Sexually Transmitted Infections
Gonorrhea: Signs And Symptoms
Gonorrhea is a very common sexually transmitted infection (STI) that you may hear referred to as "the clap" or "the drip." An infected person can pass it to a partner during vaginal, anal, and/or oral sex. It can also be spread via contaminated sex toys and close genital-to-genital contact, even if there's no penetration. You can also get it if the infection touches your eyes. If left untreated, it can cause serious complications, including:
Gonorrhea symptoms normally show up within 14 days after you get the infection. Some people don't experience any symptoms until after they've had the infection for months. Many people with gonorrhea — usually people with vaginas — never have symptoms at all.
Know the signs of this common STI so you'll have a better chance of recognizing and curing it quickly.
You get gonorrhea from a bacterium. This germ infects you when someone who has it passes it to you during sexual contact. The most common symptoms show up in the mucous membranes (the linings of certain openings in your body) involved in these types of intercourse. These include your genital tract, rectum, and throat.
Gonorrhea can also cause problems with other parts of your body, such as your joints, or even your eyes.
Often, gonorrhea has no symptoms. Symptoms typically don't start immediately, because the infection may not trigger your immune system for up to several weeks. Most people who contract gonorrhea will begin to have symptoms within 14 days.
It's possible for people with penises not to have any symptoms. But when they do have symptoms, they commonly include:
People with vaginas are more likely to not have symptoms of gonorrhea than people with penises. People with vaginas also tend to have milder symptoms. Its symptoms can be mistaken for those of a bladder infection. The symptoms include:
Pelvic pain can be a symptom of gonorrhea for women and those assigned female at birth. (Photo Credit: Moment/Getty Images)
Symptoms of gonorrhea can affect any infected area. It generally depends on what type of sex has spread the infection. You may experience symptoms in the following areas of your body:
Rectum
Gonorrhea in your rectum typically occurs following unprotected anal sex. However, if you have gonorrhea, you can spread the infection from your genitals to your rectum. For example, if you touch your rectum with infected toilet paper after wiping your vagina, you may spread the infection. Most of the time, you won't have any symptoms. Possible symptoms include:
Throat
Unprotected oral sex can lead to gonorrhea infection in your mouth and throat. Such infections usually don't cause symptoms. When symptoms do occur, they can include:
Eyes
If you touch your eyes after touching bodily fluids infected with gonorrhea, you could get gonococcal conjunctivitis, a contagious eye infection sometimes referred to as pink eye. Symptoms include:
Joints
If the bacteria that cause gonorrhea infect your joints, it's called septic arthritis. You'll notice the affected joints are painful, red, swollen, and warm to the touch. It'll hurt to move them.
Gonorrhea infections can lead to many complications if they go untreated. Some complications can be quite serious, even life-threatening. These complications and their symptoms include:
Pelvic inflammatory disease (PID)
PID is a serious infection that develops in your uterus, fallopian tubes, and/or your ovaries. It can lead to infertility, chronic pelvic pain, ectopic pregnancy, and potentially life-threatening abscesses called tubo-ovarian abscesses (TOA). Symptoms of PID include:
Epididymitis
This is inflammation of the epididymis, a tube that leads from each testicle to another tube called the vas deferens. Both the epididymis and the vas deferens are parts of male reproductive organs. The epididymis stores sperm as it matures, while the vas deferens moves that sperm along shortly before you ejaculate. If left untreated, epididymitis can become chronic. It can also lead to infertility and cause the death of tissue in your testicles. The symptoms of epididymitis include:
Prostatitis
This is an often painful swelling of the prostate gland, a part of the male reproductive system that helps make semen. It can lead to sexual dysfunction, inflammation in other parts of your reproductive system near your prostate, an abscess in your prostate, and dangerous bacterial infections of your bloodstream, called bacteremia, which can cause sepsis. The symptoms include:
Urethritis
This is swelling of the urethra, the tube that carries pee from your bladder to the outside of your body. If left untreated, it can cause blockages of the urethra, boosting your risk of infections in your bladder and kidneys. Urethritis may not cause symptoms, but if it does, they can include:
Sepsis
This is a life-threatening medical emergency. It occurs when your immune system goes haywire in response to an infection. Rather than continuing to fight that infection, your immune system begins to attack your organs and other parts of your body. This causes damaging inflammation. Sepsis can also trigger blood clots that can block the flow of blood to essential organs, leading to damage or organ failure. Gonorrhea infections, as well as infections that can occur when gonorrhea goes untreated, can result in sepsis. It requires immediate treatment and can be quickly fatal. Sepsis has many potential symptoms because it can affect many parts of the body. These symptoms include:
If you notice any of the symptoms listed above, get tested for gonorrhea. You should also be tested if you're having sex with someone who has symptoms.
