Gonorrhoea is a sexually transmitted infection (STI) transmitted during unprotected intercourse. In 2022, the prevalence of diagnosed cases doubled compared to the previous year, with over 80 million cases reported by the UK Health Security Agency. Although it is a preventable and curable disease, prevention strategies such as education on safe sexual practices, modes of transmission, and methods of early detection and treatment are necessary to ensure population health.¹

Overview: what is gonorrhoea?

Gonorrhoea is an STI, a sexually transmitted infection.¹ The bacterial infection caused by Neisseria gonorrhoeae or gonococcus was previously called  ‘the clap’. It is transmitted during unprotected intercourse via the exchange of infected genital fluid from the penis (ejaculate and pre-ejaculate) or vagina (discharge). The disease most affects the genitals (penis or vagina/cervix), but the anus, throat and eyes can also become infected depending on the sexual practice. The infection can also be passed down from mother to infant during childbirth.^1,2

Symptoms for gonorrhoea vary depending on the subject’s biological sex (born with either male or female attributes) and the advancement of the disease, with a significant number of patients not displaying any noticeable symptoms and hence delaying diagnosis and treatment of the infection.^1,3

Education & awareness: why is gonorrhoea prevention important?

Gonorrhoea is currently the second most common cause of bacterial STI worldwide.^4,5 Given the recent number of gonorrhoea infections in the UK and other countries, it is crucial to implement governmental prevention strategies to provide the population with health literacy on gonorrhoea and other STIs. By learning more about the disease, its transmission mode, and its symptoms, individuals can take measures to avoid gonorrheal infection and be able to recognise early signs, which leads to quicker diagnosis and more effective treatment.^4,6

Mode of transmission & safe sexual practices

Gonorrhoea is transmitted mainly by the infected genital fluid transmitted to a second partner during intimate contact. Hence, it is recommended that people wear a physical barrier to avoid transmission, such as male or female condoms during penetrative sex and dental dams during oral sex. Additionally, sharing sex toys can lead to infection if the tool is not correctly disinfected between partner use.^1,3

Early detection and symptoms

Symptoms usually develop within two weeks following infection but may not appear until months later.10% of infected men and 50% of infected women will not experience any apparent symptoms.¹

Symptoms vary between the biological male and female sexes and the region concerned by the infection (genital, anal, or other). Here are summarised symptoms of gonorrhoea depending on the infected region.^1,3

Throat and ocular (eye) infections 

Although those are less common, they should not be ignored; common symptoms include sore-throat-like symptoms, light sensitivity, eye pain, and pus-like discharge.¹

Target audience: higher-risk groups for gonorrhoea

Prevention campaigns should focus on higher-risk groups for gonorrhoea. Those include sexually active young adults (between 20-20 years old), men who have sex with men (MSM) and individuals with multiple sexual partners.^3,4 These demographic populations are more likely to engage in behaviours that increase the risk of gonorrhoea transmission.^3,4

Regular testing, especially in those high-risk groups, is vital to prevent the spread of the virus. The Centres for Disease Control and Prevention (CDC) recommends that sexually active women, especially those under the age of 25 years old and even older than 25 years old (if at increased risk), undergo regular screenings for gonorrhoea and other STIs.^3,5

Suspicion of gonorrhoeal infection and treatment

Gonorrhoea is a preventable infection, but in case of contamination, common strains of the disease are easily treated via antibiotic injection.^1,3

Symptoms tend to dissipate quickly in the days following antibiotic intake, but with more intense pain in the pelvis and genital area, it may take up to two weeks for those to resolve.^1,3  Because symptoms tend to worsen if left untreated and can go on to develop further issues and pathological conditions such as pelvic inflammatory disease (PID), it is recommended that individuals suspecting gonorrhoeal infection get in touch with their pharmacist or general practitioner as soon as possible.^1,7 They can advise on screenings, treatments, and methods for partner notification. 

