Symptoms of Gonorrhea

Symptoms occur, but only sometimes—leaving many people untreated

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gonorrhea symptoms
© Verywell, 2018

Gonorrhea ("the clap") is the second most common sexually transmitted disease (STD) in the United States, but many people with it don't even know they have it because there are often no signs of infection—especially in women. When symptoms do appear, they typically include a discharge from the penis or vagina and pain while urinating or having sex.

While the infection rarely causes death, it can lead to pelvic inflammatory disease (PID) in women and inflammation of the epididymis in men, both of which can result in infertility.

In rare cases, gonorrhea can cause the inflammation of the heart, joints, and spinal cord, as well as serious complications in babies infected during pregnancy.

Initial Symptoms

Gonorrhea is transmitted during oral, vaginal, or anal sex, and initial symptoms experienced—if any—will generally involve the affected area (the genitals, rectum, or throat).

When present in the genitals in women, symptoms can include:

  • Vaginal discharge
  • Burning or pain when urinating (dysuria)
  • Vaginal itchiness
  • Bleeding between periods
  • Lower abdominal pain or discomfort
  • Pain during sex (dyspareunia)

However, according to the Centers for Disease Control and Prevention (CDC), most women with this kind of infection will have no symptoms or, if they do, will mistake them for a bladder or vaginal infection.

 

When present in the genitals in men, symptoms can include:

  • A greenish-yellow discharge from the penis
  • Dysuria
  • Pain and swelling in the testicles or scrotum

Around 90 percent of gonorrheal infections of the throat will not have any symptoms at all, while the remaining 10 percent may only be evidenced by a sore throat.

Rectal gonorrhea may cause mild itchiness, discomfort, bleeding, or pain during defecation, symptoms that are frequently mistaken for hemorrhoids.

In all types, if signs and symptoms do develop, they usually appear 10 to 14 days after exposure to the Neisseria gonorrhoeae bacterium.

Symptoms in Babies

In addition to sexual transmission, gonorrhea can be passed from mother to child during pregnancy. This usually doesn't happen while the baby is in the womb (as the fetal tissues provide protection against infection). Rather, the transmission can occur during delivery when the baby is exposed to the mother's genital secretions.

When this happens, the bacteria may be transferred to the newborn's eyes and cause ophthalmia neonatorum, a form of conjunctivitis characterized by eye redness, pain, and discharge. The condition is largely avoided today due to the routine administration of an antibacterial eye ointment in all babies at the time of birth.

If the infection isn't averted, symptoms will usually develop within two to five days. In addition to conjunctivitis, scalp infection, respiratory inflammation, vaginitis, and urethritis are common. Complications include vision loss, meningitis, septic arthritis, and blindness.

Complications

If left untreated, gonorrhea can lead to serious complications affecting the female and male reproductive tract 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 reproductive tract. Symptoms will often appear immediately after your menstrual period and, in some cases, be your first sign of infection. PID is characterized by pain in the pelvis and lower abdomen, as well as nausea, vomiting, fevers, chills, cramping, and a foul-smelling discharge.

An infection can sometimes cause scarring in the fallopian tubes, leading to complete tubal blockage and infertility. If only partial blockage occurs, an egg can still be fertilized but may be unable to pass from the ovaries to the uterus. This would result in an ectopic (tubal) pregnancy in which a miscarriage is not only inevitable but can place the mother's life at risk if a rupture and hemorrhage occur.

Complications in Men

In the same way that gonorrhea can lead to infertility in women, an untreated infection can cause damage and blockage of the epididymis (the narrow tube that stores sperm in the scrotum) in men.

Gonorrheal epididymitis may be identified by dysuria, a foul-smelling discharge, painful ejaculation, and swollen lymph nodes in the groin. As with PID, the blockage of one or both tubes can lead to functional infertility.

Gonococcal Conjunctivitis

If infected body fluids get into your eyes, a condition known as gonococcal conjunctivitis (pink eye) may occur, causing redness, pain, swelling, and an often profuse discharge.

If left untreated, the infection can cause scarring and perforation of the cornea, leading to vision loss and blindness. In rare cases, the infection can cause the cornea to "melt," binding the eyeball partially or completely to the eyelid.

Disseminated Gonococcal Infection (DGI)

In rare cases, a gonorrheal infection can spread through the bloodstream and infects distant organs. This is referred to as disseminated gonococcal infection (DGI), a complication that occurs in around 3 percent of women and 1 percent of men. Those most at risk are people with compromised immune systems, including organ recipients and people with HIV.

DGI is often referred to as arthritis-dermatitis syndrome because it frequently causes inflammation of the joints (septic arthritis) and pus-filled lesions on the skin.

Very rarely, the infection can settle in the heart and cause inflammation of the heart valves (endocarditis), manifesting with symptoms of malaise, fever, chills, and a heart murmur. DGI can also cause inflammation of the membranes surrounding the brain and spinal cord (meningitis), triggering headache, fever, fatigue, stiff neck, and mental confusion.

When to See a Doctor

While some signs of a gonorrhea infection are classic (such as a discharge in men), most are relatively non-specific and easily missed. Because of this, the best rule of thumb is to see a doctor and request an STD screen if you have had unprotected sex and any signs of infection, however mild. This is especially true if your sex partner is someone you barely know or suspect may have an STD.

If you're hesitant, remember that health professionals are not there to judge you. Rather, their role is to provide you treatment, if needed, and guidance to reduce your future risk.

Due to the high rate of infections in the United States and the impact they can have on women of childbearing age, the U.S. Preventive Services Task Force recommends the screening for gonorrhea and chlamydia in all sexually active women who are at an increased risk of infection, including pregnant women.

Some institutions have expanded on these recommendations and will conduct the routine screening for gonorrhea and chlamydia, as well as syphilis, hepatitis B, and HIV, as part of the first prenatal visit.

Sources:

Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines: Gonococcal Infections. Atlanta, Georgia; issued June 4, 2015; updated January 4, 2018.

Lee, K.; Ngo-Metzger, Q.; Wolff, T. et al. Sexually Transmitted Infections: Recommendations from the U.S. Preventive Services Task Force. Am Fam Physician. 2016; 94(11):907-915.

McAnena, L.; Knowles, S.; Curry, A. et al Prevalence of gonococcal conjunctivitis in adults and neonates. Eye. 2015; 29:875-80. DOI: 10.1038/eye.2015.57.

Workowski, K.; Bolan, G.; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015; 2015; 64(33):924.