Gonorrhea: symptoms, treatment and therapy in men and women


  • Gonorrhea
  • The ways of transmission of gonorrhea
  • How gonorrhea manifests itself
  • What can cause gonorrhea
  • How is gonorrhea diagnosed
  • How gonorrhea is treated
  • Gonorrhea and other sexually transmitted diseases
  • Preventing Gonorrhea

Questions and answers


The gonorrhea (also known as the clap ) is a sexually transmitted disease (STDs) conveyed by the bacterium Neisseria gonorrhoeae , more widely known as gonococcus .

To reproduce, this microorganism needs warm and humid environments. For this reason, it infects:

  • In humans: low urinary tracts (urethra), causing inflammation (urethritis);
  • In women: the uro-genital tracts, mainly the bladder (gonococcal cystitis), and the uterine cervix, ie the cervix (gonococcal cervicitis);
  • In both: pharynx, conjunctiva and rectum.

Of all sexually transmitted infections, it is the one for which treatment is becoming progressively more difficult, due to the phenomenon of antibiotic resistance .

Since the 1970s, the incidence of this venereal disease has been declining, also and above all thanks to information and awareness campaigns on risk factors. The current risk is that the continuous mutations that the bacterium is able to carry out lead to the selection of multi-resistant strains.

Today in Italy there are about a hundred new cases a year. However, the World Health Organization reports 78 million new confirmed cases worldwide every year.

Consult the facilities that perform Neisseria gonorrhoeae culture examination:

Where to perform Neisseria gonorrhoeae culture test?

The ways of transmission of gonorrhea

How do you get gonorrhea? Gonorrhea is spread through unprotected sex with an infected partner. The woman-human transmission occurs with a probability equal to approximately 20% , while the man-woman is about 50% .

The incubation period of the disease is generally between 3 and 5 days .
Is it possible to acquire gonorrhea without having had risky sex? At the moment, official sources exclude that there may be alternative ways of contagion than sexual. However, an Australian study was published in 2019in which the possibility is considered that the disease can also be transmitted through kissing between male homosexuals.

Contagion is also possible from the infected mother to the child at the time of delivery (neonatal conjunctivitis). This is a serious occurrence, which can lead to blindness. To avoid this risk, all newborns are subjected to prophylaxis with eye drops or antibiotic ophthalmic ointment immediately after birth.

Transmission through the exchange of objects (clothes, towels) is not possible , given the low resistance capacity of the microorganism in the environment outside the human body. For the same reasons, friendly kisses and hugs do not carry the disease.

Gonorrhea and pregnancy

In pregnancy , gonorrhea can lead to miscarriage or premature birth.
A pregnant woman with gonorrhea can pass the disease to her newborn at the time of delivery (neonatal conjunctivitis). The conjunctivitis neonatal can develop into corneal ulcers, abscesses and ocular perforation, severe clinical eventualities that can lead to blindness . To avoid this risk, all newborns undergo prophylaxis with eye drops or antibiotic ophthalmic ointment (based on silver nitrate or tetracycline ) immediately after birth. Cases of gonococcal infection blindness have declined sharply since the introduction of prophylaxis.
The newborn infected by the mother at the time of delivery can also develop joint inflammation or serious systemic infections , even fatal.

How gonorrhea manifests itself

Once contact has taken place, the carried bacterium adheres to the epithelial cells lining the skin (epidermis) or mucous membranes and penetrates deeply through them: infection takes place.

In women, the symptoms , which appear 7 to 21 days after contact at risk, include:

  • Burning when urinating ;
  • Dysuria: difficulty urinating, which occurs when the disease attacks the cervix;
  • Vaginal discharge;
  • Blood loss between periods
  • Pelvic pain ;
  • Sore throat: the disease can occasionally develop in the mouth and produce gonococcal pharyngitis (pharyngeal gonorrhea) can affect people who have had oral sexual contact with an infected individual; it is asymptomatic in most cases.

The fact that almost half of women are asymptomatic makes diagnosis of the disease more difficult and amplifies its chances of spreading. This is the reason why doctors recommend getting tested for gonorrhea in case of risky sexual contacts, even in the absence of symptoms.

