Gonorrhea symptoms

Although many people may be asymptomatic and not experience any signs of infection, those that do have gonorrhea symptoms typically experience pain or burning when urinating and/or discharge from the penis or vagina. Symptoms from gonorrhea usually appear 2 to 6 weeks after transmission. 

Studies show that 10-15% of infected penises  and about 80% of infected vaginas show no symptoms at all. Symptoms are uncommon in gonorrhea infections of the throat or bum (anus/rectum).

Gonorrhea penile infection

In persons with a penis, gonorrhea symptoms include:

• Burning or painful sensation when urinating
• Pus-like discharge from the penis

• The discharge may present as a drip, leak, or ooze
• The discharge is typically white, yellow, beige, or greenish
• The discharge may or may not have an odor

• Increased frequency and/or urgency of urination
• Swelling or redness at the opening (urethra) of the penis
• Pain or swelling in the testicles or scrotum

Burning/pain when urinating and discharge are usually the first symptoms to present after infection.

Penile infection complications

If left untreated, people with a penis may experience a scarring of the urethra and/or a painful condition known as epididymitis. The tube that transports sperm to the testicles becomes inflamed. A painful abscess may also develop in the interior of the penis.

Though these complications are rare, they can be painful, might require significant medical intervention, and cause reduced fertility and even sterility.

Gonorrhea vaginal infection

In persons with a vagina, symptoms can sometimes be mistaken for common vaginal yeast infections, bladder infections, or urinary tract infections (UTIs), making it essential to get testing done to determine the exact cause of symptoms. Gonorrhea symptoms can include:

• Discharge from the vagina (discharge may be watery, creamy, or greenish)
• Pain or burning sensation when urinating
• Increased urgency of urination
• Fever
• Sharp pain in the lower abdomen
• Heavier period or spotting
• Pain during vaginal intercourse

Vaginal infection complications

People with a vagina have a higher risk for developing long-term complications known as a pelvic inflammatory disease (PID) if gonorrhea is left untreated. This occurs when the bacteria travel up the reproductive tract to the uterus, ovaries, and/or fallopian tubes. Scarring and blocking of the fallopian tubes can occur, preventing future pregnancies or causing an ectopic pregnancy.

Pregnant parents with gonorrhea may also pass the bacteria on to their newborn in the birth canal during delivery. This can lead to blindness, joint infection, and/or blood infections of the infant. Newborns infected with gonorrhea typically start with eye infections.

Gonorrhea rectal infection

Individuals of any gender may experience rectal gonorrhea infections. Symptoms typically include:

• Pain or itching in or around the anus
• Anal discharge
• Soreness
• Bleeding
• Painful bowel movements
• Urgent feeling of needing to have a bowel movement
• Inflammation of the rectal tissue lining (proctitis)

Rectal gonorrhea infections are more common in men who have sex with men and individuals who have receptive anal sex. However, some people with vaginas may experience a rectal infection in the absence of anal sex. This is due to the close proximity of the anus and vagina.

Gonorrhea oral infection

Oral/throat infections are less common than genital and anal infections. Though most oral infections have no symptoms, those that do may experience:

• Sore throat
• Swollen lymph nodes
• Difficulty swallowing

Performing oral sex on someone with a gonorrhea infection can transmit the infection to your mouth and/or throat. Gonorrhea transmission is increased when performing fellatio (oral sex on a penis) compared to performing cunnilingus (oral sex on a vagina) or annalingus (oral sex on the anus).

Oral infection rates are higher in those with same-sex partners.

Gonorrhea eye infection

Infections of the eye caused by gonorrhea are sporadic and uncommon, but possible and very serious. This is known as gonococcal conjunctivitis. Symptoms include:

• Itchy eyes
• Red eyes
• Sensitivity to light
• Green, white, or yellow discharge that crusts over the eye 

Left untreated, gonorrhea infections of the eye can cause loss of vision and other significant complications. 

Disseminated gonococcal infection (DGI)

On rare occasions, gonorrhea can infect the bloodstream; this is  known as disseminated gonococcal infection (DGI).

DGI can infect any part of the body, though symptoms usually include:

• Arthritis, leading to joint pain (this is the most common manifestation of DGI. DGI can settle into the one or two joints causing disability unless treated)
• Heart valve damage
• Inflammation of the brain's lining or spinal cord
• Skin lesions or sores

These complications are uncommon but can be very serious if not treated. Treatment for DGI usually requires admission to hospital and involves a longer course of intravenous antibiotics to make sure that all of the bacteria is killed. 

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Sources:

• https://www.britannica.com/science/gonorrhea
• https://www.canada.ca/en/public-health/services/diseases/gonorrhea.html
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086760/