Gonorrhea

Causes

Gonorrhea is passed through vaginal, oral, and anal sexual contact.  This includes both penetrative sex and sexual activities where there is an exchange of body fluids.  You can also get gonorrhea by sharing sex toys.  Once you have this infection, you can pass it to others even if you don’t have symptoms.

Symptoms

If you have gonorrhea, it is common to not notice any symptoms.  If you do get symptoms, they will most likely show up between 2 to 7 days.  Your symptoms will depend on where the infection is located, but occur most often in the penis/external genitals.  The most common symptoms include:

• Penis/external genitals:  You may notice abnormal discharge and an unusual, painful, or itchy sensation.  You may also have pain or trouble when urinating.  If you have testicles you may experience pain and sometimes a little swelling in the area.
• Vagina/internal genitals:  You may notice abnormal discharge and bleeding.  Other symptoms may include lower abdominal pain and sometimes pain during sex.
• Anus:  You may notice abnormal discharge.  You can also have generalized pain in the area.
• Throat:  It is rare to have symptoms, but you might experience a sore throat.
• Eye: You may notice swelling or abnormal discharge.

*Note: If you have had lower surgery, your genital symptoms may vary.

Tests and Diagnosis

There are choices for how you test for gonorrhea.  A health care provider will recommend certain tests depending on the types of sex that you’re having. Testing is usually done with a urine sample or a swab of the throat, rectum or vagina. 

It is best to get tested for gonorrhea if you:

• have symptoms
• have a sexual partner who has tested positive for gonorrhea
• are doing routine screening for STIs
• are pregnant
• are going to have an IUD inserted, a surgical abortion, or a gynecological procedure

Window Period (how long to wait before testing):  Most test results are accurate 7 days after you come in contact with gonorrhea. In British Columbia, most test results should be ready in 10 days.

Treatment

Gonorrhea is treated with prescription antibiotics.  It is important to take all your medications as directed.  If you miss any doses, the infection may not be cured.  See your health care provider if this happens or if you still have symptoms after you finish your treatment.

It is important to not have sex (including oral sex and sex with a condom) for 7 days after the start of your treatment.  If you do have sex, you could pass gonorrhea to your sexual partners or get it again. If this happens, talk to your health care provider.

The medications used to treat gonorrhea are available for free in BC.  Talk to your health care provider to see if they have them in stock.

Tell your healthcare provider if your symptoms (if any) do not go away, if you did not finish your medication, or if you experienced vomiting after taking medication (in case it did not absorb).

Before having sex with a recent partner, be sure they started treatment at least 7 days ago. If your partner was not treated (even if they tested negative), they could still have the infection and can pass it back to you

Retest in 6 months to confirm that there was no re-infection. If you retest sooner, wait at least 4 weeks after completing treatment. This is because dead bacteria may still be detected if you test too soon after treatment. It is sometimes recommended to have a test-of-cure. Talk to your health care provider for their recommendation.

Sexual Partners

Your sexual partners within the last two months should be tested and treated for chlamydia. If you haven’t had sex in the last two months, your last partner should be tested and treated. Recent sexual partners should be treated even if they test negative because it can take up to 6 weeks before an infection can be detected by the test.

There are a few ways to tell partners, talk to your health care provider about what is right for you. Some ways to let sexual partners know to get tested:

• Tell your partners in person or over the phone. It can help if you prepare for this conversation, we've developed some tips to help talk to partners.
• Tell your partners with your healthcare provider. Your healthcare provider can help answer any questions that you or your partners might have.
• Your healthcare provider might be able to tell your partners for you. They can inform them they have been exposed to an STI and need to get tested without giving your name. Not all providers offer this option.
• Another way to anonymously notify partners is to use an online tool such as this tool developed by HIM, or TellYourPartner.org

Complications

If you treat gonorrhea early, there are usually no other health problems. If left untreated, it can lead to serious complications including:

• higher chance of getting and passing HIV
• pelvic inflammatory disease
• epididymitis
• infertility
• ectopic pregnancy
• chronic pelvic pain
• reactive arthritis
• disseminated gonococcal infection

Pregnancy: If you are pregnant you should be screened for gonorrhea.  You can pass gonorrhea to your child during birth.

Prevention

It is a good idea to be tested regularly for STIs, especially if you have new sexual partners or open relationships.  Talking with partners about safer sex makes sure everyone knows what to expect.  Condoms are great if they work for you – the correct use of condoms reduces your chances of getting and passing gonorrhea.

Resources

HealthLink BC – Information about gonorrhea 
SmartSexResource – If you are worried or have anxiety about gonorrhea
Trans Care BC – Gender-affirming sexual and reproductive health information

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