Note that following unprotected sex, the GP may recommend waiting a few days before testing to avoid a false positive, as the STI may not be detectable immediately after infection.  Nonetheless, in some cases, preventive antibiotic therapy may be recommended.^1,8

STI testing is required to confirm a diagnosis of gonorrhoeal infection. It can involve urine or swab screening sent to the laboratory for analysis.^1,3,5

The future of gonorrhoea prevention

Public health measures

Because gonorrhoea, amongst other STIs, poses a significant public health threat, even in more developed countries, governments have implemented public health measures to prevent its spread.^5,8 Those include, for example:

• Surveillance programs using data from testing and treatment facilities
• Policy initiatives, including awareness and educative campaigns to high-risk groups, but also to younger individuals
• Anonymous partner notification system
• Community efforts^5,6-9

These measures have a proven effect on improving the general public health literacy and informing on safe sexual practices, hence reducing the risks for gonorrhoea and other STI infections.⁵

Super STI strains

Unfortunately, due to the frequent use of antibiotics for minor infections, some bacteria have evolved into so-called super-strains.  In the case of Neisseria gonorrhoeae, this has led to the emergence of ‘Super-Gonorrhea’ - a type of gonorrhoea that is resistant to multiple antibiotics and cannot be easily treated with standard medications.^11,12 

This poses a threat to the current guidelines for treating gonorrhoea infections, making it necessary to develop new treatments to address the issue.¹²

Frequently asked questions (FAQs)

How can I prevent gonorrhoea infection?

Gonorrhoea infection can be prevented by avoiding direct contact with infected genital fluids. It is recommended to wear a physical barrier with new or untested sexual partners during intimate contact. Products recommended include male and female condoms as well as dental dams. Note that gonorrhoea can be passed from mother to child during childbirth, and different measures are required to lower the risk of transmission in those cases.

Can you get gonorrhoea from anal or oral sex?

Yes, gonorrhoea infection can occur during all types of sexual practices, including vaginal, anal, and oral sex.  Gonorrhoea is an STI which is transmitted via infected genital fluid, so even sharing sex toys without disinfection between partners can lead to contamination.

What are the symptoms of gonorrhoea? When should I get tested for STIs?

Symptoms of gonorrhoea vary depending on the zone of infection and the progression of the disease. There are various types of infected areas which may include genitalia (penis, vagina and/or cervix), anus, throat, eye, etc. Following gonorrhoeal infection, patients may remain asymptomatic (i.e., do not have any symptoms or signs), but if you feel any change in secretions, discomfort, or pain in genital zones or your throat or eyes following unprotected sex practices, it is recommended to get tested for STIs as soon as possible following local prevention guidelines.

What should I do if I get tested for gonorrhoea?

Do not wait to test positive to seek medical professional advice; following the potential risk of infection, you might be eligible for a preventive antibiotic prescription even ahead of confirmation of diagnosis. Contact your GP at the first signs or following unprotected sex.

Summary of prevention strategies for gonorrhoea

Gonorrhoea is a sexually transmitted infection (STI) caused by Neisseria gonorrhoeae, transmitted during unprotected sex through infected genital fluids. It can affect the genitals, anus, throat, and eyes, and may be passed from mother to child during childbirth. Symptoms can vary, with many individuals showing no symptoms, leading to delayed diagnosis. Gonorrhoea is preventable and treatable with antibiotics, but timely diagnosis is essential to prevent complications like pelvic inflammatory disease (PID).

Prevention strategies include safe sexual practices, such as using male or female condoms and dental dams during sex, and regular STI testing for sexually active individuals, particularly those in high-risk groups (young adults, men who have sex with men, and those with multiple partners). Education and awareness campaigns play a crucial role in improving public health literacy and promoting early detection.

Super-gonorrhoea, antibiotic-resistant strains, pose a growing threat, highlighting the need for new treatment strategies. Public health measures, such as surveillance, education, and anonymous partner notification, are essential to control the spread of gonorrhoea.

If suspected of infection, individuals should seek medical advice promptly for testing and possible preventive treatment.