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Gonorrhoea is among the commonest reasons men come to a urology clinic worried. The typical presentation is a thick, pus-like discharge from the urethra with burning on passing urine, usually within a week or two of exposure. It is caused by the bacterium Neisseria gonorrhoeae, and it is curable — but three things about it are frequently got wrong, and each of them matters.

How it presents

ใน men, urethral infection usually announces itself — discharge and burning within days of exposure. Not always, though: a proportion of urethral infections cause little or nothing, and the older figure of over 90% symptomatic overstates how reliably it declares itself.

ใน women, more than half never develop symptoms, and when they do — discharge, burning, pelvic pain — they are easily attributed to something else. This asymmetry is why gonorrhoea spreads so effectively, and why a man diagnosed with it must tell his partner regardless of whether she feels unwell.

The sites a urine test does not check

This was missing from the earlier version and is the most practically useful thing on the page.

Gonorrhoea also infects the throat and the rectum, and at those sites it is usually completely silent. A urine sample tests the urethra and nothing else. Someone who has had oral or receptive anal sex and receives a negative urine result has been reassured about one site out of three — and can go on transmitting from an untreated one, or be re-infected from it.

The remedy is simple: say what kind of exposure you have had, so that throat and rectal swabs are taken where relevant. It is an awkward conversation that takes ten seconds and changes what gets tested.

Testing is not optional

An earlier version of this article said that gonorrhoea is primarily a clinical diagnosis and that confirmatory testing is optional in many cases. That no longer reflects good practice and has been corrected.

Discharge and burning are not specific to gonorrhoea — chlamydia, ไมโคพลาสมา องคชาต and trichomonas produce the same picture and are treated differently. Beyond getting the treatment right, testing matters for three further reasons: it makes partner notification possible on solid ground rather than suspicion; it allows a culture to be taken where treatment fails, which is how resistance is detected; and it prompts testing for the infections that travel alongside it, including HIV and syphilis.

ดิ nucleic acid amplification test is highly accurate on a first-catch urine sample, and the same technology is used on throat and rectal swabs. See also the treatment guideline in more detail และ ซิฟิลิส.

Treatment, and why it has changed

The mainstay is a single intramuscular antibiotic injection. An oral antibiotic is added when chlamydia has not been excluded — which is a change from the older approach of giving both to everyone as a matter of routine, and the earlier version of this article described that older approach. Where testing has shown chlamydia is not present, the second drug is not needed.

Partners must be treated at the same time, whether or not they have symptoms, or the infection simply travels back and forth. This is not optional and it is the step most often skipped.

The resistance problem

Also absent from the earlier version, and the reason none of the above should be done casually.

Neisseria gonorrhoeae has developed resistance to every class of antibiotic used against it in turn, and the World Health Organization lists it among the organisms of greatest concern. The current injection works; the margin is narrower than it was. Three consequences follow for anyone being treated:

• Take the treatment given, in full, rather than a leftover antibiotic from a friend or a pharmacy purchase — partial treatment is exactly how resistant strains are selected.
• Go back if symptoms persist after treatment, rather than assuming it needs longer. Persistent symptoms need a culture, which is what identifies a resistant strain.
• Throat infection is harder to clear than urethral infection, and is one situation where a repeat test after treatment is appropriate.

After treatment

• Abstain from sex for at least a week after treatment, and until partners have been treated too.
• Get tested for HIV and syphilis at the same time, and remember that some of these need repeating after a window period.
• Consider a repeat test around three months later. Reinfection is common — commoner than treatment failure — and it is usually silent in the partner who passed it back.
• Use condoms with new or casual partners. Gonorrhoea and HIV travel in the same populations and gonorrhoea inflammation makes HIV easier to acquire, which is the real reason the two are linked rather than any single statistic.

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ในกรณีฉุกเฉินในประเทศไทย โทร 1669.

• Testicular pain and swelling — the infection has reached the epididymis. Sudden severe testicular pain is an emergency in its own right and is treated as torsion until proved otherwise.
• Fever with painful, swollen joints or a rash — uncommon, but it means the infection has entered the bloodstream and needs hospital treatment.
• A red, painful, discharging eye after any genital infection — this can threaten sight and is urgent.
• Severe lower abdominal or pelvic pain in a female partner, with or without fever.
• การไม่สามารถถ่ายปัสสาวะได้.

