The Freddie Guide to: Gonorrhea

At Freddie, we want to give everyone the tools they need to have safer sex. That means friendly, judgment-free information about taking care of your health – including STIs. Read on for our guide to gonorrhea.
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What is gonorrhea?

Gonorrhea is a sexually transmitted infection (STI), and it’s pretty common. It affects body parts that people use for sex, so you can get it in your mouth/throat, your genitals and your rectum. If you get cum in your eye, then it’s possible to get gonorrhea there too.

Sometimes gonorrhea has no symptoms. For people that get them, symptoms usually show up 2-14 days after you were exposed.

You can test for gonorrhea with a urine sample and vaginal, throat or rectal swabs. You can treat gonorrhea with a course of antibiotics.
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What are the symptoms of gonorrhea?

Gonorrhea sometimes has no symptoms. For people who have symptoms, they can include:
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• Genital or anal discharge
• Pain upon urinating
• Genital or anal pain
• Lower abdominal pain
• Anal or vaginal bleeding (more than usual)
• Fever

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How is gonorrhea transmitted?

Gonorrhea affects warm, moist body parts known as “mucous membranes”. It’s transmitted through bodily fluids like vaginal fluid, semen and rectal fluid. Someone doesn’t have to cum to transmit gonorrhea, because the bacteria are present in pre-cum.

Gonorrhea is most commonly transmitted through sex without a barrier (e.g. dental dams or condoms). This includes vaginal, anal and oral sex. It can be transmitted from one body part that has the infection to another.

For example, if someone has rectal gonorrhea and they bottom for a partner without a condom, they can give their partner genital gonorrhea. If someone has gonorrhea in their penis and their partner performs oral sex on them, their partner could get gonorrhea in their throat.

You can also transmit gonorrhea on hands or toys if they have fluids on. For example, if someone used a dildo on a partner with rectal gonorrhea and then used that dildo on themself.

How is gonorrhea treated?

In North America, gonorrhea is treated with an antibiotic injection and a single dose of oral antibiotics, both taken at the same time. In some cases, gonorrhea can be resistant to this first choice of antibiotics. This may require a more intensive course of antibiotics, usually over 7 days.

If you test positive for gonorrhea, it’s important to get treatment. It can cause serious complications if you don’t, like infertility. If you’ve had treatment then you should wait at least one week afterwards before resuming sexual activity. If you have any symptoms that come back, then make an appointment with your care provider and avoid sex while you are waiting.

Treatment does not prevent getting gonorrhea again in future. To lower your risk you can use safer sex strategies as outlined below.

How do you prevent gonorrhea?

The only way to completely avoid all STIs is to not have sex. But we know that this isn’t realistic for most people! Here are some strategies to lower your STI risk.

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Condoms

Barrier methods like dental dams and condoms can help prevent bacterial STIs, which includes gonorrhea. They’re only effective if you use them for every type of sex – in other words, if you use them for anal sex but not for blow jobs then you still have a risk through oral sex.

For condoms to work properly, they also need to be worn for the entire duration of sex. If you’re sharing toys, then you need to use a fresh condom with every new hole and every new partner. 
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DoxyPEP

DoxyPEP is short for Doxycycline Post-Exposure Prophylaxis. It’s where you take an antibiotic (doxycycline) after condomless sex to help prevent syphilis, chlamydia and gonorrhea. It can reduce, but does not eliminate, bacterial STI risk.

DoxyPEP needs to be taken within 72 hours after condomless oral sex, anal sex or insertive vaginal sex. Ideally it should be taken within 24 hours. 

DoxyPEP is for men who have sex with men, trans women and other gender-diverse people who were born with a penis. This is because the research supporting DoxyPEP showed it was effective in people with these body types. 

Unfortunately, research suggests DoxyPEP is not as effective for people who were born with vaginas. This includes cis women, trans men and other gender-diverse people with this body type. At this time, DoxyPEP is not recommended for these people – however, you can speak to your clinician to decide what might be best for you.

Some researchers have cautioned that using doxycycline for DoxyPEP may increase the risk of antibiotic resistance, particularly when used inconsistently. Public health units are carefully considering these risks alongside the benefits of reducing STI transmission. At the time of writing, DoxyPEP has been formally endorsed by America's Centers for Disease Control and Prevention. The Public Health Agency of Canada is currently conducting its review.

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I’ve been exposed to gonorrhea. What should I do?

If someone you’ve had sex with tells you they’ve got gonorrhea, then get tested as soon as you can. You should do this even if you don’t have symptoms. You should also avoid sex while your results are pending. Sometimes you may be given treatment for gonorrhea if you report an exposure, even if you are symptomless.

You can get testing and treatment for STIs at family doctors, sexual health clinics, walk-in clinics, public health clinics, and some community health centres.

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I have symptoms of an STI. What should I do?

Make an appointment to see a care provider as soon as you can if you’ve got STI symptoms. You can often be diagnosed and treated the same day if you have symptoms like genital discharge.

If you’ve got symptoms, your health provider may do a swab of your penis, your rectum or your vagina/front hole. You might also need to give a urine sample.

Depending on your symptoms, your provider may send samples off for some further tests. They will usually reach out to you when they’ve got those results back.

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I just tested positive for gonorrhea. What now?

So you’ve got a positive test result. Don’t panic! STIs can happen to anyone, and the good news is that getting treatment is usually straightforward.

Get in touch with your care provider by making an appointment or going to walk-in hours as soon as you can. Avoid sex until you’ve had treatment and your provider says you can resume sexual activity. In most cases, this will be one week after your treatment is complete.

If you are diagnosed with an STI then you’ll need to tell recent partners so that they can receive testing and treatment if they need it. If you don’t feel comfortable reaching out to a partner directly, then there are services available to send an anonymous text to someone saying they’ve had an STI exposure. However, if you’re the only person that your partner is having sex with then they will know the message is coming from you.

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