What Is Gonococcal Urethritis?

Introduction

The urethra is a small tube that extends from the urinary bladder, which is the structure storing urine, to where urine leaves the body.^1,2 In those assigned as male at birth, the urethra passes through the penis, whereas in those assigned as female at birth, it is located above the vaginal opening.¹ When the urethra becomes inflamed and swells, a condition called urethritis arises. Urethritis can be classified as either non-gonococcal or gonococcal, the latter, that is, gonococcal urethritis, being the result of a bacteria called Neisseria gonorrhoeae.^3,4 

Neisseria gonorrhoeae is transmitted through unprotected sexual activity, and therefore, gonococcal urethritis is a type of sexually transmitted infection. This condition can cause several signs and symptoms or cause none at all; every patient is different. Treatment involves antibiotics, which can completely eradicate the condition; avoiding delaying treatment is critical to avoid complications and ensure the best outcomes.^3,5,6,7

Cause of gonococcal urethritis

Gonococcal urethritis is caused by a bacteria called Neisseria gonorrhoeae which is transmitted from one person to another through unprotected sexual activity, including vaginal, anal, and oral sexual intercourse.⁸

Signs and symptoms of gonococcal urethritis

Neisseria gonorrhoeae can commonly cause no signs and symptoms whatsoever, though this is more common in those assigned as female at birth compared to those assigned as male at birth.⁵ Gonococcal urethritis can cause several signs and symptoms. However, it is important to note that not every patient will share the same signs and symptoms:³

• Burning, pain, itching, or stinging when urinating
• Redness at the region where urine exits the body
• Pain in the testicular region
• Swelling at the anus
• Pus production at the anus
• Pain in the anus
• Bleeding from anus
• Lesions around the anus
• Continuous urges to go to the bathroom to pass a stool
• Mucus-like or pus-like discharge from the urethra
• Discomfort at the urethra

Diagnosis of gonococcal urethritis

Gonococcal urethritis is typically diagnosed with either a swab test or a urine test. The tests can often be done by seeing your general practitioner or visiting a sexual health clinic. If you are diagnosed with gonococcal urethritis, it is important to notify any of your sexual partners so that they can get tested and treated, too.⁴

Swab tests

A cotton bud can be used to take a sample of fluid from the urethra. This can be uncomfortable, but, takes only a matter of seconds to complete.⁴

Urine tests

A urine test involves you providing a sample of your urine, which Neisseria gonorrhoeae can then detect. Before providing this sample, you may be asked not to urinate for at least two hours prior, helping to ensure the results are as reliable as possible.⁴

Management and treatment of gonococcal urethritis

Management and treatment for gonococcal urethritis typically involve antibiotics. You may be given a single dose of an antibiotic injected into muscle, in the arm or buttocks, for example. The antibiotic typically used for gonococcal urethritis is called ceftriaxone, in a class of drugs called cephalosporins.^{6 9}

If you are aware that you have an allergy to a class of drugs called cephalosporins, notify your doctor so they can help create an alternative management and treatment plan for you.⁶

It is important to abstain from sexual whilst undergoing management and treatment of gonococcal urethritis and until signs and symptoms resolve.⁴

Prevention of gonococcal urethritis

The NHS sets out several ways through which you can reduce your chances of getting gonococcal urethritis:⁴

• Use a condom during vaginal sex or anal sex
• Use a condom to cover the penis or a latex or plastic square to cover the vagina during oral sex
• Do not share sex toys or wash them and cover them with a condom if anyone else uses them

FAQs

How common is gonococcal urethritis?

There are typically 448 million new cases of curable sexually transmitted diseases each year, where approximately 88 million of these are due to Neisseria gonorrhoeae. Cases of gonococcal urethritis are rising as more strains of Neisseria gonorrhoeae, which are resistant to several drugs, are appearing.⁸

How is gonococcal urethritis transmitted?

Neisseria gonorrhoeae is transmitted through unprotected sexual activity, including vaginal, anal, and oral sexual intercourse.⁸ Condoms can help prevent transmission.⁴

Is gonococcal urethritis a sexually transmitted infection?

