Gonorrhea: symptoms and signs you should know

Gonorrhea, also known as “the clap,” is one of the more common sexually transmitted infections (STIs)– the third most common STI seen worldwide (Newman, 2015). And it’s on the rise. In 2017, more than 550,000 cases were reported in the United States — a 75% increase since 2009, according to the Centers for Disease Control and Prevention.

Gonorrhea is caused by a bacterium known as Neisseria gonorrhoeae, which tends to flourish in mucous membranes. It’s transmitted through sexual contact — via vaginal, anal or oral sex — and it can infect the penis, vagina, throat, rectum, or eyes. Symptoms of gonorrhea tend to show up 2 to 30 days after infection. These are the most common gonorrhea symptoms to watch for.

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• Painful urination. A feeling of pain or burning sensation when urinating, along with a discharge, are the most common symptoms of gonorrhea, says Amesh A. Adalja, MD, a board-certified infectious medicine physician and senior scholar at the Johns Hopkins Center for Health Security.

• Discharge from the penis. This might be white, yellowish, or green discharge.

• Pain or swelling in the testicles. Your scrotum might swell or ache, but that’s rare, says Adalja. This can be due to epididymitis—inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm.

• A sore throat. Gonorrhea can be spread through oral sex, and a sore throat is the primary symptom of oral gonorrhea.

• Rectal itch or discharge. Gonorrhea can also be transmitted through anal sex, and the infection can cause itching, pain, or discharge from the anus.

• No signs. “Some people have no symptoms at all,” says Adalja. “Yet they’re still contagious.”

• Aches and fever. “In certain instances, gonorrhea can disseminate” throughout the body, says Adalja. “People may have fever, muscle aches, rash, and joint swelling.”

It’s vital to visit your health care provider if you have any symptoms of gonorrhea. According to the CDC fact sheet on the subject, untreated gonorrhea can cause an infection in the tubes attached to the testicles, which can cause sterility, or spread to the blood or joints, which can be life-threatening. It can also increase your chances of contracting HIV.

Women are less likely to show signs of gonorrhea than men, says Adalja. But in addition to painful urination or vaginal discharge, women might experience pelvic pain or vaginal bleeding between periods. Left untreated, gonorrhea can lead to pelvic inflammatory disease (PID), an infection of the female reproductive organs, including the uterus, cervix, fallopian tubes, and ovaries. Left untreated, pelvic inflammatory disease can cause scar tissue and abscesses to form in the fallopian tubes, which can impact a woman’s fertility, including ectopic pregnancy which can be fatal.

“You should see a doctor if you have any of the above symptoms or were notified by a sexual partner that he or she has gonorrhea or another STD,” says Adalja.

Gonorrhea is diagnosed with a urine test, and the clinician might swab the throat or rectum to check for gonorrhea there if you’ve had oral or receptive anal sex. Antibiotics can clear the infection. If you’re diagnosed with the infection, inform sexual partners you’ve had in the last 60 days, so they can be tested as well.

“It’s important to practice safe sexual intercourse and use condoms,” says Adalja. “Gonorrhea is highly prevalent and may not have overt symptoms.”

The CDC treatment guidelines recommend dual therapy with two different antibiotics: ceftriaxone and azithromycin. Each of these antibiotics has a different mechanism of action against N. gonorrhea—the bacteria that causes gonorrhea. This two-pronged approach increases the chances that the treatment will be effective.

You can learn more about gonorrhea treatment here.

Gonorrhea’s nickname, “the clap,” appears in books that are more than 500 years old, and it’s the subject of a slight debate. Most historians believe that it came from “Les Clapiers,” the red-light district in Paris where prostitutes plied their trade. Others think it might have arisen from a folk remedy — clapping the penis between the hands or two objects to clear discharge. (A WWII-era treatment for gonorrhea involved squeezing an antibiotic cream into the urethra, then massaging it through the length of the penis, but no banging was recommended.) Still, others think it could have originated with an Old English word denoting pain.

Read more about the theories behind gonorrhea’s nickname here.

Aside from the title of the least amusing comic book that’s yet to be written, “super gonorrhea” is shorthand for what health officials call “super-resistant gonorrhea,” or gonorrhea that has evolved to become resistant to first-line drugs available to treat it. Health officials are watching the advent of drug-resistant gonorrhea with concern because additional antibiotics have yet to be developed.

Read more about “super gonorrhea” here.

The CDC reported that 555,608 reported cases of gonorrhea were diagnosed in the U.S. in 2017, a 19% increase from the year before and a 75% increase from the record low reported in 2009. Since then, researchers say a decline in condom use and cuts in STI-prevention programs have hastened the disease’s spread (Dall, 2018). The U.S. is not alone in reporting an increase in gonorrhea: In 2017, the United Kingdom reported that cases of gonorrhea had risen 22% since the previous year.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

August 30, 2019

Written by

Michael Martin

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.