Gonorrhea guide: Risk factors and clinical manifestations

Risk factors and clinical manifestations of Neisseria gonorrhoeae infections

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Risk factors

Common risk factors for gonorrhea:

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 gonorrheaFootnote 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 periodFootnote 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 femalesFootnote 3Footnote 4 but may be asymptomatic in both. In all individuals, rectal and pharyngeal infections are more likely to be asymptomaticFootnote 5.

Gonorrhea signs and symptoms

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

Females

Males

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

Complications of gonorrhea infection

Females

Males

Both genders

References

Footnote 1

Danby CS, Cosentino LA, Rabe LK, et al. Patterns of Extragenital Chlamydia and Gonorrhea in Women and Men Who Have Sex With Men Reporting a History of Receptive Anal Intercourse. Sex Transm Dis. 2016; 43(2):105-109. doi:10.1097/OLQ.0000000000000384

Return to footnote 1 referrer

Footnote 2

Lewis DA. Global resistance of Neisseria gonorrhoeae: When theory becomes reality. Curr Opin Infect Dis. 2014; 27(1):62-67. doi: 10.1097/QCO.0000000000000025

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Footnote 3

Klein EJ, Fisher LS, Chow AW, Guze LB. Anorectal gonococcal infection. Ann Intern Med. 1977;86 (3):340-346. doi:10.7326/0003-4819-86-3-340

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Footnote 4

Komaroff AL, Aronson MD, Pass TM, Ervin CT. Prevalence of pharyngeal gonorrhea in general medical patients with sore throats. Sex Transm Dis. 1980; 7(3):116-119. doi:10.1097/00007435-198007000-00004

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Footnote 5

Committee on Infectious Diseases, American Academy of Pediatrics. Gonococcal infections. In: Pickering L, ed. Red book: 2012 report of the committee on infectious diseases. Vol 29th Edition. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012:336-344. https://redbook.solutions.aap.org/DocumentLibrary/RB12_interior.pdf.

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Footnote 6

Creighton S, Tenant-Flowers M, Taylor C, Miller R, Low N. Co-infection with gonorrhoea and chlamydia: How much is there and what does it mean? Int J STD AIDS. 2003; 14(2):109-113. doi:10.1258/095646203321156872

Return to footnote 6 referrer

Footnote 7

Lyss SB, Kamb ML, Peterman TA, et al. Chlamydia trachomatis among patients infected with and treated for Neisseria gonorrhoeae in sexually transmitted disease clinics in the United States. Ann Intern Med. 2003;139(3):178-185. doi:10.7326/0003-4819-139-3-200308050-00007

Return to footnote 7 referrer

Footnote 8

Mayor MT, Roett MA, Uduhiri KA. Diagnosis and management of gonococcal infections]. Am Fam Physician. 2012;86 (10):931-938. [published correction appears in Am Fam Physician. 2013 Feb 1;87(3):163

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Footnote 9

Woods CR. Gonococcal infections in neonates and young children. Semin Pediatr Infect Dis. 2005;16(4):258-270. doi:10.1053/j.spid.2005.06.006

Return to footnote 9 referrer

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