Gonorrhea guide: Risk factors and clinical manifestations

On this page

• Risk Factors
• Transmission
• Clinical Manifestations
  • Gonorrhea signs and symptoms
  • Complications of gonorrhea infection
• References

Risk factors

Common risk factors for gonorrhea:

• Sexual contact with a person who has gonorrhea
• Sex with a new partner without barrier protection
• Unprotected sex with someone from an area with high gonorrhea burden
• Sexually active people under 25 years of age
• History of STBBI
• Being birthed by a person with gonorrhea
• Unprotected anal intercourse in gay, bisexual and other men who have sex with men (gbMSM)
• Unprotected sex with multiple partners
• Exchange of sex for money or drugs 

Other activities that may increase potential exposure to STBBIs include anonymous sexual partnering, street involvement and substance use. Refer to STBBI prevention guide.

Transmission

N. gonorrhoeae is transmitted when there is contact with exudates from mucous membranes from people with gonorrhea.

Sexual transmission: Gonorrhea is usually transmitted through oral, vaginal, or anal sexual contact with a partner with gonorrhea^{Footnote 1}.

Vertical transmission: A person with gonorrhea can transmit the infection to the neonate during vaginal delivery if they have not received treatment during the perinatal period^{Footnote 2}.

Autoinoculation may also occur from an infected genital site to conjunctivae or rectum.

Clinical manifestations

Gonococcal infection can result in a broad spectrum of clinical presentations depending on the anatomical site of infection and the sex of the individual. Incubation period is usually two to seven days, but it may range from one to 14 days.

Infection is usually symptomatic in males and asymptomatic in females^{Footnote 3Footnote 4} but may be asymptomatic in both. In all individuals, rectal and pharyngeal infections are more likely to be asymptomatic^{Footnote 5}.

Gonorrhea signs and symptoms

Persons with N. gonorrhoeae infection often have a co-infection with C. trachomatis^{Footnote 6Footnote 7Footnote 8}. Signs and symptoms may indicate other STIs. If present, symptoms may include one or more of the following:

Females

• Vaginal discharge
• Lower abdominal pain
• Abnormal vaginal bleeding
• Dysuria
• Cervical discharge
• Bartholinitis
• Deep dyspareunia
• Rectal pain and discharge with proctitis

Males

• Urethral discharge
• Dysuria
• Urethral itch
• Testicular pain or symptoms of epididymitis
• Rectal pain and discharge with proctitis

Children over 30 days

All the above signs and symptoms can occur in children. However, children are thought to be more likely than adults to present conjunctivitis or disseminated gonococcal infection (DGI).

Neonates

• Ophthalmia neonatorum, which is the most common manifestation in infants born to mothers with genital tract infection^{Footnote 9}. Symptoms include eyelid edema, conjunctival erythema, and profuse purulent discharge.
• Disseminated gonococcal infection (rare)

Complications of gonorrhea infection

• If diagnosis and treatment are delayed, inadequate, or no treatment is given, infection can spread from the local site and lead to serious complications or sequelae in both sexes.  

Females

• Pelvic inflammatory disease (PID), which may lead to infertility and an increased risk of ectopic pregnancy
• Chronic pelvic pain

Males

•   Epididymo-orchitis (in rare cases may lead to infertility) 

Both sexes

• DGI (encompasses a spectrum of conditions including arthritis, tenosynovitis, dermatitis, endocarditis and meningitis)
• Reactive arthritis (oculo-urethro-synovial syndrome)
• Perihepatitis

References