Gonorrhea (drip): Symptoms, Treatment and Prevention

What is Gonorrhea?

Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is part of the 'Big Five' of venereal diseases, along with chlamydia, syphilis, hepatitis B and HIV. The bacterium Neisseria gonorrhoeae is the causative agent of gonorrhea. In the vernacular, gonorrhea is often referred to as 'drip'.

Gonorrhea can cause inflammation in the vagina, cervix, anus, urethra and throat.

How can I get infected with gonorrhea?

The chance of getting infected increases considerably if you have sex without using a condom. You can contract gonorrhea if you have these types of sex with an infected person:
• Vaginal sex
• Anal sex
• Oral sex (sucking or licking the other)

The chance of a woman becoming infected with gonorrhea after one sexual contact with an infected man is 50% to 90%. A man has a 20% chance of becoming infected through one sexual contact with an infected woman.

Although the chances are not that great, you can also get infected in the following ways:
• Lying naked on top of each other, with the genitals and/or the anus touching each other
• To kiss
• Using saliva from the mouth as a lubricant for vaginal or anal sex

A pregnant woman can also pass gonorrhea to her unborn baby.

It is not possible to get infected through manual sex (jerking off, fingering), a toilet seat or by using the same room (think of a swimming pool or sauna, for example).

What are the symptoms of gonorrhea?

Not everyone who is infected with gonorrhea develops symptoms. If complaints do occur, this will happen fairly quickly after your sexual contact (2 to 14 days). The complaints that men and women experience can differ. In general, women suffer less from complaints than men.

Symptoms in men:
• Fluid, pus or mucus draining from the penis (hence the term 'drip')
• Pain during urination
• Pain in the scrotum
• A sore throat
• Pain or itching in the anus
• Mucus or blood in the stool
• Diarrhoea
• To a lesser extent: joint pain, inflammation of the eye

Symptoms in women:
• Loss of fluid from the vagina, greenish yellow in color and with a strong odor
• Bleeding outside the menstrual period
• Bleeding during or after sex
• Pain during urination
• A sore throat
• Pain or itching in the anus
• Mucus or blood in the stool
• Stomach ache
• Diarrhoea
• To a lesser extent: joint pain, inflammation of the eye

Do you have one or more of these complaints after having sex? Then make an appointment with your GP or do a self-test. The complaints can also mean that you have another sexually transmitted disease with similar symptoms.

You can read more about it on the Soa Aids Nederland website gonorrhea symptoms.

Is gonorrhea common?

So not everyone gets complaints from gonorrhea. And not everyone who has symptoms can be tested. Therefore, it is not possible to give an exact number of how many people become infected with gonorrhea. We know that approximately 20,000 people in the Netherlands test positive for gonorrhea every year, so the actual numbers will be much higher.

Important to mention: there is currently a remarkable increase in the number of gonorrhea infections. There has been a slight increase since 2014, but this has recently increased considerably. In 2022 there was an increase of no less than 33% compared to 2021. This increase may be due to the fact that less attention is paid to the importance of safe sex these days.

Some people are at increased risk of gonorrhea:
• People who have unprotected sex with many changing contacts
• Men who have sex with men
• Migrants
• Transgender people who have sex with men
• Sex workers and their clients

If you have gonorrhea, you may be carrying another STD at the same time. Usually it is chlamydia. About 40% of the women and heterosexual men diagnosed with gonorrhea have concomitant chlamydia. In men who have sex with men, this percentage is approximately 25%.

The possibility that you have syphilis or an HIV infection in addition to gonorrhea is smaller. These combinations are most common in men who have sex with men. 4 to 5% of this group has syphilis in addition to gonorrhea. In addition to gonorrhea, 0.8 to 0.91 TP2T of men who have sex with men also have an HIV infection.

How can I test for gonorrhea?

If you suspect an STD based on your complaints, it is advisable to get tested. Even if a person you have had sex with has complaints or has tested positive for an STD.

