ICD codes: A54 What is the ICD Code?
Gonorrhea is a sexually transmitted, infectious disease caused by the Neisseria gonorrhoeae bacterium, also known as gonococcus. 87 million people per year catch the disease worldwide. This article explains more about the symptoms and consequences of the disease, and about prevention and treatment options.
At a glance
- It is caused by infection with the Neisseria gonorrhoeae (gonococcus) bacterium.
- Sufferers typically develop a purulent inflammation of the urethra with a strong discharge, though the rectum and throat are also often infected too.
- The infection does not always cause symptoms.
- People who are infected but have no symptoms can also spread the bacteria.
- If the gonorrhea remains untreated, men and women who are affected can become infertile.
- The disease can be treated with antibiotics, but gonococcus is increasingly resistant to antibiotics.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
What is gonorrhea?
Gonorrhea is one of the sexually transmitted diseases. The term gonorrhea comes from the Greek and means “seed flow”. The slang word “clap” is related to rabbits via the French word for rabbit hutch, “clapier”. Both terms describe a typical symptom of the disease: a whitish discharge from the vagina or penis.
If gonorrhea remains untreated, both men and women can become infertile. If the bacteria spread to the body via the blood, the sufferer can become seriously ill with bouts of fever, joint pains and changes to the skin.
Important: Someone who has had gonorrhea once does not have protection against reinfection. Sexual contact with an infected person can cause reinfection at any time.
What are the symptoms of gonorrhea?
Not everybody who is infected with gonococcus also has symptoms. This increases the risk of the disease being transmitted unknowingly. The gonorrhea can produce a variety of symptoms.
Gonorrhea in males
10 to 30 percent of affected males have no complaints. The others typically have these symptoms:
- a burning sensation when urinating
- difficulty in urinating
- a urethral discharge, sometimes solid, white, light gray to light yellow or clear
If the infection spreads, there may be inflammations and pain in the prostate, seminal vesicles, vas deferens (spermatic duct) and epididymis. Infertility may be a long-term effect.
Gonorrhea in females
Around 50 percent of affected women have few or no symptoms. But there is an increased risk of serious complications. In women, the signs of the disease are easily confused with a bladder infection. The following symptoms occur:
- a burning sensation when urinating
- an increased vaginal discharge
- bleeding between menstrual periods and heavier periods
If the infection spreads, inflammation of the womb, fallopian tubes and peritoneum, stomach pain and fever, may occur. Possible long-term effects are infertility, tubal pregnancy and chronic abdominal pains.
If a pregnant woman is infected, the result may be a premature birth or stillbirth. The disease may also be transmitted to the child at birth. Typically, there is a purulent eye inflammation that can blind the baby if it is not treated.
So-called rectal gonorrhea may occur without causing discomfort. Typical symptoms occur primarily in men:
- anal discharge
- anal itching or pain
- inflammations and soreness in the rectal area
- pain when defecating
The throat is frequently infected. Transmission is by oral sex. Most cases of oral infection by gonococcus occur with no symptoms. This is true of 50 to 80 percent.
Gonorrhea of the eye
If the bacteria reach the eye via the hands (smear infection), they cause a purulent inflammation of the conjunctiva which can cause blindness.
In rare cases, the bacteria spread to the body via the blood. This causes a severe illness with bouts of fever, joint pains and changes to the skin.
Important: If gonorrhea is diagnosed, sufferers with symptoms should notify all their sexual partners from the last 8 weeks, while sufferers with no symptoms should notify all their sexual partners from the last 6 months. They should all have a medical examination and, if necessary, get treatment, even if they have no symptoms. This is the only way to stop it spreading.
What causes gonorrhea?
Gonorrhea is caused by infection with the Neisseria gonorrhoeae bacterium, also known as gonococcus. The bacteria are usually passed from person to person through unprotected sexual contact.
What are infectious diseases?
The video below looks at when doctors talk about an infectious disease, which pathogens trigger infectious diseases, and how they are transmitted.
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What are the risk factors?
Anyone can contract gonorrhea.
In very rare cases medications such as biologic drugs, certain rheumatic diseases such as lupus erythematodes, or hereditary immune system diseases such as complement deficiency can lead to more serious developments.
Would you like to calculate your risk of gonorrhea and other sexually transmitted infections (STIs)? WIR – Walk In Ruhr Center for Sexual Health and Medicine offers an anonymous online test for your STD risk.
How common is gonorrhea?
