Gonorrhea

Updated on:
August 7, 2021

Gonorrhea is a sexually transmitted infection (STI) caused by the bacteria, Neisseria gonorrhoea. This bacteria likes to target warm, moist areas (i.e. the mucous membranes) and may infect the mouth, throat, penis, vagina, and/or rectum. It is easily passed from person to person through sexual contact.

Many people infected with gonorrhea are asymptomatic, meaning they exhibit no symptoms at all. Those that do have symptoms typically show them within 2-14 days after the initial infection.

If left untreated, gonorrhea can lead to serious long-term health effects. Through STI screening - collecting a urine sample and swabs of the affected area(s) - gonorrhea can be effectively detected and treated with antibiotics.

The history of Gonorrhea

How has our understanding of Gonorrhea evolved?

Gonorrhea is one of the oldest known sexually transmitted infections, having been referenced throughout history for centuries. It's slang name is "the clap.” A term with divisive origins - some claim it stemmed from the thirteenth-century French term for brothel, "clappier.” While others argue it's derived from an Old English word "clappan" meaning to throb or beat, referencing the throbbing sensation an infected person felt when urinating.

Before antibiotics were discovered, metals including gold, mercury, and bismuth were used in attempts to treat the infection. These crude forms of treatment continued until Penicillin was found in the 1940s and became the primary therapy in treating gonorrhea. Unfortunately, gonorrhea is very good at developing resistance to antibiotics and it has done so since penicillin was first used. Modern treatment for gonorrhea recommends treatment with two different antibiotics to reduce this risk and, fortunately, we are still able to cure this infection. .

Gonorrhea rates have rapidly increased over the last ten years. Along with this increase, there has been an emergence of new strains of antibiotic-resistant gonorrhea, which require more aggressive treatments to cure them. How prevalent is Gonorrhea in at-risk groups? In Canada, gonorrhea is the second most commonly reported sexually transmitted infection. Between 2009-2018, reported gonorrhea infection rates in Canada increased by 190%, with 30,874 cases reported in 2018. The average rate of reported gonorrhea infection in 2018 was 95.7 per 100,000 people.

Men represented 65% of those reported cases. In 2017, the male rate of infection almost doubled that of females. This difference is mainly due to higher rates of infection among men who have sex with men and the higher rate of asymptomatic presentation in females.

The highest proportion of reported gonorrhea cases is amongst young adults aged 15-29, representing 56.2% of reported cases in 2018. While all age groups have experienced an increase in reported gonorrhea rates, those above 24 years old have doubled their reported rates with the 25-29-year-old age group having the most drastic increase. 

Gonorrhea can affect anyone, although some populations contain a higher risk for gonorrhea. Gay, bisexual, and other men who have sex with men experience higher rates of gonorrhea than other at-risk populations.

Factors that can increase your risk of contracting gonorrhea include:

  • Inconsistent condom use
  • Having a new sexual partner
  • Having multiple sexual partners
  • Having anonymous sexual partners
  • Being a male who has sex with other males
  • Being a sex worker or having sex with sex workers
  • Being a young adult
  • Drug use
  • Lower socioeconomic status
  • Experiencing violence and/or discrimination
  • Experiencing mental health issues
  • Having previously contracted gonorrhea or other STIs

Gonorrhea myths

You will know you have gonorrhea because you'll show symptoms.

Most people infected with gonorrhea may not show or experience any symptoms. The only way to know for sure if you have gonorrhea or not is to get STI testing.

You can’t transmit gonorrhea once you start antibiotics.

While antibiotics are still highly effective at curing gonorrhea, your healthcare provider will let you know when it will be safe again to resume sexual activity. This is often seven days after your last dose of antibiotics: a single high-dose treatment, a  7-day treatment, or a combination of both.

Gonorrhea can’t pass from a pregnant parent to their baby.

Gonorrhea is easily transmitted, and the bacteria can be transmitted to a newborn during the birthing process. Expecting parents should undergo STI screening to reduce the risk of transmission and complications to the baby.

Gonorrhea will clear up on its own.

Gonorrhea is a bacterial infection that will not resolve without treatment by a healthcare provider in the form of antibiotics. Even if gonorrhea symptoms never appear or they go away, the bacteria can still be transmitted to others and cause you serious, long-term complications if not treated.

How is Gonorrhea transmitted?

Gonorrhea is most easily transmitted during condomless sex, including oral, vaginal (front), and anal (back) sex. Additionally:

  1. Performing oral sex on someone infected with gonorrhea can transmit the infection to your throat and/or mouth.
  2. Gonorrhea transmission is more likely when performing oral sex on a penis compared to performing oral sex on a vagina.
  3. If your partner has gonorrhea in their mouth and they perform oral sex on you, they can transfer the gonorrhea infection to your genitals or rectum.
  4. Sharing of sex toys.
  5. Performing hand jobs or finger stimulation of the vagina or anus, if infected fluids come into contact with the hand, can transmit the gonorrhea bacteria to mucous membranes the hand then comes into contact with (i.e. genitals, mouth/throat, eyes, rectum).
  6. Pregnant parents with gonorrhea can also transmit the bacteria to their newborns during birth.

For more information about transmission, read our Gonorrhea Transmission article.

How to protect yourself from transmission

Preventing gonorrhea, along with many other STIs can include a multitude of methods, including:

  • Washing your body and genitals before and after sexual activity
  • Using Antibacterial mouthwash after oral sex
  • Not flossing your teeth within thirty minutes of giving oral sex
  • Speaking to your sexual partners about their STI and testing history.
  • Avoiding having sexual contact if you or your sexual partner notices any unusual discharge, pain or burning (especially when urinating), or discomfort in the genital or anal region.
  • Getting tested (and treated) for STIs regularly
  • If you test positive for gonorrhea (or other STIs), treat it as soon as possible and notify your sexual partners so they can get tested as well to prevent future re-infection. Abstain from sexual contact until your healthcare provider says it’s ok to resume.

Is gonorrhea treatable & curable?

Yes! The current treatment to cure gonorrhea typically involves dual antibiotic therapy. This consists of receiving a high-dose intramuscular injection of the antibiotic Ceftriaxone into your bum cheek along with the oral antibiotic azithromycin (Zithromax).

Individuals with allergies to cephalosporin antibiotics (like Ceftriaxone) may receive oral gemifloxacin (Factive) or injectable gentamicin and oral azithromycin.

If symptoms remain more thanfive days after treatment, follow up with your healthcare provider as you may require additional treatment or a different antibiotic.

With rising rates of gonorrheal resistance to certain types of antibiotics used as first-line treatments, it’s essential to get re-tested to confirm your treatment was effective and gonorrhea has cleared. If you have symptoms, a special test (gonorrhea culture) may also be performed to check specifically for resistance.

Sources:

  • https://www.cdho.org/Advisories/CDHO_Factsheet_Gonorrhea.pdf
  • https://www.healthline.com/health/healthy-sex/clean-up-after-sex#clean--up-kit
Reviewed by:
Dr. Caley Shukalek

Caley is passionate about evidence-based, patient-centred care, including telemedicine that can provide high quality care from wherever a patient may choose.

He helped create Alberta's PrEP guidelines and works as a specialist in General Internal Medicine with additional training in sexual health, including HIV and sexually transmitted infections.

He holds an Masters of Public Health from Johns Hopkins University, an MD from the University of Calgary and an MSc from the University of Alberta.