Gonorrhea: signs, symptoms and complications

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Gonorrhea (sometimes colloquially called "cotton") is one of the most common sexually transmitted diseases (STDs) in the United States, with more than 1.5 new cases each year.

Despite its prevalence, many people are unaware that they have gonorrhea. This is because many people, especially women, do not experience any symptoms associated with the infection. Although men tend to experience more noticeable symptoms, they generally do not seek help early enough to prevent the spread of the disease to other partners. When symptoms do appear, they usually include discharge from the penis or vagina and pain when urinating or having sex.

Complications of untreated gonorrhea can range from infertility to organ inflammation, so it is imperative to stay up-to-date when testing for STDs.

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Initial symptoms

Gonorrhea is spread through oral, vaginal, or anal sex, and if there are any early symptoms, it usually affects the affected area (genitals, rectum, or throat).

Women with this infection can develop:

  • Vaginal discharge
  • Burning or pain when urinating ( dysuria )
  • Vaginal itching
  • Bleeding between periods
  • Pain or discomfort in the lower abdomen.
  • Pain during sexual intercourse (dyspareunia)

Women and asymptomatic gonorrhea

According to the Centers for Disease Control and Prevention (CDC), most women infected with gonorrhea will have no symptoms, or these symptoms could be mistaken for a bladder or vaginal infection.

Men with this infection can develop:

  • Greenish-yellow discharge from the penis
  • Dysuria
  • Pain and swelling of the testicles or scrotum.

Rectal gonorrhea can cause mild itching, discomfort, bleeding, or pain during bowel movements. These symptoms can be mistaken for hemorrhoids.

Time of onset of gonorrhea symptoms

If signs and symptoms of gonorrhea appear, they usually appear 10 to 14 days after exposure to the bacteria Neisseria gonorrhoeae .

Symptoms in Babies

In addition to sexual transmission, gonorrhea can be passed from a pregnant mother to her baby. This usually does not happen while the baby is in the womb. Transmission can occur during delivery when the baby is exposed to the mother's genitals.

When this happens, the bacteria can spread to the newborn's eyes, causing newborn ophthalmia , a form of conjunctivitis (eye infection) characterized by redness, pain, and discharge from the eyes. The condition can usually be prevented by regularly applying antibacterial eye ointment to all babies at birth.

If infection is not prevented, symptoms usually develop within two to five days. Besides conjunctivitis, other common effects include scalp infection, airway inflammation, vaginitis, and urethritis. Complications include vision loss, meningitis, septic arthritis, and blindness.

Complications

If left untreated, gonorrhea can lead to serious complications that affect the female and male genital tracts and, less commonly, the joints, skin, heart, and central nervous system.

Complications in women

In women with untreated gonorrhea, the most common complication is pelvic inflammatory disease (PID) , a potentially serious infection of the female genital tract. Symptoms usually appear immediately after menstruation and, in some cases, are the first signs of infection. PID is characterized by pain in the pelvis and lower abdomen, as well as nausea, vomiting, fever, chills, cramps, and foul-smelling discharge.

Sterility

The infection can sometimes cause scarring of the fallopian tubes , leading to complete blockage of the fallopian tubes and infertility. If only partial blockage occurs, the egg can still be fertilized, but it may not pass from the ovaries to the uterus . This can lead to an ectopic (tubal) pregnancy, in which a miscarriage is unavoidable and could endanger the mother's life if it ruptures and bleeds.

Complications in men

Untreated infection can damage and block the epididymis (the narrow tube that stores semen in the scrotum) in men.

Gonorrheal epididymitis can be identified by dysuria, foul-smelling discharge, painful ejaculation, and swollen lymph nodes in the groin. A blockage in one or both tubes can lead to infertility.

Gonococcal conjunctivitis

If infected body fluids get into the eyes, a condition known as gonococcal conjunctivitis can occur, causing redness, pain, swelling, and heavy discharge from the eyes.

If left untreated, the infection can cause corneal scarring and perforation, resulting in vision loss and blindness. In rare cases, the infection can cause the cornea to melt, partially or completely tying the eyeball to the eyelid.

Disseminated gonococcal infection (DGI)

In rare cases, gonorrhea infection can spread through the bloodstream and infect distant organs. This is called disseminated gonococcal infection (DGI), a complication that occurs in about 3% of people with gonorrhea.

People with weakened immune systems , including organ transplants and people with inadequate HIV treatment, are at higher risk of spreading gonococcal infection.

DGI is often called arthritis-dermatitis syndrome because it often causes inflammation of the joints ( septic arthritis ) and purulent lesions on the skin.

In very rare cases, the infection can settle in the heart and cause endocarditis (inflammation of the heart valve) with symptoms of malaise, fever, chills, and a heart murmur . DGI can also cause meningitis (inflammation of the membranes that surround the brain and spinal cord), headaches, fever, fatigue, stiff neck, and confusion.

When to see a doctor

Most of the signs of gonorrhea are relatively nonspecific and easy to miss. Because of this, the best general rule of thumb is to see your doctor and request an STD test if you've had unprotected sex or any signs of infection, even if it's mild. This is especially true if your sexual partner is someone you don't know well or think you have an STD.

Even if you are asymptomatic and have not had unprotected sex, the CDC recommends that sexually active men and women get tested for gonorrhea and other STDs once a year. When in doubt, remember that healthcare professionals will not judge you. Their role is to provide you with treatment , if needed, and advice on how to lower your risk in the future.

Guide to Talking to a Doctor About Gonorrhea

Get our printable guide to your next doctor's appointment to help you ask the right questions.

CDC Guidelines for Screening and Treatment

In 2021, the CDC released updated guidelines for the detection and treatment of STDs, including gonorrhea. An annual screening test is recommended for all sexually active women under the age of 25, older women at higher risk, and all men who have sex with men. Gonorrhea is usually treated with antibiotics, namely ceftriaxone.

Frequently asked questions

  • Gonorrhea is treated with antibiotics to treat the infection. However, any damage caused by infection before treatment can be irreversible. As bacteria become more resistant to drugs, prevention is the best way to protect yourself.

  • A person with gonorrhea may not know it until it causes complications, such as a secondary infection. In people who do show symptoms, it can take up to 30 days before the first symptoms appear.

  • Whether gonorrhea can go away without treatment has not been widely studied. The information we have suggests that gonorrhea can persist in the body if left untreated. One study, for example, showed that in 16 women, gonorrhea did not go away without treatment. Another study in men showed that they survived the disease for at least six weeks, but the study could not conclude whether it would go away on its own after that time.

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