Do you think it's a big step to get tested at the GP? Then you can join us order a home test. You do this test in your own familiar environment. Both ordering and requesting your test result can be done completely anonymously. We also have a test that focuses on all body areas, so that you do not have to order all kinds of separate tests. After all, gonorrhea can occur in the throat, genitals or anus. In addition, it is possible to immediately test for the combination of a chlamydia and gonorrhea infection.

It is important to test at the right time, because gonorrhea is a incubation time from 2 to 14 days. So it makes no sense to test immediately the day after sexual contact. The infection can be determined with sufficient certainty after 3 weeks, so the advice is to test from 3 weeks after unprotected sex.

Have the 3 weeks not yet passed, but do you experience complaints? Then you can test immediately. In that case, keep in mind that it is wise to test again after 3 weeks if that test gives a negative result.

How is gonorrhea treated?

If the test shows that you have gonorrhea, there are several possible treatments. At the GP or GGD you can be given medicines (antibiotics) through an injection in your buttock. The drug ceftriaxone is usually used for this. If you are pregnant, ceftriaxone is also safe.

If you cannot be treated with ceftriaxone (for example due to an allergy), taking pills is also possible. Ciprofloxacin or amoxicillin is often chosen, and very rarely azithromycin. You will then have to do another STD test a few weeks after taking the pill (see also 'Do I have to get tested again after the treatment?'). Discuss this with your doctor.

Make an appointment with your GP or at our STD consultation hour to obtain the necessary medication. The complaints often disappear within a few days after your treatment. After a week, the infection should be gone from your body.

What are the consequences if I don't get treatment?

Regardless of whether you have any complaints: always get gonorrhea treatment. After all, you can pass gonorrhea on to someone else, even if you don't have any symptoms yourself. After treatment with medication, you can rest assured that you will no longer be able to infect your sexual partners.

If you don't have gonorrhea treated, you can get annoying complaints. Even though it doesn't happen often, the consequences for your health can be serious.

Men can suffer from an epididymis infection or an inflammation of the prostate. Women are at risk of pelvic inflammatory disease, resulting in fertility problems. If you have had an abortion or an IUD in the past, you are at increased risk of complications. The gonorrhea infection can then 'take off' more easily in your uterus.

If you are pregnant, treating gonorrhea is strongly recommended. A gonorrhea infection can cause premature birth or an underweight child. You can also pass on gonorrhea to your newborn child. Your child can then get an eye or pneumonia.

Do I have to inform my (former) sex partners?

Let any sexual partners you have had in the past six months know that you have gonorrhea. These people can therefore be tested and treated. Your sex partners could infect even more people, spreading the infection further. You can also become infected again if your sexual partner does not undergo treatment.

It is also possible to inform your sex partners anonymously via www.partnerwaarschuwing.nl. Take for this Contact with us.

When can I have sex again after my treatment?

You can still infect others with gonorrhea within seven days of your treatment. So wait at least seven days before having sex, calculated from the day on which you received the injection or took your first pill. This also applies to sex with your mouth or hands. This gives your body a chance to recover from the infection.

Do you choose to have sex in the first week after your treatment? Then use a condom.

Do I have to get tested again after the treatment?

Usually you are rid of your complaints a week after the treatment. If your symptoms persist, make an appointment with your doctor. You may then need a different treatment. For example, there could be another STD.

Have you taken the antibiotics ciprofloxacin, amoxicillin or azithromycin? Three to six weeks after your treatment you will then have to do another STD test.

Have you been treated with ceftriaxone by injection? Then you only have to do another STD test if you are pregnant, four to six weeks after the treatment.

If you have had sex with a person infected with an STD after treatment, you will need to take another STD test.

How can I avoid getting gonorrhea (again)?

Unfortunately, you can become infected with gonorrhea more than once. Condom use during sexual contact will significantly reduce the risk of infection. In addition, it may be wise to test yourself and your bed partner(s) for gonorrhea before having sex with each other, so that you are sure that you will not infect each other with gonorrhea.