Gonorrhoea is a sexually transmitted infection (STI) that is becoming more and more common. It mostly affects young people aged under 30, especially men who have sex with men and Aboriginal and Torres strait islanders. Like chlamydia, if it isn’t treated it can cause serious long term problems for women and it increases the risk of acquiring HIV in men who have sex with men (MSM).

How do you get gonorrhoea?

Gonorrhoea, like chlamydia, is transmitted through direct contact with mucous membranes. It can infect the same places as chlamydia – in the throat via oral sex, in the cervix of the vagina via sexual intercourse and in the rectum via anal sex. In men who have sex with men it is common to get gonorrhoea from oral sex. Gonorrhoea, unlike chlamydia, can also be transmitted through passionate kissing sometimes known as french kissing. It may also be transmitted from mouth to anus through the practice sometimes known as rimming.

Gonorrhoea is much more likely than chlamydia to cause symptoms when it affects the genitals of men or women but it may still be asymptomatic. It is almost always asymptomatic when infecting the throat or anus. Genital symptoms usually start within 2-5 days of infection and include a burning sensation when passing urine and a discharge of pus.

How is gonorrhoea diagnosed?

Gonorrhoea, like chlamydia, is diagnosed with urine samples or swabs. In men a urine sample will diagnose chlamydia that has infected the penis. In women a urine sample can also be used but is less reliable than a self-collected vaginal swab or a swab of the cervix collected by the doctor. Throat infections are diagnosed by a swab collected by the doctor and rectal infections can be diagnosed by a swab that is either self-collected or performed by the doctor.

Who should be tested for gonorrhoea?

Anybody with symptoms should be tested for Gonorrhoea. In people without symptoms testing should be provided to young people (under age 30) who are sexually active at least once a year. Annual testing is also recommend for men who have sex with men with testing up to 4 times per year if there is also a background of any unprotected anal sex, more than 10 sexual partners in the last 6 months, group sex or recreational drug use during sex. Gonorrhoea testing should also be provided to anyone who requests testing, to pregnant women and to people who have been sexually assaulted.

A urine test or vaginal swab that is negative for gonorrhoea is a reliable way of ruling out genital infection but infection of the throat or anus will be missed if these specific regions are not also swabbed.

What happens when you get gonorrhoea?

Gonorrhoea can be asymptomatic in women up to 80% of the time but genital infections in men usually do cause symptoms. Throat and anus infections usually don’t cause any symptoms in men or women.

In women who have an infection of the cervix there are no symptoms around 75% of the time (similar to chlamydia). If there are symptoms they will be a discharge, burning pain on passing urine or bleeding after intercourse. If it’s not treated then in about 10-20% of women it can spread to the uterus where it can cause infertility or put women at risk of an ectopic pregnancy if they do fall pregnant. Ectopic pregnancies are very dangerous and often life threatening. Gonorrhoea can also lead to a blood infection which can be very dangerous, even fatal, with potential for infection of large joints and even meningitis.

In men with a gonorrhoea infection at their penis they will develop symptoms about 90% of the time. Like wome symptoms will be a burning pain when passing urine and sometimes a slight discharge. If it’s not treated it will sometimes spread to infect the prostate or a part of the testicles called the epididymus. It can also cause a blood infection, as in women, which is just as dangerous.

In men and women it can sometimes affect the throat but it is very rare for it to cause any symptoms. Most anorectal infections don’t cause any symptoms either and if they do it would be anal pain and and bloody, mucous discharge. An anorectal infection in man who have sex with men puts them at much higher risk of acquiring HIV if they have sex with someone who is positive with a detectable viral load.

How is gonorrhoea treated?

Gonorrheoa is treated the same way regardless of whether the infection is in the genitals, the throat or the anus. It requires treatment with 1g of azithromycin taken once only (usually delivered as two 500mg tablets) and an injection with 500mg of ceftriaxone (usually given into the muscle of the buttocks). Gonorrhoea is treated with two different kind of antibiotics to prevent the development of resistance. There are currently no known resistant strains circulating in Australia but there are case reports of gonorrhoea developing overseas which is unable to be treated with antibiotics.

What follow up is needed?

There is no need to test for cure where gonorrhoea has infected the penis or urethra. Test of cure is recommended however for throat infection, anal infection and infection of the cervix (inside the vagina). A repeat test is also recommended 3 months after a patient has been treated for chlamydia to identify any new infections.
Following treatment, sexual intercourse should be avoided for 7 days to allow the antibiotics to work and it is important to let any partners from the at least the last 2 months know so they can also be tested and treated.