Gonorrhea

What is Gonorrhea?

Gonorrhoea is a common bacterial sexually transmitted infection caused by Neisseria gonorrhoeae, primarily transmitted through vaginal, oral, or anal sexual contact. As part of the broader group of sexually transmitted infections (STIs), it spreads via contact with genital areas or bodily fluids and is particularly prevalent among young individuals aged 15–24 years.

From an epidemiological perspective, the global burden remains substantial, with an estimated 82.4 million new infections reported in 2020 among adults aged 15–49 years. Higher prevalence is observed in key populations, including men who have sex with men, sex workers, transgender women, and adolescents and young people in high-burden regions, highlighting ongoing public health challenges in prevention and control.

Female gonorrhea, medical concept. 3D illustration showing close-up view of Neisseria gonorrhoeae bacteria infecting cervix uteri

What are the causes of Gonorrhea?

Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae. Transmission occurs primarily through sexual contact, including vaginal, oral, and anal intercourse, where the bacterium is transferred between individuals during exposure to infected mucosal surfaces or bodily fluids.

How is Gonorrhea transmitted?

Gonorrhoea is transmitted primarily through unprotected sexual contact, including vaginal, anal, or oral intercourse with an infected individual. The infection can also be passed from an infected mother to her infant during childbirth, resulting in perinatal transmission.

Symptoms of Gonorrhea

Gonorrhoea is often asymptomatic, but when symptoms occur they typically appear 1–14 days after exposure and vary by site of infection and sex.

Genital symptoms (men):

Pain or burning during urination
Thick white, yellow, or greenish penile discharge
Painful or swollen testicles

Genital symptoms (women):

Increased vaginal discharge
Pain or burning during urination
Intermenstrual or post-coital vaginal bleeding
Lower abdominal or pelvic pain

Rectal (anal) infection – in both sexes:

Discharge
Bleeding
Itching and soreness
Painful bowel movements

Diagnostics and Treatment of Gonorrhea

Gonorrhoea is primarily diagnosed using molecular testing, which is considered the gold standard and can be performed in laboratories or at point-of-care settings. While Gram stain microscopy is sometimes used, its sensitivity is lower in women with genital discharge and in throat or rectal infections. In resource-limited settings, a syndromic management approach is often adopted when molecular diagnostics are unavailable.

Antibiotic resistance in Neisseria gonorrhoeae has significantly reduced treatment options, making cephalosporins the mainstay of therapy.

Recommended treatment:

Ceftriaxone (intramuscular injection; first-line and preferred option per CDC guidelines)
Cefixime (oral alternative when ceftriaxone is not feasible, often with follow-up testing or combination therapy)

Key management advice:

Avoid sexual activity for at least 7 days after completing treatment
Sexual partners should be notified for testing and/or treatment to prevent reinfection and further transmission

Recent Updates

Gonorrhoea has been identified by the WHO as a major global public health concern due to its high prevalence and increasing antimicrobial resistance. Through the Global Health Sector Strategies on HIV, viral hepatitis, and STIs (2022–2030), the WHO has established a target to reduce the incidence of Neisseria gonorrhoeae infections by 90% by 2030, using 2020 levels as the baseline. This goal emphasizes strengthened prevention, improved diagnostic capacity, and effective treatment strategies to control transmission worldwide.