Gonococcal urethritis is a sexually-transmitted infection, with it being caused by a bacteria, that is Neisseria gonorrhoeae, that can be passed from one person to another through unprotected sexual activity, including vaginal, anal, and oral sexual intercourse.⁸

What are the complications of untreated gonococcal urethritis?

If left untreated, gonococcal urethritis can cause complications, including ectopic pregnancy, epididymitis, pelvic inflammatory disease, infertility, and infections of the bloodstream, which can lead to sepsis, a life-threatening condition.^{7 13}

Can gonococcal urethritis be cured?

Gonococcal urethritis can be cured with antibiotics, typically involving an injection of an antibiotic called ceftriaxone into the muscle.⁶

Should sexual partners also be tested and treated for gonococcal urethritis?

Yes, if you find out you are infected with Neisseria gonorrhoeae, it is important to notify any sexual partners so that they can be tested and treated, too.⁴

Is there a vaccine available for gonococcal urethritis?

There is no vaccine currently available for gonococcal urethritis.¹⁰

Can gonococcal urethritis be contracted from oral or anal sex?

Yes, gonococcal urethritis can be contracted from oral or anal sex, as well as vaginal sex.⁸ Condoms can help protect you from contracting gonococcal urethritis during sexual activity.⁴

Can a person get gonococcal urethritis more than once?

Reinfection with Neisseria gonorrhoeae is possible, and therefore, a person can get gonococcal urethritis more than once. Using condoms during sexual activity is critical in avoiding reinfection with Neisseria gonorrhoeae, as well as avoiding other sexually transmitted infections.⁴,¹¹

Can gonococcal urethritis lead to infertility?

Neisseria gonorrhoeae, the bacteria causing gonococcal urethritis, can cause infertility as a complication, with the presence of Neisseria gonorrhoeae being more common in infertile persons compared to their fertile counterparts.¹²

Is it necessary to abstain from sexual activity during the treatment of gonococcal urethritis?

Yes, it is necessary to abstain from sexual activity during treatment of gonococcal urethritis and until signs and symptoms have gone, which may take a couple of weeks. You may be retested for Neisseria gonorrhoeae after you have finished treatment to check the infection has cleared completely.⁴

Can gonococcal urethritis be transmitted from a pregnant woman to her baby?

Neisseria gonorrhoeae can be passed from a pregnant woman to her baby during birth, as the baby passes down the birth canal. It is therefore particularly important to consult a doctor if you’re pregnant and suspect you have gonococcal urethritis.¹⁴

How should individuals be tested for gonococcal urethritis and other sexually transmitted diseases?

Individuals can be tested for gonococcal urethritis through a swab of the urethra or by providing a sample of their urine.⁴ In testing for other sexually transmitted diseases, blood tests are a commonly utilised tool. As well as this, those assigned as female at birth may have a swab of the vagina. Sexual health clinics offer testing, as well as treatment, for sexually transmitted diseases and provide a confidential service.¹⁵

Summary

Gonococcal urethritis is a sexually transmitted infection caused by Neisseria gonorrhoeae, which can be passed on from one person to another through unprotected sexual activity, such as vaginal, anal, and oral sexual intercourse. Condoms offer protection against the spread of the condition. Gonococcal urethritis is often asymptomatic, particularly in those assigned as female at birth, but can also cause signs and symptoms, such as discomfort when urinating, redness at the region where urine exits the body, and pain, swelling, and pus at the anus. 

A diagnosis of the condition can be confirmed with a swab of the urethra or a urine sample. Treatment involves antibiotics, and it is important to be treated as soon as possible to avoid complications, such as ectopic pregnancy, epididymitis, pelvic inflammatory disease, infertility, and infections of the bloodstream, which can lead to sepsis. Avoiding sexual activity is also important during treatment. It is critical to inform any sexual partners if they are diagnosed with gonococcal urethritis so they can be tested and treated for the condition, too.