Everything you need to know about Gonorrhoea

Everything you need to know about Gonorrhoea

Gonorrhoea is a sexually transmitted disease or infection (STD/STI) that can be passed on during anal, vaginal and oral sex. Consistent condom use during sex is an effective way of preventing gonorrhoea.

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What Is Gonorrhoea?

Gonorrhoea is a sexually transmitted infection (STI) that is caused by a bacteria called Neisseria gonorrhoeae.

It can affect both men and women and is the second most common STI (or STD – sexually transmitted disease) reported in Singapore(1). Based on the Singapore Department of Sexually Transmitted Infection Control (DSC), there were 2,051 cases of gonorrhoea reported in 2018.

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How is Gonorrhoea spread?

Common causes of Gonorrhoea

Gonorrhoea can be spread from one person to another during oral, vaginal, penile or anal sex. It can be transmitted even without ejaculation. You are unable to become infected with gonorrhoea by touching objects, like a toilet seat or even by casual social contact. Gonorrhoea can also be spread from an infected mother to the baby during childbirth.

Common signs & symptoms in men and women

Symptoms of gonorrhoea usually appear between two and ten days after acquiring the bacteria.

Symptoms differ in both men and women and also depend on where the infection is. It should be noted however that some people have no symptoms at all, risking its spread from person to person before it is diagnosed and if unrecognized and left untreated, may lead to complications. 

Both men and women can develop infection of the throat, urethra (where urine exits), and rectum. Infection of the throat or mouth can cause a sore throat. In women, infection can also occur in the cervix, uterus, fallopian tubes and ovaries. Infection in men can affect the prostate and the epididymis (a tube that connects the testicle to a vas deferens or the duct that transports sperm in the male reproductive system). 

For women, symptoms can include:

  • Vaginal itching
  • Abnormal vaginal discharge
  • Vaginal bleeding or spotting
  • Pain of burning during urination
  • Rectal discharge or constipation
  • Pain with bowel movements 
  • Sore throat

For men, symptoms can include:

  • Pain with urination
  • A milky discharge from the penis 
  • Pain and swelling in one testicle
  • Rectal discharge or constipation
  • Pain with bowel movements 
  • Sore throat 

Who should get tested?

Any sexually active person can be infected with gonorrhoea.

However, there are risk factors that increase the risk of contracting gonorrhoea. These include a recent sexual partner, multiple sexual partners, young age, low educational and socioeconomic levels, substance abuse, and a history of previous gonorrhoea. 

Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should stop having sex and get tested immediately for gonorrhoea as well as for other STDs. In addition, anyone with a sexual partner recently diagnosed with an STD should also get tests done even if there are no symptoms. If you have a new or have multiple sex partners, you should also get tested for gonorrhoea and for other STDs.

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Complications from Gonorrhoea

If gonorrhoea is left untreated, serious complications can occur in both men and women.

They include:

  • Pelvic inflammatory disease (PID) if the infection spreads from the cervix to the uterus and fallopian tubes in women. As a consequence, the fallopian tubes can scar and lead to infertility and can increase the risk of ectopic pregnancy (pregnancy that develops in the fallopian tube).
  • Men can develop epididymitis which can lead to infertility.
  • Both men and women can develop bloodstream infection from gonorrhoea, causing infection in the joints, called arthritis. Rarely, conjunctivitis, bone infection (osteomyelitis), meningitis and infection involving the heart valves (endocarditis) can occur as a result of gonorrhoea bloodstream infection. 
  • Infants born to untreated mothers can develop conjunctivitis (infection of the eyes)

Gonorrhoea & HIV

Untreated gonorrhoea can increase a person’s risk of acquiring and/or transmitting HIV. This is proven in a study of HIV-infected men in Malawi that showed that the level of HIV viral concentrations in semen were eightfold higher among those with infection of the urethra, particularly due to gonorrhoea, compared to those without (2).

Prevention

There are several ways to prevent infection with gonorrhoea. These include:

  • Proper and consistent use of condoms. 
  • Abstaining from sex if you or your sexual partner has abnormal discharge or burning with urination.

If you think you may be at risk of being  infected or you suspect that you have been infected with Gonorrhoea, you may wish to visit any of our DTAP clinics to speak to our friendly doctors for further advice.

Treatment options

Gonorrhoea can easily be treated with a single dose combination of antibiotics – single dose ceftriaxone (given by injection) and azithromycin tablets (taken once). This treatment regimen is the first-line treatment recommended by many guidelines. 

Occasionally, a second course of antibiotics is needed if symptoms persist or if the gonorrhoea is resistant to the first-line treatment. 

It is important not to have any vaginal, anal or oral sex until up to 1 week after completion of treatment. To avoid re-infection, your sexual partners should be tested and treated. Resumption of sexual activity can be made only after all symptoms have resolved and sexual partners have been treated.

References:

(1) 2018 STI updates 

https://www.dsc-clinic.sg/Patient Care/Prevention%20and%20Education/STI/Pages/STI-Statistics.aspx

(2) Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997; 349(9069):1868

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Speak to your doctor for more information or if you have any questions regarding Gonorrhoea or other STD/STI related topics: Throat/ Oral Gonorrhoea, Antibiotic Resistant Gonorrhoea or Super Gonorrhoea, Rapid Gonorrhoea Testing, STD Testing Singapore

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