Conditions Gonorrhea

Gonorrhea is a sexually transmitted infection (STI). This means that it is mainly spread from person to person through unprotected sexual contact. Colloquially, gonorrhea is also known as “the clap”.

The disease is caused by bacteria called gonococci. Typical symptoms are a burning sensation when urinating and a discharge from the vagina or penis that varies from whitish to yellowish in color. When a small amount of pus is discharged from the penis in the morning, this is sometimes called “the morning drip”.

Gonorrhea can produce a variety of symptoms, which normally occur between 1 and 14 days after contracting the infection.

Women and men with gonorrhea typically experience symptoms in the area of their sex organs.

Gonorrhea in males

Some men have no symptoms. However, most men affected usually experience the following symptoms:

• burning sensation when urinating
• a discharge from the urethral opening, which varies from white to yellow in color, but in rare cases may be clear

The head of the penis and the foreskin may be inflamed in some cases. If the infection spreads, there may be painful inflammation in the prostate, seminal vesicles, vas deferens (spermatic duct) and epididymis (the tube at the back of each testicle). This can cause infertility.

Gonorrhea in females

Around half of all women affected have few symptoms or none at all. In the remaining cases, the following symptoms typically occur:

• increased vaginal discharge, sometimes yellowish in color
• burning sensation when urinating
• heavier menstrual periods or bleeding between periods (breakthrough bleeding) in some cases

If the infection spreads, there may be inflammation of the womb, fallopian tubes and peritoneum (the membrane lining the abdominal cavity), accompanied by abdominal pain and fever. This can result in the woman no longer being able to have children. Other effects include an increased risk of ectopic pregnancy (a pregnancy that grows outside the womb) and chronic pain in the lower abdomen.

However, in addition to affecting the sex organs, gonococci bacteria can also cause symptoms in other parts of the body.

Rectal gonorrhea

An infection in the rectum may produce no symptoms. However, gonorrhea in this part of the body can cause the following symptoms, especially in men:

• anal discharge
• anal itching
• pain in the rectal area, especially during bowel movements

An infection in the rectum can occur as a result of anal sex. In women, it can also occur if vaginal discharge containing the bacteria enters the rectum.

Oral gonorrhea

The throat is frequently infected. Infections are generally spread through oral sex. In most cases, an infection of the throat with gonorrhea causes no symptoms.

Gonorrhea of the eye

If the bacteria reach the eye via the hands, they cause a pus-producing inflammation of the clear membrane protecting the eye (conjunctiva). This can result in blindness.

Gonorrhea that spreads to the bloodstream (disseminated gonococcal infection)

In rare cases, the bacteria spread to the body via the blood. This usually causes severe bouts of fever, problems with the joints, and skin changes. The heart, meninges (brain membranes), or bones can also be affected in some cases.

Gonorrhea is caused by infection with the Neisseria gonorrhoeae bacterium (gonococci bacteria). The bacteria are usually spread through direct contact between mucous membranes during sex. They mostly settle in the mucous membrane of the urethral opening, cervix, rectum, throat, and eyes.

It is also possible for an infected mother to pass the bacteria to her baby during the birth.

Anyone can contract gonorrhea. People who have sexual contact with multiple partners without using condoms are at a particularly high risk.

The risk of contracting gonorrhea is also increased if a person has other sexually transmitted infections or has had these in the past. STIs include infections with chlamydia or HIV.

Women can, at certain times, be at an elevated risk of the bacteria increasing in number in the body or spreading through the bloodstream. This is the case, for example, following menstrual periods, after giving birth, or after having a contraceptive coil fitted.

You can use an online STI risk test to assess your risk of contracting gonorrhea or other sexually transmitted diseases. The test is available on the website of the WIR – Walk In Ruhr, Center for Sexual Health and Medicine (Zentrum für Sexuelle Gesundheit und Medizin).

