A 2021 study from Alfred Health found that gonorrhoea cases have ‘dramatically increased’ over the past 10 years in Victoria, particularly among women and heterosexual men (Papworth 2021; Cunningham 2022).

Not only did Victorian cases increase from 6,500 in 2020 to 7,000 in 2021, but alarmingly, despite this rise in infections, gonorrhoea screening rates dropped by 70% due to the COVID-19 pandemic (Cunningham 2022).

It’s believed, therefore, that there are many more infections in the community than what has been officially reported (Cunningham 2022).

With cases on the rise, it’s important to familiarise yourself with the signs and symptoms of this condition.

What is Gonorrhoea?

Gonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae (Healthdirect 2021).

Gonorrhoea infection affects the mucosa of the urethra, cervix, rectum, throat and/or eyes, and rarely, the joints, skin or heart (Morris 2021).

What Causes Gonorrhoea?

Neisseria gonorrhoeae bacteria is typically found in penile discharge and vaginal fluid (NHS 2021). It can be spread through:

• Unprotected vaginal, oral or anal sex
• Sharing unwashed sex toys.

(NHS 2021)

A pregnant person who is infected with gonorrhoea can also spread the disease to their newborn during childbirth when the neonate makes contact with the infected cervical or urethral mucosa. This can lead to gonococcal conjunctivitis, which may cause permanent blindness in the baby (Costumbrado et al. 2021).

Risk Factors for Gonorrhoea

Those at increased risk of contracting gonorrhoea include:

• People who are sexually active, especially if partaking in unprotected sex
• People who inject drugs
• People travelling to areas where gonorrhoea is common
• Aboriginal and Torres Strait Islander peoples living in remote areas
• Sex workers
• People diagnosed with sexually transmitted infections, including HIV, syphilis and chlamydia.

(Better Health Channel 2020; ASHM 2021)

Symptoms of Gonorrhoea

Gonorrhoea is often asymptomatic, especially in women (ASHM 2021). The likelihood of experiencing symptoms depends on the area of the body affected:

• Anal and pharyngeal gonorrhoea are almost always asymptomatic
• Vaginal gonorrhoea is asymptomatic in 80% of cases
• Penile gonorrhoea is asymptomatic in 10 to 15% of cases.

(ASHM 2021)

Symptoms, if they do occur, may include:

(ASHM 2021; Healthdirect 2021; Better Health Channel 2020)

The incubation period is typically up to 10 days for females, and 1 to 3 days for males (Healthdirect 2021).

Diagnosis of Gonorrhoea

The most effective way of testing for gonorrhoea is via a nucleic acid amplification test (NAAT), which depending on the patient, involves taking an endocervical, vaginal, anorectal or pharyngeal swab, or taking a first pass urine (FPU) sample (ASHM 2021).

A NAAT works by amplifying genetic sequences into millions of copies, allowing even very small amounts of Neisseria gonorrhoeae bacteria to be detected if they are present (CDC 2021; Qureshi 2021).

The test can be performed either by a practitioner or at home by the patient (ASHM 2021). It’s likely to be combined with testing for other sexually transmitted infections like chlamydia (Pathology Tests Explained 2021).

Gonorrhoea can also be diagnosed using a gonococcal culture, which also allows for antibiotic sensitivity testing to be performed. However, this method is less sensitive than a NAAT (ASHM 2021).

Testing can be used to either diagnose active symptoms, or screen sexually active individuals. Those who are sexually active are recommended to be tested at least once every year (Pathology Tests Explained 2021).

Treatment of Gonorrhoea

Gonorrhoea requires antibiotic treatment and will usually resolve within one week once the regimen has commenced (Better Health Channel 2020).

The first-line treatment for gonorrhoea is both intramuscular ceftriaxone and oral azithromycin. Due to high levels of antibiotic resistance among gonococcal strains, alternatives to this regimen are not recommended apart from in very specific circumstances (e.g. severe allergy to first-line antibiotics) (ASHM 2021).

The patient should avoid any kind of sexual contact for seven days after the antibiotics are first administered in order to prevent spreading the infection to others. They are also advised to advise their sexual partners that they have gonorrhoea and avoid sexual contact with all sexual partners from the previous two months unless those people have been tested and treated for gonorrhoea (ASHM 2021; Better Health Channel 2020).

Complications of Gonorrhoea

If left untreated, gonorrhoea may lead to serious complications such as:

• Pelvic inflammatory disease (PID), which may scar the fallopian tubes and cause infertility
• Prostatitis, epididymitis or urethral stricture, which may cause inflammation and lead to infertility
• Disseminated gonococcal infection (DGI), which occurs when the bacteria enter the bloodstream. This may cause septic arthritis or macular rash
• Bartholin gland abscess
• Meningitis or endocarditis.

(ASHM 2021; Pathology Tests Explained 2021)

Preventing Gonorrhoea

The risk of contracting gonorrhoea can be reduced by:

• Practicing safe sex with condoms and water-based lubricant
• Using dental dams for oral sex
• Getting a full sexual health check annually, including tests for gonorrhoea, syphilis, HIV and chlamydia.

(Healthdirect 2021; Better Health Channel 2020)