Gonorrhoea infection is a common STI caused by Neisseria gonorrhoeae, a gram-negative diplococcus bacterium that is closely related to other human Neisseria species.
Men typically present with a urethral discharge; women are often asymptomatic, but may have vaginal discharge.
Risk factors include multiple sex partners in recent months, known partner with gonorrhoea, drug use, prior STI, and men who have sex with men.
If left untreated, N gonorrhoeae can disseminate to areas of the body to cause skin and synovial infections; rarer complications include meningitis, endocarditis, and perihepatic abscesses.
High rates of antimicrobial resistance have been reported, and antibiotic treatment should be guided by local and national guidelines. The main treatment for uncomplicated gonorrhoea is monotherapy with single-dose intramuscular ceftriaxone.
The treatment of N gonorrhoeae is important in the prevention of infertility, chronic pelvic pain, and ectopic pregnancy in women.
If acquired congenitally from an infected mother, the neonate can present with ophthalmia neonatorum, which left untreated can cause blindness.
Neisseria gonorrhoeae is a gram-negative diplococcus bacterium that is closely related to other human Neisseria species. Gonorrhoea is any manifestation of infection by N gonorrhoeae. Aside from causing infection in the lower genital tract, it can also cause conjunctivitis and severe disseminated infections, especially if acquired congenitally. The pathogen is almost exclusively sexually transmitted and can be found in the genital tract, pharynx, and rectum.
History and exam
Key diagnostic factors
- presence of risk factors
- urethral discharge in men
- tenderness and/or swelling of the epididymis
- mucopurulent or purulent exudate at the endocervix
Other diagnostic factors
- pelvic pain in women
- urethral irritation in men
- dysuria in men
- tenderness and/or swelling of testis
- tenderness and/or swelling of prostate
- anal pruritus
- mucopurulent discharge from the rectum
- rectal pain
- rectal bleeding
- vaginal discharge
- cervical friability
- uterine, adnexal, or cervical motion tenderness
- uterine mass
- anterior cervical lymphadenopathy
- skin lesions (papules, bullae, petechiae, or necrotic) at extremities
- purpuric rash
- positive Brudzinski's sign and Kernig's sign
- focal cerebral signs
- ophthalmia neonatorum
- urethritis (infantile)
- age 20 to 29 years
- men who have sex with men (MSM)
- black ancestry
- current or prior history of STI
- multiple recent sex partners
- inconsistent condom use
- risk factors of partner
- history of sexual or physical abuse
- substance use
- past incarceration
- high morbidity community
1st investigations to order
- nucleic acid amplification test (NAAT)
- urinalysis in men
- Gram stain of urine sediment
- Gram stain of urethral discharge
- HIV test
- syphilis test
Investigations to consider
- transvaginal ultrasound
- pelvic CT/MRI
non-pregnant >45 kg: urogenital/anorectal or pharyngeal infection (excluding complicated genitourinary infection)
non-pregnant >45 kg: complicated genitourinary infection
non-pregnant >45 kg: disseminated gonococcal infection
pregnant: uncomplicated urogenital/anorectal or pharyngeal infection (excluding complicated genitourinary infection)
pregnant: complicated infection
child ≤45 kg
recurrent/resistant: urogenital/anorectal infection or pharyngitis
Sheldon Morris, MD, MPH
Division of Infectious Diseases
Department of Medicine
UCSD Antiviral Research Center
Division of Family Medicine
Department of Family and Preventive Medicine
UCSD La Jolla Family and Sports Medicine
SM has received research funding via his institution from Merck, Gilead Sciences, National Institutes of Health, California HIV/AIDS Research Program, and California Institute for Regenerative Medicine. He has completed a National Institutes of Health contract for research study on the Visby Medical Sexual Health Test. He holds stock in Bristol Myers Squibb and Pfizer. He is a co-founder of Aspera Biomedicines and a consultant for Primmune Therapeutics. SM is an author of a number of references cited in this topic.
Vani Dandolu, MD, MPH
Ob/Gyn and Urology
Division of Urogynecology
Associate Residency Program Director
Temple University Hospital
VD declares that he has no competing interests.
Eva Jungmann, FRCP MSc
Consultant in Genitourinary and HIV Medicine
Archway Centre & Mortimer Market Centre
EJ declares that she has no competing interests.
- Chlamydia infection
- Other infectious causes of urethritis, cervicitis, pelvic inflammatory disease (PID), and epididymitis
- Reducing sexually transmitted infections
- Guidance on the use of expedited partner therapy in the treatment of gonorrhea
GonorrhoeaMore Patient leaflets
Intramuscular injection animated demonstrationMore videos
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer