Gonorrhoea in men and women

Gonorrhoea causes noticeable symptoms more often in men than in women. In men, discharge from the penis and burning urination are fairly typical, while women often notice nothing or only vague signals. Yet that difference is no reliable gauge: only a test tells you for sure. And the clap can sit in the throat or anus in anyone.

I hear it often: he felt something, she did not, so she must be fine. Sadly it does not work that way.

Why do symptoms differ between men and women?

The difference is mostly about anatomy and the site of infection. In men gonorrhoea often sits in the urethra, where discharge and burning urination stand out sooner. In women it usually starts on the cervix, where an infection more easily goes unnoticed. So it seems men are infected more often, while the difference is really about visibility.

A study in five countries showed that a large share of gonorrhoea and chlamydia infections run without symptoms, in both sexes (Detels et al., Sex Transm Dis 2011, PMID 22256336). No symptoms does not mean no infection.

Gonorrhoea symptoms in men

In men gonorrhoea more often gives a clear signal, usually within 1 to 2 weeks. A burning or painful feeling when urinating is common, as is yellow or greenish fluid from the urethra, the classic clap. Still, even in men plenty of people have no symptoms.

• Burning urination, a painful feeling while peeing.
• Discharge, yellow or greenish fluid from the urethra.
• Pain or swelling, sometimes an uncomfortable feeling in the scrotum.

Burning urination can just as easily point to something else, like irritation or a bladder infection. When it does or does not point to an STI is explained in burning when urinating: an STI or something else. More men-specific advice is in STI test for men.

Gonorrhoea symptoms in women

In women symptoms stay away more often, and when there are signals, they are usually vague. Changed or increased discharge can occur, as can a burning feeling when urinating. Sometimes there is bleeding between periods or pain low in the belly. Because many women notice nothing, an infection sometimes goes unnoticed for longer.

• Discharge, more or differently coloured vaginal discharge.
• Bleeding, between periods or after sex.
• Belly pain, sometimes a nagging feeling low in the abdomen.

If you are unsure about your discharge, discharge: when does it point to an STI helps. Women-specific explanation is in STI test for women.

Where does gonorrhoea sit, and which test fits?

Which site you test depends on the contact you had. A urine test looks at the urethra but misses a throat or anal infection. For those sites a swab is usually needed. The table below is a guide, not a prescription.

The standard method for detecting gonorrhoea is a sensitive NAAT (Papp et al., MMWR Recomm Rep 2014, PMID 24622331). Faster point-of-care tests are also being studied, though their reliability still varies (Herbst de Cortina et al., Infect Dis Obstet Gynecol 2016, PMID 27313440). If you want to get checked, you can choose a targeted gonorrhoea test or a combined test for chlamydia, gonorrhoea and trichomonas.

Why testing without symptoms is wise

Precisely because women and people with a throat or anal infection often notice nothing, testing is the only way to get certainty. Without symptoms you can still infect a partner. So it is best to decouple a short check from symptoms.

To understand the clap more broadly, read the pillar gonorrhoea (the clap): recognising symptoms and testing. If you are unsure about the discharge itself, recognising the symptoms of the clap helps.

A practical point for couples: if one of you gets checked, it often makes sense to do it together. Gonorrhoea can bounce back and forth between partners, even if one of you has no symptoms. That way you avoid a treated infection coming back through the other person.

The difference between men and women is real, but it says little about your situation. A test at the right site gives clarity, for both.

Sources

• RIVM, Gonorrhoea (rivm.nl).
• Thuisarts.nl, STI (thuisarts.nl).
• Detels R et al. The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries. Sex Transm Dis. 2011 (PMID 22256336).
• Papp JR et al. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae 2014. MMWR Recomm Rep. 2014 (PMID 24622331).
• Herbst de Cortina S et al. A systematic review of point of care testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Infect Dis Obstet Gynecol. 2016 (PMID 27313440).

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP. This article is meant as explanation, not as medical advice.