At your appointment, your doctor will ask about your sex life to get a better idea of your risk for this STI. They'll also ask what symptoms you are having and when they started.
To test you for the infection, they'll take a sample from or swab one or more of the following places:
Your doctor will send the sample to a lab, where it'll be tested for the bacterium that causes gonorrhea. Having it increases your chances of getting other STIs (such as chlamydia), so your doctor may recommend that the lab test your sample for those, too.
If you're a woman or AFAB, there are also home test kits that you can use to check for gonorrhea. These come with swabs you use on your vagina to collect a sample. You mail the sample to a lab. The lab will contact you with your results.
Gonorrhea is a common and serious sexually transmitted infection (STI). For many people, it does not cause symptoms. When symptoms do occur, some of those will depend on whether you have a penis or vagina. If you have symptoms or think that you may have gonorrhea, see a doctor right away. The infection usually can be treated with a single dose of antibiotics. Without treatment, it can cause potentially life-threatening complications, such as sepsis.
How serious is gonorrhea?
It can be very serious. If untreated, gonorrhea can lead to a long list of complications, including infertility, liver, heart, and brain damage, and sepsis.
Can gonorrhea be cured?
Most of the time, gonorrhea can be cured by a single injection of antibiotics. However, antibiotic-resistant gonorrhea is becoming more common. That makes it even more important to avoid the infection in the first place. Practice safe sex and avoid sex with people who have gonorrhea or symptoms of gonorrhea.
What is the 7-day antibiotic for gonorrhea?
The antibiotic is called ceftriaxone. It's given once, by injection. You should avoid sex for at least 7 days after your injection to keep the infection from spreading. The CDC recommends that you get tested for gonorrhea 3 months after treatment to be sure you have not been reinfected. Your sexual partner or partners also should be treated.
How transmissible is gonorrhea from women to men?
There's about a 1 in 5, or 20%, chance of an infected woman passing gonorrhea to a male partner if they did not use a condom during sex.
Genital Warts: Having Sex In A Well-lit Room Helpful In Preventing Some STIs
Adetona Fayemiwo is an Associate Professor of Medicine, Consultant Clinical Microbiologist, and Head of the Department of Medical Microbiology and Parasitology at the University College Hospital, Ibadan. In this interview with SADE OGUNTOLA, he states that it is impossible to develop immunity against sexually transmitted infections, and that the best protection is mutual faithfulness by couples and abstinence for adolescents.
NEISSERIA gonorrhoea and Chlamydia are examples of sexually transmitted infections that you treat in the clinic as a consultant clinical microbiologist. What are these diseases, and how common are they?
These are two separate organisms that negatively impact human beings but have different manifestations in different groups of people. Chlamydia causes non-gonococcal urethritis in males and non-gonococcal cervicitis in females. Gonorrhoea, commonly referred to as "atosi" in Yoruba, however, causes gonococcal urethritis in men or gonococcal cervicitis in females.
These organisms are most often sexually transmitted. Their transmission can also be from an infected mother during childbirth. When twins are born, the germ most commonly affects the first twin. Although syphilis can be contracted through blood transfusion, Neisseria gonorrhoea and Chlamydia are rarely transmitted via blood transfusion.
However, cases of chlamydia and gonorrhoea in women are a bit serious because they might not feel or notice any symptoms for as long as two years or more. As such, many patients wouldn't even know that they contracted these infections. Many women get to know until after engaging in sexual intercourse with their male partners, who, within three days—one week—start to have yellowish pus-like discharge or drip from their penis in the case of gonorrhoea and watery discharge in the case of Chlamydia.
What are the other things people with these two organisms are likely to experience?
Many women with gonorrhoea have no symptoms in the early phase. The men often experience a burning sensation during urination, yellowish discharge, and pain or swelling in the testicles. There could also be pain in one or both testicles and swelling. In women, there may be a vaginal discharge and bleeding between periods, as well as pain in the lower abdominal area.
