Recognising the symptoms of the clap

The clap is the common name for gonorrhoea, and that name refers to discharge from the urethra. That discharge is often yellow or greenish and sometimes goes together with burning urination. Yet the clap is not present in everyone: many infections run without symptoms. If you notice something, that is a reason to get checked, not proof in itself.

In short: seeing the clap is a signal, not seeing the clap means nothing. That is what this piece is about.

What exactly is the clap?

Clap is the informal name for gonorrhoea, an STI caused by the bacterium Neisseria gonorrhoeae. The name comes from the discharge that sometimes drips from the urethra. You pick it up through vaginal, oral and anal contact, and the bacterium can also settle in the throat and anus.

Important to know: a large share of infections cause no or barely any symptoms (Detels et al., Sex Transm Dis 2011, PMID 22256336). So the typical clap is more the exception than the rule, especially in women and in a throat infection.

How does the discharge of the clap look?

When there is discharge, it is often yellow to greenish and a bit thicker than usual. In men it usually comes from the urethra, sometimes with burning urination. In women the discharge can change in colour or amount, but it stands out less. The table below lists the features.

If you are unsure about your discharge, discharge: when does it point to an STI helps further. The differences between men and women are in gonorrhoea in men and women.

When do symptoms appear?

When symptoms come, it is usually within 1 to 2 weeks after a risk contact. But the symptoms can also appear later or stay away entirely. That is why you can only test reliably from about 1 to 2 weeks after contact, because before that there is sometimes too little material.

How that window period works exactly is in how long after unprotected sex you can test. If you have clear symptoms, you can always visit your GP or the GGD sooner.

The clap or something else?

Discharge and burning urination can also come from other things. Chlamydia causes similar symptoms and often occurs together with gonorrhoea. A bladder infection or irritation can also cause a burning feeling without any STI involved. Only a test can really tell the difference.

When burning urination does or does not point to an STI is in burning when urinating: an STI or something else. More about the bacterium itself is in the pillar gonorrhoea (the clap): recognising symptoms and testing.

Pay attention to where your symptoms are too. A burning feeling when urinating can come from the urethra, but a sore throat after oral sex or an uncomfortable feeling around the anus belongs just as much. Precisely because those sites often give no clear discharge, they are easily overlooked.

What do you do if in doubt?

If in doubt, the calmest step is a test. Gonorrhoea is detected with a sensitive NAAT on urine or a swab (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 keep it discreet, you can do a targeted gonorrhoea test. Because gonorrhoea and chlamydia often occur together, many people choose a combined test for chlamydia, gonorrhoea and trichomonas.

You cannot always recognise the clap by the discharge. So do not rely on what you see alone, and get checked if in doubt.

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.