Frequently Asked Questions About Gonorrhoea

What are the symptoms in men?

Typically a thick pus-like discharge from the urethra with burning on passing urine, within days of exposure. Testicular pain or swelling suggests the infection has spread and needs prompt assessment. A proportion of urethral infections cause few or no symptoms, so absence of discharge does not exclude it.

Can women have gonorrhoea without symptoms?

Yes — more than half never develop noticeable symptoms, and when they do, they are easily mistaken for something else. This is why a man diagnosed with gonorrhoea must tell his partner regardless of how she feels, and why she needs treating rather than testing alone.

My urine test was negative. Am I clear?

For the urethra, yes. A urine sample does not test the throat or the rectum, where gonorrhoea is usually silent. If you have had oral or receptive anal sex, those sites need their own swabs — tell whoever is testing you what kind of exposure you have had.

Do I really need a test, or can it be treated on symptoms?

Test. Chlamydia, ไมโคพลาสมา องคชาต and trichomonas cause the same symptoms and are treated differently. Testing also underpins partner notification, allows a culture if treatment fails — which is how resistance is found — and prompts screening for HIV and syphilis. An earlier version of this article described confirmatory testing as optional, which has been corrected.

How is it treated?

A single intramuscular antibiotic injection is the mainstay, with an oral antibiotic added when chlamydia has not been excluded — rather than routinely giving both, which was the older approach. Partners are treated at the same time whether or not they have symptoms.

My symptoms have not settled after treatment. What now?

Go back rather than waiting or taking more antibiotics on your own. Persistent symptoms need a culture, which is how a resistant strain is identified — and they may equally represent reinfection from an untreated partner, which is commoner than treatment failure.

What happens if it is left untreated?

In men, epididymitis and, rarely, urethral scarring. In women, pelvic inflammatory disease, chronic pelvic pain, infertility and ectopic pregnancy. Rarely the infection enters the bloodstream, causing fever, joint pain and rash. Untreated gonorrhoea also makes HIV easier to acquire and to transmit.

การนัดหมายเพื่อปรึกษา

Dr. Soarawee Weerasopone sees patients confidentially at โรงพยาบาลกรุงเทพ สำนักงานใหญ่ และที่โรงพยาบาล สมิติเวช ศรีราชา ในจังหวัดชลบุรี เมื่อวันที่ 088-022-1445. Bring any test results you already have, and be ready to say what kind of exposure occurred and when — it determines which samples are taken.

โรงพยาบาลกรุงเทพฯ มีบริการแพทย์ทางไกลสำหรับผู้ป่วยที่ไม่สามารถมาพบแพทย์ด้วยตนเอง รวมถึงผู้ป่วยต่างชาติ กรุณาแจ้งล่วงหน้าทางอีเมลไปยังแผนกศัลยกรรมทางเดินปัสสาวะที่ bhquro@bdms.co.th. Samitivej Sriracha ให้บริการเฉพาะการพบแพทย์ด้วยตนเองเท่านั้น สอบถามเรื่องค่าใช้จ่ายได้ที่โรงพยาบาลโดยตรง ไม่ใช่ผ่านทางเว็บไซต์นี้.

ข้อจำกัดความรับผิดชอบ เนื้อหานี้ถูกเขียนและตรวจสอบโดย นพ. สรวีร์ วีระโสภณ ซึ่งเป็นแพทย์ผู้เชี่ยวชาญที่ได้รับการรับรองจากคณะกรรมการที่ โรงพยาบาลกรุงเทพ สำนักงานใหญ่ และมีวัตถุประสงค์เพื่อการศึกษาเท่านั้น เนื้อหานี้ไม่ใช่คำแนะนำทางการแพทย์ การวินิจฉัย หรือใบสั่งยาสำหรับบุคคลใดทั้งสิ้น และไม่มีการให้คำแนะนำ การวินิจฉัย หรือใบสั่งยาผ่านช่องทางส่งข้อความส่วนตัวหรือสื่อสังคมออนไลน์ นพ. สรวีร์ ไม่มีบัญชีสื่อสังคมออนไลน์สาธารณะใดทั้งสิ้น; บัญชีใดที่เสนอการปรึกษาส่วนตัวในชื่อของเขาเป็นการหลอกลวง ในกรณีฉุกเฉินในประเทศไทย ให้โทร 1669.