What All Sexually Active People Should Know About Gonorrhea
Question: How many times have you thought or talked about gonorrhea since you started having sex? Odds are, your answer is "basically never" or "only while watching Mean Girls."
As a society, we're still pretty hush-hush around the topic of sexually transmitted infections. And the experts in the STI advocacy sphere aren't exactly focusing their efforts on gonorrhea — there just aren't gonorrhea-positive influencers the way there are for viral STIs like herpes and HIV, for example. (Related: What's the Difference Between and STI and STD?)
Given all that, this statistic may shock you: In 2019, gonorrhea cases rose to an all-time high in the United States for the sixth year in a row, with a total of 616,392 cases, according to the Centers for Disease Control and Prevention's most recent STI report. That's a lot.
So, uh… how do you know if you're part of that statistic, exactly? Glad you asked! Below, health professionals answer all your pressing questions about gonorrhea, including: what is gonorrhea, what do gonorrhea symptoms look like, how do you take a gonorrhea test, what do you do if you test positive, and so much more.
What Is Gonorrhea, Exactly?
Known colloquially as "the clap," gonorrhea is a sexually transmitted infection caused by the Neisseria gonorrhoeae bacteria. This bacteria can infect any mucous membrane, aka the moist, inner lining of some organs and body cavities (such as the vagina, mouth, etc.). Gonorrhea primarily takes root in the urethra, rectum, throat, cervix, and fallopian tubes, says Amy Pearlman, M.D., urologist, health specialist, expert with Promescent, a sexual health and wellness brand. (But it's worth noting that the infection can also be can also be transmitted to your eye.)
So, how do you get gonorrhea? It can infect someone of any gender or sexuality who comes into contact with the virus during vaginal, oral, or anal sex with an infected partner, says Dr. Pearlman.
Gonorrhea Symptoms
As is true with most other STIs, gonorrhea is not like Christmas carolers; it doesn't always announce itself with obvious symptoms or a doorbell ding. In fact, the majority of individuals are asymptomatic, according to the CDC — meaning, there's no noticeable change following transmission.
As far as genital gonorrhea goes, "people with vaginas are even more likely to have no symptoms than people with penises," says Emily Rymland, D.N.P., F.N.P.-C., clinical development manager at Nurx, a virtual healthcare platform. Half of women and one-tenth of men with gonorrhea have no symptoms, according to the U.K. National Health Service (NHS) in England.
When someone does experience gonorrhea symptoms, which usually appear within two weeks of transmission, Dr. Pearlman says they usually include one or more of the following:
Pain during urination or defecation
Greater frequency or urgency to urinate
Discharge or pus from the penis or vagina
Swelling, itchiness, or pain at the infection site
Persistent sore throat
Bleeding between periods
Of course, gonorrhea symptoms vary based on the site of infection. For example, a gonorrhea infection in the throat can cause a sore throat, fever, or swollen lymph nodes, while an eye infection can cause sensitivity to light, vision changes, and increased eye discharge, says Rymland. (See: The Most Common Signs and Symptoms of STDs)
Yes, You Need to Know Your Current Gonorrhea Status
"Knowing your current STI status is an essential component of taking care of your overall health," says Dr. Pearlman. All STIs are treatable or manageable if caught and treated, but if they're left unchecked, they can be dangerous and even deadly, says Rymland. Indeed, this is true for gonorrhea, whether symptoms are present or not. (More Here: Can STIs Go Away On Their Own?)
"A big risk of genital gonorrhea is that, left untreated, it can lead to pelvic inflammatory disease in people with uteruses, which can lead to infertility and/or long-term pelvic pain," she says. In people with testicles, untreated gonorrhea can result in a painful condition in the tubes attached to the testicles. In more extreme instances, "untreated gonorrhea can also spread to the blood or joints, and this can be life-threatening," says Rymland. And if a pregnant person has gonorrhea and isn't tested and treated, they can pass it to their baby during delivery, which can pose serious health threats to the baby, she adds.
Exactly How to Get Tested for Gonorrhea
The good news: Getting tested for gonorrhea is easy. It can be done via a swab of the (potentially) infected area. In the case of genital gonorrhea, the test can also be done via a urine sample. (Related: How Often Should You Get Tested for STDs?)
Where should you go to get tested for gonorrhea? Good question. Your primary care physician will be able to test you, if you have one. If not, you'll be able to access low-cost STI testing from Planned Parenthood, your local health department, a mobile health clinic, or your college or university health center.
Another option is use a direct-to-consumer, at-home STI testing kit. A great option if you don't have transportation to a testing clinic or childcare, or simply prefer doing your own tests, these kits allow you to test for some or all STIs without leaving your own home. If you're interested, check out Nurx, Everlywell, LetsGetChecked, and MyLabBox. (See More: The Complete Guide to At-Home STD Tests)
Whether you opt for in-person or an at-home testing option, it's essential that you're testing all possible sites of infection. Unlike some STIs (like HIV and syphilis, for example), which are full-body infections, gonorrhea and chlamydia stay localized, explains Rymland. Meaning, "if you get a urine or vaginal test for gonorrhea it won't pick up an infection in your throat or anus," she says. "You need to test any area that could have been infected." That means getting tested for oral gonorrhea if you had oral sex with anyone whose STI status you didn't/don't know, or who was positive for gonorrhea. If you don't test all the areas that could potentially be infected, "you can keep infecting your partner(s) who will then re-infect you," she explains.
Gonorrhea Is Curable with Proper Treatment
Of course, no one is psyched to get a positive gonorrhea result — but, truthfully, a positive gonorrhea test result is basically NBD. Assuming you caught the infection before it had a chance to spread, antibiotics will clear the infection right up. Typically, treatment involves a single-dose intramuscular injection of an antibiotic called ceftriaxone, says Pearlman. Or, a single injection of ceftriaxone combined with a single oral dose of azithromycin, according to the World Health Organization.
After treatment, most doctors recommend that you get re-tested. Known as a "test of cure," the point of re-testing is to make sure the treatment worked and you no longer have gonorrhea. This is important because some strains of gonorrhea are a little more finicky (read: resistant to certain antibiotics) than others, says Dr. Pearlman. (If you've heard of "super gonorrhea," that's what it's referring to: gonorrhea that's resistant to antibiotics.)
This is especially true for throat infections of gonorrhea. "Getting re-tested after 7 to 14 days is especially important if you tested positive for throat gonorrhea, because throat infections are more difficult to treat," says Dr. Pearlman.
As for returning to sex? Wait until a week has passed since you completed treatment. (If your partner also tested positive, you'll want to wait a week after they received treatment as well.) Then, assuming you're not experiencing any lingering symptoms, you're good to get it on. (Related: Your Guide to Dealing with a Positive STI Diagnosis)
How to Prevent Transmission of Gonorrhea
No sex act is ever guaranteed to be 100-percent STI-free, but there are simple things you can do to reduce your risk of getting gonorrhea.
As is the case with most STIs, the best way to protect yourself from gonorrhea is to know your current STI status and communicate your current STI status to potential partners before having any kind of sex. Then, ask to know their current STI status and use protection with anyone whose (current) STI status you do not know, or who is STI-positive. Finally, get tested after every new partner or once a year, whichever comes first.