In men, the incubation period is highly variable. Symptoms appear two to 30 days from the time of infection and are:

  • Burning when urinating;
  • Dysuria : difficulty urinating;
  • Losses of white, yellow or green color: it is the product of the inflammatory reaction carried out by the immune system, following which the white blood cells decompose;
  • Testicular pain and swelling : not always present;
  • Sore throat : the disease can occasionally develop in the mouth and produce gonococcal pharyngitis ( pharyngeal gonorrhea ) can affect people who have had oral sexual contact with an infected individual; it is asymptomatic in most cases.

Men can also be asymptomatic: it happens in 10% of cases. Gonococcal pharyngitis, usually asymptomatic, can cause a sore throat.

What can cause gonorrhea

Not treated properly, gonorrhea can evolve and cause serious consequences .
In women, the bacterium can be responsible for the inflammatory disease of the pelvis (Pelvic Inflammatory Disease, PID ), an infection of the upper genital tracts that occurs in 10-20% of cases and which may cause:

  • Fever ;
  • Pelvic abscesses;
  • Chronic pelvic pain (typically bilateral);
  • Pelvic peritonitis;
  • Injuries to the fallopian tubes: they occur when the bacterium goes up through the endometrium (the mucous membrane that lines the uterine cavity) and reaches the tubes ( salpingitis ). The consequences of tubal contamination can lead to infertility and an increased risk of ectopic pregnancy (pathology in which the implantation of the fertilized egg takes place in different places than the physiological one, represented by the uterus). Ectopic pregnancy (or ectopic pregnancy ), if not treated promptly, can itself be a cause of infertility.

It should be noted that pelvic inflammatory disease is asymptomatic in 80% of cases.
If pelvic inflammatory disease is due to gonorrhea, treating the latter results in healing.
In humans, the riskiest (but infrequent) complication is epididymitis , which occurs due to the ascent of the bacterium from the urethra towards the upper urinary tracts and which causes testicular pain and swelling. Although less common than inflammatory female pelvic disease, epididymitis can lead to infertility .

A further complication of gonorrhea and pelvic inflammatory disease is Fitz-Hugh-Curtis Syndrome. It is an inflammation of the liver ( perihepatitis ) which occurs mainly in women and causes abdominal pain, fever, nausea, vomiting. It is often confused with oneliver or biliary tract disease .

The gonorrhea bacterium can spread into the bloodstream (disseminated gonococcal infection or arthritis-dermatitis syndrome). This occurrence occurs in 1% of cases (especially in women ) and causes:

  • Intermittent fever
  • Migrant polyarthritis : it is a condition that manifests itself in an asymmetrical way that attacks the joints, the membrane that covers them (synovitis) and the tendons (tenosynovitis) and causes their inflammation. The result is joint pain and swelling, particularly in the hands, wrists, knees, ankles and feet;
  • Dermatitis: erythematous skin lesions on the skin of the arms and legs;
  • Hepatitis;
  • Endocarditis;
  • Meningitis.

L ‘ septic arthritis gonococcal is, instead, a more localized form of systemic gonococcal infection. It determines the onset of painful arthritis with effusion in the large joints (knees, ankles, wrists and elbows), which swell, limiting the possibility of movement and generating intense local pain.

L ‘ septic arthritis is joint inflammation caused by an infectious agent (in this case the bacterium of gonorrhea) present in a different site than articulate and that reaches the same joint through the bloodstream.
It typically occurs in damage to a single joint , such as the knee or hip.

Can gonorrhea be asymptomatic ? Gonorrhea can be asymptomatic for long periods of time: for this reason it is important to undergo the test, regardless of the manifestations, after a risky intercourse.
What happens if gonorrhea is not treated ? If not properly treated, the disease can last for months or years and be contagious for very long periods. Furthermore, if the patient does not take the appropriate medications, he is at a greater risk of complications. Failure to promptly establish antibiotic therapy reduces the chances of success.

How is gonorrhea diagnosed

How is gonorrhea recognized? The non-specific and not always present symptomatology in gonorrhea always requires the performance of laboratory diagnostic tests. For the diagnosis of this disease, swabs are carried out on the cervix, urethra, rectum or pharynx (the parts of the body normally infected) or analyzes on small urine samples (only in humans ). The tampon is a painless procedure that lasts a few seconds.

In humans , the search for the microorganism in the urethral exudate is carried out, an effective test with a diagnostic sensitivity of 95; the examination carried out on the culture of vaginal secretions in the woman has a diagnostic sensitivity of 60%.
In case of involvement of the rectum, rectoscopy is used , which highlights the mucopus plaques present on the intestinal walls.