Men often wrongly assume that the watery discharge due to Chlamydia is because they are sexually stimulated and wouldn't present early for treatment at the hospital. But in light-skinned men, the area around the penis opening will be reddened; they may experience a burning sensation during urination, urgency to urinate, and pain in one or both testicles. Some of them will also experience pains around the loins.
Unfortunately, in females, the disease-causing germs end up affecting all the structures in the pelvis region. It's an ascending infection; it comes in through the vagina and spreads to the cervix, the womb, the fallopian tubes, and finally the ovary. That's why, without prompt treatment, they may end up with blocked fallopian tubes and thereafter infertility.
So, whenever there is a discharge, it should be a cause for concern and enough reason for a man to go to the hospital for treatment. We don't usually want to attend to some of them until they bring their partners. Usually, the male partners are like saviours to the female partners. It's of public health importance. That is why we also want to ensure that we break their chain of transmission within that community. I've seen a situation where a lady has five to six sexual contacts who have contracted the infection from her. It is one of them that came to the hospital. The other partners had visited nearby pharmacists for treatment; some just took herbal medicine. So, all these have negative impacts on public health.
What were your findings on gonorrhoea and Chlamydia infections in the community in your recent study?
The study was carried out among perceived infertile women. Some time ago, one of its authors mentioned that there are so many requests from the O&G department to Radiology for one investigation called HSG, where they put a contrast through the cervix to assess a woman's fallopian tubes. Most of them were discovered to have blocked fallopian tubes. So, we decided to screen them for Chlamydia and Gonorrhoea infections.
Our finding was that a lot of these women were referred for HSG because they had previously had pelvic inflammatory disease (PID), chlamydia infections, gonorrhoea infections, trichomoniasis, and other genital sexually transmitted infections.
In the group, about 2.4%, 17.6%, 11.2%, and 17.7% of the women had gonorrhoea, chlamydia, trichomoniasis, and a previous pelvic inflammatory disease, respectively. That means that they must have been infected with either of these agents, chlamydia or gonorrhoea, for a very long time. For you to develop PID, you must have had gonorrhoea or chlamydia infection in the past.
So, as a result of this study, the policy in our teaching hospital now is that no infertile woman should go for HSG investigation without being screened first for Sexually transmitted infections(STI). In women, some of these infections will not show any symptoms for two to three years. And then when you now push a contrast through the cervix to the fallopian tubes, it makes the infection spread further, so worsening the case.
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Is it possible to have two or more STI germs coexisting in a woman?
It is possible that chlamydia and gonorrhoea can coexist in a woman. For instance, gonorrhoea and trichomoniasis can coexist because trichomoniasis will affect the cells that line the vagina, making it more susceptible to acquiring gonorrhoea or chlamydia. Also, other infections, especially HIV, also increase the chances of coming down with gonorrhoea or chlamydia.
The majority of people acquire chlamydia and gonorrhoea through sex. It could result in serious complications, including infection in the newborn, infertility, and ectopic pregnancy in a woman. When the infection spreads into the pelvic area, it can lead to PID. In women, PID can cause difficulty getting pregnant or infertility. In men, it can affect the testicles, so sperm may not be produced or produced abnormally.
During pregnancy, gonorrhoea can cause miscarriage, premature labour and birth, and the baby being born with conjunctivitis. In men, when gonorrhoea has been left untreated, it can spread through the bloodstream and cause life-threatening infections in other parts of the body (sepsis) in rare cases.
Are cases of STIs on the rise?
Well, cases of STIs are on the rise. Initially, it was a bit controlled when we had HIV under check. But with good reports about HIV, people are now more relaxed since they are taking their ARV drugs. The fear of acquiring HIV is no longer there, so cases of other STIs are now on the rise. Also, the fact that you are well-treated for gonorrhoea today doesn't mean that when you are exposed again, there cannot be a reinfection. There is no immunity for gonorrhoea. You can have it as many times as the number of times one gets exposed to it.
In our clinic, the most common STI presented is genital wart. Genital warts can be anywhere on the body, including the perineum, vagina, breast folds, and penis. It can be on the penis; it can be on the shaft; it can be everywhere.
What about cases of syphilis, gonorrhoea, and trichomoniasis?
The incidence of syphilis, gonorrhoea, and trichomoniasis is also on the increase. In a study, which cuts across the six geopolitical zones of Nigeria, we found that the rise in these STI cases was higher in the northwest and the southeast. The increasing incidence of STIs is because people are not protecting themselves; they are not using condoms. We have been preaching barrier methods for a very long time. However, people are not too comfortable using condoms. They want the actual contact. That is even one of the reasons why cases of genital warts are on the rise. This virus spreads through contact, depending on where the infected sexual organ is in contact with.
