Gonorrhoea

Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae. It is one of the most common bacterial STIs worldwide and is particularly concerning because of rapidly rising antibiotic resistance — multi-drug-resistant and even untreatable strains have been documented globally, including in India.

Gonorrhoea can infect the genitals, rectum, and throat. Untreated infection can spread to the reproductive organs, causing Pelvic Inflammatory Disease (PID) in women and epididymitis in men, both of which can lead to infertility.

Symptoms differ significantly between men and women:

• MEN (usually symptomatic within 1–14 days): Thick yellow, green, or white penile discharge; burning or pain when urinating; swollen or painful testicles.
• WOMEN (often asymptomatic or mild): Increased vaginal discharge; burning when urinating; inter-menstrual bleeding or bleeding after sex; pelvic pain. Up to 70% of women have no symptoms.
• RECTAL infection: Discharge, anal itching, soreness, bleeding, or painful bowel movements — often no symptoms.
• THROAT infection: Sore throat in some cases — usually no symptoms.

• Vaginal, anal, or oral sex with an infected person
• Mother-to-child transmission during birth (neonatal conjunctivitis — a serious eye infection in newborns)
• Does not require ejaculation to spread

Gonorrhoea is NOT spread through casual contact, toilet seats, or shared objects.

• NAAT (Nucleic Acid Amplification Test) — the most sensitive and specific test. Can be done on urine, urethral swab, cervical swab, rectal swab, or throat swab. Window period: 1–14 days.
• Culture — required for antibiotic sensitivity testing (crucial given drug resistance). Swab from infected site.
• Gram stain — quick microscopy test; less sensitive in women.
• 'Test of cure' — a follow-up NAAT 1–2 weeks after completing treatment, recommended given drug resistance.

Due to increasing antibiotic resistance, gonorrhoea must be treated with dual antibiotic therapy:

• Ceftriaxone 500mg IM (intramuscular injection) — the cornerstone of current Indian treatment guidelines
• Plus azithromycin 1g orally (for suspected co-infection with chlamydia)
• Never self-treat with leftover antibiotics — partial treatment promotes resistance
• Follow up with a 'test of cure' 1–2 weeks after treatment

• Any genital discharge or burning urination — even mild
• After unprotected sex with a new or casual partner
• Every 3–6 months if you have multiple sexual partners
• If a partner has been diagnosed with gonorrhoea
• Before starting any new relationship