Gonorrhea only occurs in humans and it is widespread throughout the world. Most of those affected are between 15 and 45 years old.
The World Health Organization (WHO) estimates that around 87 million people per year contract gonorrhea. This makes it, after trichomonas vaginalis, chlamydia and the human papilloma virus, the fourth most common sexually transmitted infection (STI).
In 2018 gonorrhea was the second most frequently reported STI in the European Union, with over 100,000 infections in 28 countries.
There are no recent figures for the whole of Germany, as there has been no obligation to report gonorrhea since 2001. The only exception is the state of Saxony. Infections multiplied ten-fold there between 2001 and 2019: they have risen from around 2 to about 20 infections per 100,000 people. This is probably linked to the fact that an actual increase in infections was accompanied by improvements in the advice and testing available. Since March 2020 infections with conspicuous resistances have been recorded as part of the Robert Koch Institute's laboratory reporting obligations.
Resistance means that an antibiotic fails to achieve the desired therapeutic success because the pathogen has evolved the capability to resist it.
How can gonorrhea be prevented?
Because gonorrhea is primarily transmitted through sexual contact, one can protect oneself against infection using condoms. If they are used properly, there are far fewer infections. There is no 100 percent protection, however. If gonococcus infection is suspected, those concerned should completely refrain from sexual contact until treatment has been successful.
If the throat is infected by gonococcus, the gonorrhea can also be transmitted from throat to throat or from throat to the sexual organs and rectum.
Important: If gonococcus infection is diagnosed, those affected and their sexual partners should refrain from all sexual activity. Sexual contact can be resumed 7 days after the treatment has concluded successfully.
How is gonorrhea diagnosed?
Doctors diagnose gonorrhea by taking swabs from affected areas.
The bacteria can often be detected directly under the microscope. In the laboratory, a molecular biological examination of the swab for the genetic makeup of the bacteria is carried out, and in this way the proof is provided. A bacterial culture is used to identify any potential antibiotic resistances and to select suitable antibiotics.
Important: When any sexually transmitted infection (STI) is diagnosed, the partners should be informed. In the case of a symptomatic gonococcus infection, all the potential sexual partners from the last 8 weeks are examined and also treated where necessary, while in the case of asymptomatic infections this applies to all partners from the last 6 months.
How is gonorrhea treated?
Gonorrhea can be cured with antibiotics. Unfortunately, there are now some strains of gonococcus that have developed resistances to antibiotics. In those cases, the medication is less effective than usual or completely ineffective. For this reason, doctors do a so-called sensitivity test to select the most effective antibiotic.
Points of contact for gonorrhea
Liebesleben is the website of the Federal Centre for Health Education (BZgA). It provides information on love, sex and protection.
WIR – Walk in Ruhr, Zentrum für Sexuelle Gesundheit und Medizin (Center for Sexual Health and Medicine) also provides useful information on gonorrhea and other sexually transmitted diseases.
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF). Diagnostik und Therapie der Gonorrhoe. S2k-Leitlinie. AWMF-Registernummer 059/004. 12.2018. Aufgerufen am 02.10.2020.
- Bremer V et al. Sexuell übertragbare Infektionen in Deutschland. Die aktuelle epidemiologische Lage. Bundesgesundheitsblatt 2017; 60: 948–957. Aufgerufen am 02.10.2020.
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- European Centre for Disease Prevention and Control. Factsheet about gonorrhoea. Aufgerufen am 02.10.2020.
- Holmes KK et al. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization 2004. 82(6): 454–461. Aufgerufen am 02.10.2020.
- Robert-Koch-Institut. Einführung einer Meldepflicht für N. gonorrhoeae mit verminderter Empfindlichkeit gegenüber Azithromycin, Cefixim oder Ceftriaxon. Epidemiologisches Bulletin 2020. 10: 6–13. Aufgerufen am 02.10.2020.
- Robert-Koch-Institut. Gonorrhö mit einem high-level-Azithromycin-resistenten Erreger in Deutschland. Epidemiologisches Bulletin 2019. 32/33: 299–300. Aufgerufen am 02.10.2020.
- Robert-Koch-Institut (RKI). RKI-Ratgeber: Gonorrhö (Tripper). Aufgerufen am 02.10.2020.
- Wi T et al. Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action. PLOS Medicine. 2017. 14(7): e1002344. Aufgerufen am 02.10.2020.
Reviewed by the Deutsche STI-Gesellschaft. As at: