of getting the virus.”
Additionally, gonorrhea can be spread from mother to baby during childbirth. This infection can be very dangerous to babies, even causing blindness, so pregnant women should consult their doctors for testing and treatment.
Treatment for Gonorrhea
Gonorrhea is typically treated with one injection of the antibiotic ceftriaxone. This shot can cure the infection, but it cannot undo any damage that gonorrhea may have caused in the body.
If symptoms continue for several days after treatment, you should return to your doctor for reevaluation. A “test of cure”—follow-up testing that makes sure the infection was successfully treated—is needed one to two weeks after treatment for people who have an infection in the mouth or throat. Patients with genital or rectal infections should be retested three months after treatment.
It’s important to know that you can get gonorrhea more than once. Successful treatment does not protect against future exposure to the bacteria and will not prevent reinfection.
How to Prevent Gonorrhea
Of course, “the only way to completely prevent gonorrhea is to abstain from oral, vaginal and anal encounters,” Dr. Deibel says. “Being in an exclusive, long-term sexual relationship with a partner that you know tested negative for gonorrhea at the beginning of your relationship is also an effective way to avoid it.”
For those who are not abstinent or monogamous, wearing condoms drastically reduces the risk of many sexually transmitted infections, including gonorrhea. That’s why it’s important to use a condom every time and to get annual STI tests if you’re having sex with multiple or new partners.
If you’d like to get tested for gonorrhea and other STIs, find a primary care doctor or OB-GYN near you.