Signs and Symptoms of Gonorrhea

Gonorrhea—sometimes known as "the clap"—is a common sexually transmitted infection (STI) that you can get through oral, vaginal, or anal sex. However, most people with the infection don't always know they have it because gonorrhea doesn't always cause symptoms, especially in people assigned female at birth.

If you do develop symptoms, your symptoms will depend on the area of the body that the infection is affecting. This may include your mouth, throat, anus, rectum, urinary system, and genitals. When symptoms do occur, they typically appear within one to 14 days after someone gets the infection.

Anyone who engages in sexual activity can get gonorrhea. But, it’s more common in sexually active teenagers and young adults. Over 50% of gonorrhea cases are among people between the ages of 15 and 24. Knowing the symptoms and when to get screened for STIs is important so you know when to reach out for care and reduce the risk of gonorrhea-related complications. 

Oropharyngeal Symptoms

Oropharyngeal gonorrhea causes symptoms in the mouth and throat. The primary way you can contract the virus in your mouth is through oral sex with someone.

This type of gonorrhea is commonly asymptomatic, but when symptoms occur they involve a scratchy or sore throat, difficulty swallowing, and swollen lymph nodes. Lymph nodes are small bean-shaped structures in the neck, armpits, and groin. They carry and filter lymphatic fluid which transports immune cells and waste between your tissues and the bloodstream. 

Anorectal Symptoms

Anorectal gonorrhea affects the following areas. 

• Rectum: The last part of the large intestine, located at the end of the digestive system
• Anus: The organ located after the rectum, where stool (poop) exits the body

You may develop this type of gonorrhea through penetrative anal sex. As a result, you might experience:

• Rectal discharge or pus
• Soreness or pain
• Anal bleeding
• Painful bowel movements
• Constipation
• Itching

Conjunctival Symptoms

Conjunctival gonorrhea, otherwise known as gonococcal conjunctivitis, is an infection in the eye. When it occurs in neonates (newborn babies), healthcare providers call it gonococcal ophthalmia neonatorum.

This type of gonorrheal infection is more common in babies, but adults can also get it.  Newborn babies may be exposed to the infected genital secretions in the birth canal during childbirth and delivery.

Gonococcal conjunctivitis can cause symptoms such as:

• Eyelid swelling and tenderness
• Discharge from your eyes
• Vision problems or loss

Gonococcal ophthalmia neonatorum can also cause eye scarring and blindness in newborns within 24 hours after birth. Most newborn babies receive prophylactic (preventative) erythromycin eye ointment shortly after delivery. Erythromycin is an antibiotic medicine that helps prevent gonorrheal eye infections and complications.

Urogenital Symptoms

Urogenital gonorrhea affects the urine and reproductive systems. This includes the: 

• Urethra (the tube that transports urine from the bladder to the outside of the body) 
• Penis, prostate, and epididymis (duct in the testes) in males
• Cervix, uterus (womb), ovaries, and fallopian tubes in females

Common symptoms of urogenital gonorrhea include:

• Painful urination
• Abnormal penile or vaginal discharge 
• Itchy genitals

Symptoms by Sex

Generally, gonorrhea affects people assigned male at birth more often than those assigned female at birth. In fact, only 50% of females with urogenital gonorrhea have symptoms, while over 90% of males experience symptoms. 

Symptoms in Females

When females do have symptoms, they commonly mistake them for other vaginal infections or a urinary tract infection (UTI). 

People assigned female at birth may experience symptoms, such as:

• Painful urination
• Abnormal or foul-smelling vaginal discharge (white, yellow, or green discharge that usually appears one to fourteen days after infection)
• Pain with sexual intercourse
• Itching
• Vaginal bleeding outside of the normal menstrual period
• Lower abdomen or pelvic pain

Without treatment, gonorrhea can lead to pelvic inflammatory disease (PID), which can cause reproductive complications. PID is an infection that affects the uterus (womb), ovaries, or fallopian tubes. If left untreated, you may experience complications such as:

• Infertility or difficulty getting pregnant
• Scar tissue in the fallopian tubes, which can prevent the egg from reaching the uterus
• Ectopic pregnancy, or a non-viable pregnancy outside of the uterus
• Chronic or long-term pelvic and abdominal pain

Pregnant people will typically receive screening for gonorrhea and other STIs during their first prenatal visit. If an expectant parent does have gonorrhea, taking antibiotics can help prevent passing the infection to the baby. Healthcare providers typically repeat STI screening in the last trimester, especially for high-risk pregnant people. This is important because you can get another infection, even after treatment.

Symptoms in Males

Common gonorrhea symptoms in males include:

• Painful urination
• A white, yellow, or green discharge from the penis
• Swelling or pain in one testicle

Epididymitis—a condition that causes swelling in the part of the testes that carries sperm—can also occur. This swelling is one of the most common causes of male infertility. About 40% of people with epididymitis have permanent oligospermia (low sperm count) or azoospermia (no sperm).

When to See a Healthcare Provider 

If you or your sexual partners may have been exposed to an STI or are displaying symptoms of gonorrhea, it's a good idea to see a healthcare provider or your local sexual health clinic (e.g., Planned Parenthood) for testing and treatment. 

If symptoms are severe enough to disrupt your daily life, they may warrant visiting an urgent care or emergency room. This might include severe pain, persistent vomiting, or a fever. Having these symptoms or the potential of contracting an STI may seem scary. However, don't let your fear prevent you from getting the care you need.

A Quick Review 

Gonorrhea is a common STI in the U.S. In many cases, you may not even know you have the infection because it doesn't always cause symptoms. However, when you do experience symptoms, they usually develop within a couple of weeks of getting the infection. Symptoms depend on where the site of the infection occurred. This may include the mouth, throat, anus, rectum, eyes, reproductive organs, genitals, and urinary system.

If you have symptoms of gonorrhea or notice a change in your sexual health, it's good practice to see your healthcare provider for support. They can get you an accurate diagnosis for your condition and advise you on proper treatments and prevention techniques. If left untreated, gonorrhea can cause serious health complications, including infertility—so don't wait to get the help you need.