Gonorrhea: A Hands-On Guide to This Common Infection

Gonorrhea is a common sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae bacterium, primarily found in sexual fluids from the penis and vagina.

The Centers for Disease Control and Prevention (CDC) estimated there were 1.6 million new gonococcal infections in 2018; gonorrhea is the second-most common STD in the United States, following chlamydia.

Most people who are infected with gonorrhea have no symptoms and don't know they are infected. This can be problematic.

How does gonorrhea spread?

Gonorrhea is most commonly spread during vaginal, oral or anal sex when sexual fluids (semen, pre-ejaculate and vaginal fluids) contact with the mucous membranes of the genitals, mouth or anus (and, in rare cases, eyes) of another person.

Gonorrhea can spread even if the infected partner presents no symptoms at all.

A male does not need to ejaculate to spread the infection to another person. Indeed, any contact with sexual secretions can spread the bacteria, advised Hana Patel, M.B.B.S., a mindset coach and general practitioner specializing in sexual and women's health in London.

Patel said other ways to spread the infection include:

• Close genital-to-genital contact without penetration
• Contaminated hands transferring the bacteria to susceptible mucous membranes
• Sharing sex toys that have not been properly washed or covered with a new condom

Gonorrhea also can be passed from the mother to her baby during a vaginal birth.

Despite many myths about gonorrhea, you cannot be infected through casual contact, such as hugging, coughing or sneezing, sharing food or drinks, or sitting on toilet seats.

While it is commonly believed you cannot spread gonorrhea through kissing, a 2018 study found deep ("French") kissing may be associated with transmission of oropharyngeal gonorrhea among men who have sex with men (MSM), even if they did not have sex. More research is needed to understand the risk.

Risks factors for gonorrheal infection

"It's important to remember that STDs can affect anyone regardless of race, gender identity or sexual orientation," said Julia Bennett, L.C.S.W., M.P.H., the senior director of digital education and learning strategy at Planned Parenthood Federation of America, based in New York City. "Anyone who has vaginal, anal or oral sex can get an STD."

The risk factors for being infected with gonorrhea include:

• Having a new sexual partner who has not recently tested for STDs
• Having a previous diagnosis of gonorrhea or another STD
• Having multiple sexual partners
• Inconsistent condom use when not in a mutually monogamous relationship
• Substance abuse
• Young age; the highest rate of gonorrhea in 2020 was among adults ages 20 to 24

Gonorrhea is 10 times more likely among Black people than white, and notably higher among people with lower educational and socioeconomic levels.

"As STD rates rose during the pandemic, they widened existing gaps for communities that face the greatest barriers to healthcare due to systemic racism and discrimination," Bennett said. "Access to routine STD screening became even more challenging for some. Young people, LGBTQ+ communities, people with low income and communities of color are the hardest hit by STDs."

People who have gonorrhea can more readily contract and spread HIV, the virus that causes AIDS, and vice versa: People who have HIV are more likely to contract gonorrhea.

The risk of getting gonorrhea from one unprotected sex act depends on the type of sex:

• Penis to the vagina: 50 percent
• Vagina to the penis: 20 percent
• Penis to the mouth: 63 percent
• Mouth to the penis: 9 percent
• Penis to the rectum: 84 percent
• Rectum to the penis: 2 percent

How to reduce the risk of getting gonorrhea

The only ways to completely avoid a sexually transmitted infection are to abstain from sex or to engage in a mutually monogamous relationship in which both partners have been tested for STDs.

If you are sexually active with more than one person or your partner is sexually active with other people, there are ways to reduce your risk of contracting gonorrhea:

1. Use condoms or a dental dam correctly every time you have sex.
2. Talk about your sexual history and STD testing with your new romantic interest before beginning a sexual relationship. "There is still a stigma in our society around STDs, but open and honest dialogue with providers and partners can help prevent their spread," Bennett said.
3. Since gonorrhea can be spread through shared sex toys, it's important to clean them or cover them with a new condom before someone else uses them.
4. Don't douche. Vaginal douching increases the risk of getting STDs.
5. Men who have sex with men shouldn't douche, either.

"Eighty-eight percent of MSM report using rectal douching [enemas] before anal intercourse," said Deborah Lee, M.B.Ch.B., a reproductive health specialist at Dr Fox Pharmacy, an online doctor and pharmacy service in the United Kingdom. "In a 2021 study, the authors demonstrated a link between rectal douching and having a rectal infection from chlamydia, gonorrhea or syphilis."

The symptoms of gonorrhea

"Gonorrhea rarely causes symptoms. That's why it's important to regularly test for STDs if you have vaginal, anal or oral sex," Bennett advised. "People with penises are more likely to have symptoms of gonorrhea."

At the risk of being too repetitious, it's important to keep in mind that even if you have no symptoms, you can still spread the infection to someone else.

Vaginal symptoms

The vaginal symptoms are similar to those of a bladder or vaginal infection, such as a yeast infection:

• Increased vaginal discharge that is watery or creamy
• Heavier periods or bleeding between periods
• Pain during intercourse
• Pain in the lower belly or pelvis, particularly during sex
• Pain or burning while urinating
• Urge to urinate frequently

Penile symptoms

• Discoloration or swelling at the penis tip
• Pain or burning while urinating is usually the first symptom
• Pain or swelling in the testicles (less common)
• Pus-like discharge from the penis that may be white, yellow or green

Rectal symptoms

Though typically asymptomatic, symptoms may include:

• Anal itching and soreness
• Painful bowel movements
• Pus-like discharge from the rectum
• Rectal bleeding

Oral symptoms

Though typically asymptomatic, symptoms may include:

• Persistent sore throat
• Scratchy or itchy throat
• Swollen lymph nodes in the neck

"Symptoms can occur between one and 14 days after coming into contact with the bacteria, but most appear between two to five days," Patel said.

Since many people have mild symptoms, they may not notice them for weeks or even months, during which time they may have further spread the STD.

Let's get historical

The oldest written record describing gonorrhea was from 2600 B.C.E. in China. Here are some more interesting facts about a disease that's been around for a very long time:

• The Bible mentioned a disease that is thought to be gonorrhea in Leviticus 15:2.
• The Greek physician Galen (130-200 C.E.) named the disease from the Greek words "gonos" (semen) and "rhoia" (to flow) when it was thought the disease was caused by an excess of semen.
• Gonorrhea has been known colloquially as "the clap" or "the drip." The term "the drip" comes from describing the pus-like discharge that is a common symptom of the disease. The prevailing theory about why it is called "the clap" is that it comes from the French word "les clapiers," meaning rabbit nests. Brothels in France were called "clapiers," referencing the prolific sex lives of rabbits. These brothels were well-known for spreading gonorrhea.
• Only human beings can get gonorrhea.
• In the U.S., the National Gonorrhea Control Program began in 1972 and infections decreased every year for the next 20 years. The program focused primarily on screening and partner notification.
• The rates of gonorrhea have been increasing since the early 1990s.
• In females, the highest rate of infection is between ages 15 and 24.
• In males, the highest rate of infection is between ages 20 and 29.