In addition, another sexually transmitted infection whose incidence is on the increase is the herpes simplex virus, causing genital herpes. We have herpes simplex type 1 and herpes simplex type 2. Herpes simplex virus type 1 is more in the upper part of the body, while herpes simplex virus type 2 causes genital herpes. More people now have oral sex, so we now have more of herpes simplex type 1 causing the genital infection.
Are there other things that predispose individuals to complications from these infections?
Antimicrobial resistance is a contributory factor for those STIs like gonorrhoea and Chlamydia. These are bacterial infections treated with antibiotics, unlike viral infections like herpes simplex and warts. Resistance to antibiotics has caused us to abandon the usage of different classes of antibiotics in their treatment. For instance, doxycycline and penicillin are almost useless in treating gonorrhoea and chlamydia. Part of the reason for the antibiotic resistance is because of abuse of these drugs. A lot of people take inadequate dosages of these drugs. This is also partially the reason why cases of STIs are on the rise.
Can individuals protect themselves from chlamydia and gonorrhoea? Do they come in contact with these germs?
Protection is a bit subjective. At a presentation I gave in Ethiopia, where I emphasised monogamous relationships, a gentleman stood up to ask if, in the name of protecting himself, he should divorce his four wives. He did not agree with the suggestion. But we now emphasise more on individuals having faithful partners. For instance, if a man has four wives, he needs to be faithful to these wives just as these wives should not be having sexual intercourse with anybody else than their husbands. That is a kind of protection; that's substantial protection.
For young adults or adolescents, abstinence is still the best way. If you know that you cannot abstain, then protect yourself using a condom. Many young people are sexually exposed even before they are 15 years old, and their parents are not aware. I've heard of a case of a young lady suspected to have viral conjunctivitis. She had washed her face with her urine. She had gonococcal conjunctivitis. If care is not taken, she could go blind within 72 hours. When the 17-year-old girl was asked if she was sexually exposed, the mother declared her to be a virgin. But on examination and testing, we discovered she had gonorrhoea and trichomoniasis. The next thing is to stick to a faithful partner and then use a condom.
Another unconventional method is to be in a well-lit area before having sex. It's a bit unconventional. There are different manifestations of STIs; genital warts are highly visible, and partners can view them and ask questions. In the case of gonorrhoea, you will see a purulent discharge; for herpes simplex, you will see some vesicles that look like tiny boils all around the genital; and for chancroid, there will be blisters or sores. No matter how sexually motivated, when the light is on and you see these things on the male or female genital organs, you will pull back. It is a bit unconventional, but it is still a mode of preventing STIs. These signs and symptoms can serve as red flags because they are visible. Some of my patients with giant genital warts say they only have sex in the dark. They even put on strong perfume to cover up the smell arising because of the genital wart.
When they present late, can they be helped?
They can be helped whenever they present in the hospital. They are always helped in one way or another. But not all of them can be cured; some cannot be cured. It is not only HIV that cannot be cured; herpes simplex virus and hepatitis B cannot be cured, but others like gonorrhoea, chlamydia, and trichomoniasis can be cured, even when they present late. One of the goals of treatment is to prevent these complications. Some of these complications, like a blocked fallopian tube, are irreversible.
What Causes Gray Discharge? 2 MDs Explain.
There are certain vaginal discharge colors that'll set off some serious alarm bells (looking at you, green). But then there are others that fall into a confusing middle ground, like gray discharge.
After all, it's different from your usual discharge color, but gray also doesn't seem all that far from a more "normal" white hue. So, should you be concerned about 50 shades of gray or not?
At the end of the day, any kind of gray discharge isn't ideal. "It can mean that you have an infection," says Christine Greves, MD, an ob-gyn at Orlando Health Women's Institute Center for Obstetrics & Gynecology and obstetrical and gynecological surgeon at Winnie Palmer Hospital for Women & Babies. That's not a guarantee, of course, which is why it's important to be evaluated by a medical professional, just to be sure.
While you're waiting to be seen, keep reading for more on some of the most common causes of gray discharge, according to ob-gyns. Worth noting: they're all treatable.
