Gonorrhoea

Gonorrhoea is a sexually transmitted infection. Cases of gonorrhoea in the UK increased from the late 1990s reaching a peak in 2003. In 2007, over 18,000 cases of gonorrhoea were diagnosed in the UK. Gay men and young heterosexual men and women are the groups most affected by gonorrhoea.

Transmission

Gonorrhoea can be passed on during anal, vaginal, oral, and mouth-to-anus (rimming) sex is no condom is used (unprotected sex). Gonorrhoea can affect the anus, cervix, penis and throat. Untreated gonorrhoea can make a person with HIV more infectious as gonorrhoea increases the number of HIV-infected cells in the genital area and in the mucous membranes of the mouth and throat. Having gonorrhoea can also make it more likely that an HIV-negative person will be infected if they are exposed to the virus. Gonorrhoea can also be passed on from mother to baby during childbirth, and can cause infection in the baby’s eyes, resulting in blindness if left untreated.

Prevention

Using a condom for anal, oral or vaginal sex is an effective way of avoiding infection with gonorrhoea or passing the bacteria on to somebody else. People who are sexually active are advised to have regular sexual health check-ups, where they will be tested for gonorrhoea and other sexually transmitted infections. Most HIV treatment centres have an associated sexual health clinic. These offer where confidential and free treatment. You don't need to be referred by your GP or your HIV doctor.  

Symptoms

Symptoms of gonorrhoea usually appear between two and ten days after infection. However, some people may not realise they have the infection as symptoms may not always be present, or may be mild. In men, symptoms usually consist of a yellowish or greenish discharge from the penis and burning when passing urine. The testicles may also hurt and swell.

Symptoms in women can include a burning sensation when passing urine and a discoloured or bloody discharge from the vagina.

If the infection is rectal, both men and women may notice a mucousy or bloody discharge from the anus, pain in the anus, or pain when having anal sex.

Gonorrhoea in the throat can cause a sore throat.

If left untreated, gonorrhoea can cause more serious health problems, including pelvic infections in women resulting in pain, infertility, and ectopic pregnancy, and testicular problems in men.

Gonorrhoea can also spread to the bloodstream leading to fevers, and can affect the joints, causing arthritic-like pain and swelling.

Diagnosis

A general sexual health check-up includes testing for gonorrhoea. Sexual health check-ups are free and confidential and many HIV treatment centres have sexual health clinics attached or may offer a sexual health screen as part of your clinic appointment.

To test for gonorrhoea, a swab is taken from the tip of the penis or from the cervix. If you have told the doctor that you have had oral or anal sex, swabs will also be taken from the throat and/or anus. The swabs can be a little uncomfortable. A urine sample may also be taken. It is usually possible to tell immediately from examination of the swabs if gonorrhoea is present in the anus, penis, and in many cases the cervix. But gonorrhoea in the throat can usually only be diagnosed later. However, whatever the site of infection, it can take up to three days for tests to provide  results. It is important, therefore, to contact your clinic for the result of your test so treatment can be given if the bacteria have been detected.

Treatment

Gonorrhoea is treated with antibiotics. Penicillin or ciprofloxacin used to be the first choice antibiotics to treat gonorrhoea. However, over 10% of gonorrhoea in the UK is now resistant to ciprofloxacin and an even larger amount is penicillin resistant. Because of this, clinics should now use the antibiotics ceftriaxone or spectinomycin as first choice gonorrhoea treatment. Both these drugs are given by injection.

When gonorrhoea is diagnosed you may be given the opportunity to see a health adviser. Health advisers can give you information about safer sex and how to protect your own and other people’s sexual health. They will also ask you to help them, where possible or practicable, to contact your sexual partners so they can be tested and treated too. Where appropriate, health advisers can provide referrals to other services.

You will be asked to return seven days later for tests to see that you have been cured. It is very important not to have unprotected anal, oral or vaginal sex during this period as you may be re-infected with gonorrhoea, or pass the infection to your partner.