Gonorrhea only occurs in humans and it is widespread throughout the world. Most of those affected are between 15 and 25 years old. Infections are comparatively common among men who have sex with men.

The World Health Organization (WHO) estimates that around 87 million people per year contract gonorrhea. This makes it the third most common sexually transmitted infection (STI) in the world.

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 up-to-date national infection figures for Germany, as the mandatory reporting requirement for the detection of gonococci in a lab is only a recent development. The federal state of Saxony is an exception, as it became a mandatory requirement there to report infections with gonorrhea several years ago. Figures show that infections multiplied ten-fold there between 2001 and 2019 and increased from about 2 to about 20 infections per 100,000 of the population. This is likely to be explained in part by improved availability of advice and testing, as well as an actual increase in infections.

Because gonorrhea is primarily transmitted through sexual contact, one can protect oneself against infection using condoms. If they are used correctly every time a person has sexual contact, they result in a significant decrease in infections. Dental dams also offer protection alongside condoms during oral sex. Dental dams are thin sheets that are placed between the mouth and vagina or anus. However, 100 percent protection isn’t possible. For example, if the throat is infected, the bacteria can be spread through kissing.

If you suspect that you have been infected with gonorrhea, you should avoid sexual contact and consult a doctor. Specialists in gynecology, urology or dermatology are particularly well positioned to treat an infection.

People who have an increased risk of contracting sexually transmitted infections are also advised to get tested and, if necessary, treated on a regular basis. This applies, for example, to people who have unprotected sex with multiple partners.

There is no vaccine against gonorrhea. Certain vaccines against meningococcal group B bacteria may also give some vaccinated individuals protection against gonococci. Vaccination may be considered if a person is at high risk of contracting gonorrhea. 

Advice on sexually transmitted infections, including testing, is provided, for example, by public health authorities. These services are usually anonymous and free of charge. 

The website of the German AIDS Federation (Deutsche Aidshilfe) provides more information about when testing for sexually transmitted diseases is useful and the circumstances under which the cost is covered by health insurance providers. You can also use this site to find a test center close to you.

Doctors diagnose gonorrhea by taking swabs from the mucous membranes. Swabs may be taken from various sites – such as the urethral opening, cervix, rectum, throat, or eyes. Where possible, swabs should be taken from the rectum and throat in addition to the genital area to increase the reliability of the test result. Patients can also use swabs themselves to take samples from all sites with the exception of the cervix. For men, gonorrhea of the urethral opening can also be detected by testing the urine.

Samples from swabs or urine are then sent to a lab, where the bacteria can be detected – for example, by growing them in a special culture. The bacterial culture can also help determine which medication will be effective in each individual case.

In addition, specific tests can be run to detect the genetic information in the gonococci. Alternatively, the bacteria can be identified by examination under a microscope.

The WIR – Walk in Ruhr, Center for Sexual Health and Medicine (Zentrum für Sexuelle Gesundheit und Medizin) – offers an anonymous partner notification service. 

Gonorrhea can be treated with antibiotic medication.

However, gonococci bacteria are increasingly developing resistance, which means that they are developing immunity to various antibiotics. As a result, an antibiotic may not work at all or may not be as effective as normal. For this reason, a bacterial culture is tested in a lab to determine which antibiotic drug is most effective in each individual case. 

After treatment, it is recommended that more swabs be taken to ensure that the medication used has been effective.

On the “Liebesleben” (Love life) website of the Federal Institute for Public Health (Bundesinstitut für Öffentliche Gesundheit, BIÖG), you will find information about support and advisory services, including phone and online options. At the bottom of the homepage, you will also find links to contact details for getting advice over the phone, online, or in person.

The WIR – Walk in Ruhr, Center for Sexual Health and Medicine (Zentrum für Sexuelle Gesundheit und Medizin) also provides useful information about gonorrhea and other sexually transmitted infections.

Information about sexually transmitted infections is also provided on the website of the German STI Society (Deutsche STI Gesellschaft).