Gonorrhea ("the clap")

The symptoms of gonorrhea (“the clap”) can differ considerably depending on your physiological sex and how you were infected.

• If the bacteria get into the urethra (urine tube) in the penis during sex, the infection typically leads to a pus-like or watery discharge from the penis. Sometimes only a little pus will come out during the first morning pee. Peeing may be painful or sting. The infection can spread to the head of the penis and foreskin.
• If the vagina is infected during vaginal sex, the bacteria usually grow in the lining of the cervix (the opening between the vagina and the womb). This leads to a watery, slimy discharge, which may have blood or pus in it and smell unpleasant. If the urethra is affected, it may hurt or sting when you pee.
• If the bacteria are passed on during anal sex, the lining of the rectum (the end part of the bowel) may become infected. This can lead to anal discharge, itching or pain.
• If the bacteria get into the throat during oral sex, they infect the mucous membrane there. This often doesn’t cause any symptoms, but it sometimes results in a sore throat and trouble swallowing.

Many people only have mild symptoms, or none at all. Then they don’t even know they have gonorrhea. But some have symptoms in several areas of their body at the same time. This can happen if they have (different types of) sex in different positions.

In rare cases, gonorrhea affects the eyes. Known as gonococcal conjunctivitis, this mainly happens when a mother passes the bacteria on to her baby during birth. Membranes in the newborn child’s eye become infected, causing their eyelids to stick together and possibly damage to the cornea too.

Gonorrhea (“the clap”) is caused by bacteria called gonococcus bacteria. They only infect humans – mainly the linings of the urethra, cervix, rectum and throat. They can be passed on to other people through direct contact between these linings during sex.

The bacteria do not survive very long outside of the body. So it’s unlikely that someone would get infected by sharing towels or by sitting on surfaces in swimming pools, for instance. But the infection can be passed on by sharing sex toys. Sometimes the bacteria spread from one part of a person's body to another part of their own body – for example, if a woman's vaginal discharge gets into her anus, or if someone accidentally wipes infectious fluid into their eyes.

In rare cases, gonococcus bacteria are passed from the mother’s genitals to the baby during childbirth. Then the bacteria usually infect membranes in the baby’s eyes.

Anyone can catch gonorrhea if they have sex with an infected person. The risk is greater if you

• frequently have sex with various different partners,
• don’t use condoms or
• have sex under the influence of drugs and forget to protect yourself (using a condom, for example).

The risk can also be higher in women who have an imbalanced vaginal flora (mix of good and bad germs).

Some people have a higher risk of complications, too – especially women who

• become infected during their period,
• use an IUD or
• become infected just before or after giving birth or having a miscarriage.

Gonorrhea is one of the most common sexually transmitted infections (STIs). It is estimated that roughly 87 million people around the world get it every year. Experts assume that the numbers will continue to increase – including in countries like Germany – because more people are becoming infected and more infections are being diagnosed.

Most infections occur in people between the ages of 15 and 25. Quite a lot of men catch it later, though (roughly up to their mid-40s). The infection rate is higher in men who have sex with men.

Symptoms can occur soon after the infection happens – sometimes even the very next day. But it can also take anything between several days to two weeks for them to become noticeable.

Sometimes there are no symptoms at all and the infection goes unnoticed. But then you can still pass the bacteria on to other people.

If you don't realize you’re infected and don’t get treatment, the bacteria can stay in your body and cause a chronic infection. This can result in complications, which can also go unnoticed for some time. Women may become infertile, for instance.

Problems like joint pain or lower belly pain can develop some time after the initial infection too.

People who have been treated successfully for gonorrhea can get it again. Getting over an infection does not provide immunity.

A lot of people (especially those who don't have any symptoms) don’t realize that gonorrhea can cause complications.

One potential complication is known as an “ascending infection.” Here the bacteria spread from the area that was first infected and then move up (ascend) the genital tract.

If the bacteria first entered the penis, they can spread and infect the prostate gland, seminal vesicles, sperm duct and epididymis. If the infection started in the cervix, the bacteria may go on to infect the lining of the womb (endometrium), fallopian tubes and ovaries. Sometimes, the infection spreads throughout a woman’s pelvic area.

Women’s sex organs can be particularly affected by these infections. Related bleeding and scarring may prevent the woman from having children or cause an ectopic pregnancy (where the egg gets stuck in one of the fallopian tubes).

In rare cases, the bacteria get into the eyes and infect the cornea (the clear outer layer at the front of the eye). This is known as keratitis. If it isn’t treated, the person may go blind. The gonococcus bacteria may also spread throughout the whole body, infecting joints, bones, the heart or membranes in the brain (meningitis) – or even causing life-threatening blood poisoning (sepsis).

The typical symptoms of gonorrhea (like discharge from the urethra, anal itching and pain, or a sore throat) could also be caused by other things. If you think you might have gonorrhea, a test will be able to find out for sure.

People who have a higher risk of catching STIs are advised to get themselves tested regularly. That way, symptomless gonorrhea infections won’t go unnoticed either.

The test involves taking samples: A cotton swab or small brush is used to take mucous membrane cells from parts of the body that gonococcus bacteria tend to infect – like the urethra (urine tube), cervix (the opening between the vagina and womb), throat and anus. In men, gonorrhea in the urethra can also be detected using a urine test.

Gonorrhea tests can be done at family doctors’ or specialist practices (dermatologists, for example). They are also offered by local health departments, sexual health clinics, various laboratories and – in Germany – "checkpoints" of the German AIDS Service organization (Deutsche Aidshilfe). Sometimes the tests can be done anonymously. It is also possible to get advice over the phone and have a test kit sent to your home. Then you take the samples yourself, send them to a lab for analysis, and get the result by text message or phone.

Condoms and femidoms (condoms for women) can stop the spread of gonococcus bacteria during sex. If you develop typical gonorrhea symptoms, it makes sense to get a test done soon. An early diagnosis means you can get treatment early too. That stops the bacteria being passed on to others and prevents complications.

If you have a high risk of catching gonorrhea (for example, because you have unprotected sex with different partners), it’s best to get tested regularly. Tests can be a good idea for pregnant women too. They can prevent the baby being infected during birth and also help to prevent miscarriage.

Treatment for gonorrhea is usually successful. A single-dose antibiotic drip or injection, as well as a second antibiotic (taken as a tablet), is normally enough. Depending on what your doctor says, you might not need to take the tablet. Antibiotics are also used to treat any complications that occur.

If the treatment doesn’t work, it might be because the gonococcus bacteria are resistant (don’t respond) to standard antibiotics. But gonorrhea cases in Germany can usually be treated effectively. Doctors can do a test to see which other antibiotics can be used to get rid of the bacteria.

Please note that the services mentioned below are specifically for people living in Germany. Similar services are available in other countries.

Germany’s Federal Centre for Health Education (BZgA) runs a website (www.liebesleben.de) that provides information about STIs like gonorrhea and practical advice on how to prevent them. An English version of the website is available too. You can also get advice from the BZgA online or over the phone.

The Deutsche Aidshilfe organization has information as well as telephone and online counseling services.

It also has an online search tool to help people find their nearest test center for gonorrhea or other STIs.