Experts Featured in This Article
Christine Greves, MD, is an ob-gyn at Orlando Health Women's Institute Center for Obstetrics & Gynecology and obstetrical and gynecological surgeon at Winnie Palmer Hospital for Women & Babies.
Jennifer Wider, MD, is a women's health expert, author, and podcast host.
What Does Gray Discharge Mean?
Gray discharge can indicate a few different things. "It's usually a signal that something is wrong, as normal discharge is clear, white, or off white," says Jennifer Wider, MD, a women's health expert and ob-gyn. There are a few different things that could be behind it, although all signs point to some type of infection which is why it's so important to see a doctor. Here's what could be going on, plus other symptoms to keep an eye out for.
You might have bacterial vaginosis.
Bacterial vaginosis, aka BV, is the most common vaginal condition experienced by women between the ages of 15 and 44, according to the Centers for Disease Control and Prevention (CDC). It happens when there's too much of a certain bacteria in the vagina. While several forms of bacteria can lead to BV, Gardnerella vaginalis is the most common culprit.
Bacterial vaginosis usually causes more than gray discharge. It typically also comes along with symptoms like a strong fishy or musty odor, itching or burning around the vagina, and burning while you pee, according to the World Health Organization (WHO). The discharge itself can be thin and light gray, per the WHO, although it can also be green.
BV can be cleared up with the antibiotic metronidazole but, if it's left untreated, can lead to problems in pregnancy, a higher risk of sexually transmitted infections (STIs), and pelvic inflammatory disease, per the WHO. "It needs to be treated with an antibiotic," Dr. Wider stresses.
It could be trichomoniasis.
Trichomoniasis, or trich, is an STI caused by the parasite trichomonas vaginalis, per the CDC. According to the CDC, there are more than 2.6 million trichomoniasis infections in the U.S., although only about 30% of those come with symptoms. One of the hallmark signs is a gray discharge coupled with a foul odor, explains Dr. Wider. (Said discharge may also be thin or higher in volume than your usual.) Women are more likely than men to develop trichomoniasis and may also notice itching, burning, redness, or soreness of the genitals, along with discomfort while peeing and uncomfortable sex, per the CDC. The good news: Trichomoniasis can also be treated with metronidazole, the same medication used to treat BV, Dr. Wider says.
It may be another sexually transmitted infection.
At baseline, gray discharge can be a sign of an infection, Dr. Greves points out. More specifically, both chlamydia and gonorrhea can also cause gray discharge. Chlamydia is an STI caused by the bacteria Chlamydia trachomatis, according to the U.S. National Library of Medicine. While it can cause no symptoms, it can also lead to white, yellow or gray discharge with a strong odor, pain during sex, a burning sensation when you pee, and bleeding between periods, according to the Cleveland Clinic. It's treated with antibiotics.
Gonorrhea is an STI caused by the bacterium Neisseria gonorrhoeae, per the U.S. National Library of Medicine. It can cause discharge that's gray, green, or yellow, pain during sex, a burning sensation when you pee, and bleeding between periods, according to Northwestern Medicine. And yep, you guessed it, it's also treated with antibiotics.
It's potentially a yeast infection.
Yeast infections have a classic white "cottage cheese-like" discharge, but that discharge can also be gray, Dr. Wider says, although she notes that gray is less common. Either way, the discharge is usually thick, she adds.
"Yeast infections are caused by overgrowth of the fungus Candida, according to the American College of Obstetricians and Gynecologists (ACOG). You also raise your risk of getting a yeast infection when you wear tight-fitting bottoms, sit around in wet clothes, take antibiotics unnecessarily, and use scented feminine products down there, Dr. Greves explains. In addition to the discharge, you may also have itching and burning of the vulva that gest worse when you pee or have sex, along with redness and swelling.
Yeast infections are treated by placing anti-fungal medication like miconazole into the vagina or by taking an oral medication, Dr. Greves says. Happily, these treatments will usually help you feel better within a day or two.
When to See a Doctor For Gray Discharge
Again, gray is not a typical discharge color. So, if you're seeing it constantly, it's a good idea to talk to a doctor. That's especially true if you've never had gray discharge before and it's not going away after a few days. "If you notice a change from your normal discharge, go see your doctor," Dr. Greves advises.
Dr. Wider agrees. "Gray discharge is usually the sign of an infection, especially if it comes along with other symptoms," she says. "It should always be checked out by a medical professional."
Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women's Health, Self, Health, Forbes, and more.
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