In the case of gonococcal arthritis, culture can also be performed on joint fluid, taken with an aspirated needle ( arthrocentesis ). The synovial fluid, in these circumstances, is cloudy or purulent, due to the high number of white blood cells present. As specified above, white blood cells are the signal of the defense reaction set up by the immune system against the bacterium. Gonorrhea is part of the list of diseases requiring notification to local, regional and national authorities

, as part of the surveillance systems established by law. When to take the test and where? In case of unprotected sexual intercourse or if you have any doubts about the possibility of having contracted gonorrhea, you should contact your doctor or go to the nearest Sexually Transmitted Diseases Unit ( UOMST ) to carry out the test . Gonorrhea can cause serious consequences and endangers the health of the people affectionately close: early diagnosis and the timely establishment of adequate therapy avoid additional risks.
If the test is positive , you must notifyall people with whom they have had sexual intercourse in the last month , advising them to undergo the exam themselves.

How gonorrhea is treated

The microorganism that causes gonorrhea is a bacterium : therefore the treatment envisaged is antibiotic .
Which antibiotic to use to treat gonorrhea?  The therapy scheme is a single dose of cephalosporin ( ceftriaxone ) intramuscularly, combined with azithromycin by mouth (combination therapy). Patients allergic to cephalosporins can be treated with  gentamicin  or  spectinomycin .

Medicines for gonorrhea therapy can be purchased without a prescription? Gonorrhea is a potentially serious disease that must be diagnosed by a doctor following specific clinical tests. The same doctor prescribes the drugs necessary for the treatment, on the basis of a personalized therapy.

Symptoms improve within a few days of starting therapy. As for abdominal pain , it usually disappears after about two weeks. In case of disseminated gonococcal infection with arthritis , a course of parenteral administration is performed. Treatment of gonococcal arthritis does not include joint drainage. The joint is immobilized and anti-inflammatories and one are prescribedpassive physiotherapy , replaced by active mobilization when pain disappears. Complete joint function is recovered in 95% of cases . There are no indications for intra-articular infiltration of antibiotics .
Since the treatment of gonorrhea complications is longer and more complicated than the treatment of the disease itself, early diagnosis is particularly favorable.

Partners of infected patients should also be treated with antibiotics.
Can gonorrhea heal spontaneously?Spontaneous regression of disease symptoms is not indicative of recovery. While noticing the improvement in the clinical picture, it is necessary to consult a doctor to undergo the appropriate therapy and avoid dangerous consequences and transmission to partners.
The amplification of the phenomenon of antibiotic resistance is complicating the therapy against Neisseria gonhorroeae , of which strains insensitive to common antimicrobial drugs are increasingly frequent. In order to administer the most appropriate therapy, the analysis of the culture samples must therefore be completed by an antibiogram . This test allows to evaluate the sensitivity of the bacterium to different antibiotics and to personalize the therapy.

Gonorrhea does not confer permanent immunity: after recovery, therefore, it is possible to contract the disease again.
Some of the molecules once active on the gonorrhea bacterium, such as penicillin , are no longer used today due to the fact that this microorganism has developed resistance. The tetracyclines (such as azithromycin), the first treatment of choice today are only effective in combination with cephalosporins.
Several new antibiotic molecules are currently being developed, which should counteract the phenomenon of resistance, bypassing it.
In 2018, Public Health England announced the case of a patient infected with a strain of Neisseria gonhorroeaeresistant to all antibiotics in use today. This is the first case in the world and has already been renamed super gonorrhea.

How should gonorrhea be treated in pregnant women ? Pregnant or breastfeeding women must be treated with the antibiotic to avoid the risk of abortion, early birth and infectiousness of the baby. Excluding tetracyclines and fluoroquinolones , the antibiotics used for the treatment of gonorrhea do not harm the baby, but protect him from the risk of acquiring the disease.

Gonorrhea and other sexually transmitted diseases

Gonorrhea is one of the most widespread sexually transmitted diseases in the world and, like syphilis, multiplies the risk of acquiring HIV by 2-3 times . Furthermore, co-infection with Chlamydia trachomatis occurs in 15-25% of men and 35-50% of women.
Several microorganisms responsible for sexually transmitted diseases can generate infections with symptoms similar to gonorrhea. Chlamydia, syphilis and gonorrhea have common symptoms and signs, such as abnormal discharge from the genitals , pelvic pain , itching and lesions in the genital or oral region, dysuria, pain and bleeding during and / or after sexual intercourse.

