Sexually Transmitted Infections: Gonorrhea
Gonorrhea is a Sexually Transmitted Infection (STI) caused by a bacteria known as Neisseria gonorrhea or gonococcus. It is colloquially known as ‘the clap’. It is one of the 2 most common STI in Singapore (the other common STI is chlamydia).
Neisseria gonorrhea bacteria can be found in the fluid discharges from the penis or vagina. It can be spread via unprotected sexual intercourse be it- vaginal sex, anal sex or oral sex. Sex toys or vibrators that are not cleaned properly after use can be a source of spread as well.
Those who has multiple sexual partners, or frequent change of sexual partners or men sex with men, without use of barrier method of contraception are at risk.
Symptoms of Gonorrhea STI
Symptoms typically occur within 2 weeks after exposure and infection, though it can occur much later beyond the window period.
One can have no symptoms. 1 in 10 men has no symptoms. 1 in 2 female has no symptoms.
In female, one can present with
- Unusual vaginal discharge – it can be thin, watery, colorless like to green and yellow in color
- Painful and burning sensation on urinating
- Lower abdominal pain or discomfort
- Abnormal bleeding: bleeding in between menses, heavier menses, bleeding after sex
In men, one can present with:
- Unusual discharge from the penis – it can be white, yellow or greenish in color
- Painful and burning sensation on urinating
- Pain and swelling over the foreskin
- Painful testicles
Gonorrhea can cause symptoms over the rectum (back passage), throat or eyes, leading to symptoms such as
- Pain and unusual discharge from the anus
- Sore throat
- Red eyes with abnormal discharges
Should I get tested for Gonorrhea STI?
You should, if:
- You or your partner have symptoms of gonorrhea
- You had unprotected sex with a new partner
- You or your partner had unprotected sex with other people
- Your partner told you they have STIs
- You have other concurrent STIs
- You are pregnant or planning to conceive
Diagnosis of Chlamydia STI
Testing for Female
- Gonorrhea swab test – This involve an internal examination, where the trained clinician will insert a speculum (plastic device) into your vagina, and use a brush swab to collect the sample from your cervix.
Testing for Men
- Urine sample test – You are advised to provide a urine sample for PCR testing of gonorrhea bacteria. It is important to hold your urine for at least 2 hours beforehand, as recent urination can wash the bacteria away affecting the test results.
- Swab test – This may be offered to collect sample from discharges over the tip of penis
In cases where the concerns of rectum, throat, or eyes are infected, your doctor may offer swab tests to collect samples from the affected areas.
Currently, there is a single test to detect Neisseria Gonorrhea and Chlamydia Trachomatis bacteria. This is to screen concurrently for both STIs under one setting. Speak to your doctor on CTNG PCR DNA swab/ urine tests.
Treatment of Gonorrhea STI
- Single antibiotic injection (Ceftriaxone) and Single antibiotic tablets (Azithromycin)
- You may be offered other types of antibiotics if you have drug allergies or bacteria resistance towards the offered antibiotics.
- You are advised to follow up in the clinic 2 weeks after treatment with repeat swab or urine test to ensure clearance.
- You should practice sex abstinence until clearance of disease.
- Sexual partners should be advised for treatment as well
Why should we treat Gonorrhea STI?
In women, Gonorrhea can spread in the reproductive organs, affecting the womb, the cervix, fallopian tubes or even the ovaries, causing pelvic inflammatory disease. In the long term, this can lead to chronic pelvic pain and discomfort, increase the risk of ectopic pregnancy and infertility.
If you have untreated gonorrhea and you are pregnant, the infection can be passed down to the baby, increasing the risk of permanent blindness in the baby.
In men, untreated Gonorrhea can cause infection of the urethra, painful testicles and prostate gland inflammation.
Gonorrhea infection can seed in the back passage (rectum), the throat (in cases of oral sex) or even the eyes, causing conjunctivitis. Rarely, Gonorrhea can spread into the bloodstream causing infection of the blood (septicemia), and affect the joints (Gonococcal arthritis).
How to prevent getting Gonorrhea?
- Use barrier contraception (male condoms or female condoms) every time during sexual intercourse
- Do not share sex toys, wash and cover them with a condom before anyone uses them
Importantly to note that: Previous successful treatment of gonorrhea does not give you immunity against future Gonorrhea infection, so practice safe sex.