They are often asymptomatic or appear with very mild symptoms: this aspect represents a factor in the spread of the disease, because subjects unaware of having been infected can continue to transmit them.
Furthermore, all three are related to complications such as infertility, problems during pregnancy, neonatal infections.
The similarities between gonorrhea , syphilis, and chlamydia make medical consultation and testing even more important after a risky intercourse.

Gonorrhea or candida ? One of the diseases that often makes people think of gonorrhea is candida: often people who notice abundant and smelly genital dischargethey think of potentially serious diseases such as gonorrhea, especially if they have had risky contacts. In reality, when symptomatic, the latter generates more complex manifestations than candida. In any case, to differentiate it, it is enough to undergo the test.
Gonorrhea or cystitis ? Like cystitis, gonorrhea can appear with dysuria (pain when urinating) and pollakiuria (increased frequency of urination).

Preventing gonorrhea

Correct use of condoms protects against infection.
The bacterium Neisseria gonhorroeae mutates very easily: this makes it difficult to synthesize a vaccine , considered by the World Health Organization “the only sustainable tool for the control of gonorrhea “. Despite the complexity of designing an agent directed against a constantly changing target, the scientific community appears to be relatively close to the finish line.

In 2017, the results of a study were published that tested the effectiveness of a vaccine already in use for the prevention of meningitis B. Prophylaxis carried out on a significant population of people in New Zealand revealed that people vaccinated against meningitis B have a lower risk of contracting gonorrhea . If these data were to be confirmed, it would be the starting point for launching a prevention campaign .

Questions and answers


Symptoms in women include burning when urinating, dysuria (difficulty urinating), vaginal discharge, bleeding between cycles, pelvic pain. Almost 50% of women infected with the gonorrhea bacterium are asymptomatic.
In men, which are asymptomatic in about 10% of cases, symptoms include burning when urinating, dysuria, genital discharge, testicular pain and swelling.
Occasionally, in both sexes, gonorrhea can generate a sore throat: this happens when the disease develops in the mouth and produces gonococcal pharyngitis (pharyngeal gonorrhea) can affect people who have had oral sexual contact with an infected individual; however, it should be emphasized that gonococcal pharyngitis is asymptomatic in most cases.


The disease has different symptoms depending on whether it affects men or women. The symptoms that appear in males are: burning during urination, dysuria, genital discharge, testicular pain and swelling. The riskiest (fortunately infrequent) complication of gonorrhea is epididymitis, which occurs due to the ascent of the bacterium from the urethra to the upper urinary tracts and which causes testicular pain and swelling. It can lead to infertility.


Sexually transmitted diseases are characterized by similar symptoms in some respects that include abnormal secretions of the genitals, pelvic pain, itching and lesions in the genital or oral region, dysuria, pain and bleeding during and / or after sexual intercourse. They are therefore difficult to distinguish from a clinical point of view, at least in their initial stages. In the absence of adequate therapy, they can become chronic or generate consequences with a significant impact on health and lead to infection of the partners of infected people. It is therefore necessary, after a risky intercourse, to contact the doctor, who will prescribe appropriate clinical investigations and possibly establish an adequate therapy.


For the diagnosis of this disease, swabs are carried out on the cervix, urethra, rectum or pharynx (the parts of the body normally infected) or tests on small urine samples (only in humans). The tampon is a painless procedure that lasts a few seconds. In the case of gonococcal arthritis, culture can also be performed on joint fluid, taken with an aspirated needle (arthrocentesis). In case of unprotected sexual intercourse or if you have any doubts about the possibility of having contracted gonorrhea, you should contact your doctor or go to the nearest Sexually Transmitted Diseases Unit (UOMST) to carry out the test. If the test is positive, all people with whom you have had sexual intercourse in the last month should be notified, advising them to undergo the test themselves.


Symptoms of the disease generally last until antibiotic therapy is instituted. Spontaneous regression of disease symptoms is not indicative of recovery. Even in the presence of improvement, it is necessary to consult a doctor to undergo the appropriate therapy.


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