Gonorrhoea

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Gonorrhoea (sometimes called ‘the clap’, ‘drip’ or ‘a dose’) is a bacterial sexually transmitted infection (STI). Gonorrhoea can infect the cervix, anus, throat, urethra, and eyes. It is transmitted through unprotected vaginal, anal or oral sex, open-mouth kissing, or through infected body fluids entering the eye. Gonorrhoea can be treated with antibiotics, though some strains are resistant to some antibiotics. Gonorrhoea will not go away without treatment. 

If left untreated, gonorrhoea can lead to pelvic inflammatory disease (PID) and infertility. It can also cause permanent damage to the eyes, joints, heart or brain.

Signs and Symptoms

Gonorrhoea is often asymptomatic, especially in people with vaginas. If symptoms do occur, it will usually happen within 2 to 7 days of exposure, but can take up to 2 weeks. 

Vagina/Vulva

Gonorrhoea can show no symptoms, particularly for people with vaginas. If signs or symptoms are present, there may be:

  • Green or yellow vaginal discharge
  • Unpleasant vaginal odour
  • Pain or burning sensation when urinating
  • Pelvic pain, especially during sex
  • Irregular bleeding, especially between periods or after sex

Penis

You can have gonorrhoea without showing any symptoms. If signs or symptoms are present, there may be:

  • Thick, yellow or white discharge from the penis
  • Pain, discomfort or burning sensation when passing urine
  • Pain in the testes (balls)
  • Redness around the urethra/opening of the penis

Anus/Rectum

Gonorrhoea can be asymptomatic. If signs or symptoms are present, there may be:

  • Anal itching
  • Feeling like having to poo, even when your bowels are empty
  • Anal discharge
  • Anal bleeding

Throat

Gonorrhoea often shows no symptoms at all, and gonorrhoea infection of the throat is very common. If signs or symptoms are present, there may be:

  • Sore, dry throat

Eyes

Gonorrhoea of the eyes can cause serious health issues and must be treated immediately. Symtoms can include:

  • Redness
  • Discharge, like conjunctivitis

Transmission

Gonorrhoea is mainly transmitted through vaginal, anal or oral sex, or through infected body fluid getting into the eyes. Gonorrhoea can be transmitted via: 

  • Unprotected/”natural” oral, vaginal or anal sex
  • There is some evidence to suggest that a high proportion (~80%) of gonorrhoea transmissions are from kissing. 
  • Mutual masturbation and fingering or fisting without gloves
  • Sharing sex toys without using condoms
  • Semen or vaginal fluids entering the eyes during sex, or touching your eyes when you have infected body fluid on your hands
  • Docking or nudging genitals without condoms
  • Parent to baby during birth

Gonorrhoea can be transmitted even when the person with gonorrhoea has no symptoms. You cannot get gonorrhoea from toilets, swimming pools, spas or everyday contact with people.

Prevention

As gonorrhoea is often asymptomatic, regular sexual health screening is highly recommended. You can view a list of sex worker-friendly sexual health clinics at our Where To Test page.

Additional ways to prevent gonorrhoea transmission include:

  • Use condoms for vaginal and anal sex.
  • Use condoms for oral sex/blow jobs. 
  • Avoid touching the genitals or eyes if your hands have come in contact with body fluids.
  • Change condoms between vaginal or anal sex and blow jobs to avoid spreading a potential infection to your throat.
  • Use condoms on toys if you are sharing them. Change condoms between partners or when moving them from one body part to another (for example, the vagina to the mouth). 
  • Point the penis away from the face during Spanish or hand relief to prevent semen from getting in the eyes.
  • There is increasing evidence that DFK (deep kissing) can also transmit gonorrhoea of the throat. Regular throat swabs are recommended if you provide this service.
  • A good way to tell if a client with a penis has gonorrhoea is to ‘milk’ the penis (before they shower or go to the toilet). Gently squeeze the penis along the shaft and if a thick discharge appears, it may be gonorrhoea. Find out how to perform a sexual health check on a client here.
  • Hold the base of the condom when withdrawing, so semen doesn’t spill out.

Important update on the ‘mouthwash study’ 

We have previously provided information on the first phase of the OMEGA study, which researched whether gargling with Listerine had any impact on oropharyngeal (throat) transmission of gonorrhoea. Kissing 

The final stage of the OMEGA study determined that is no conclusive evidence that gargling with mouthwash will prevent transmission of gonorrhoea to the throat. If further study is conducted on this topic that provides different findings, we will update this resource. 

Testing 

Because gonorrhoea may not show symptoms, testing is a good way to help detect it. Here’s some information about testing for gonorrhoea. You can view a list of sex worker-friendly sexual health clinics at our Where To Test page.

Testing Method

  • Urine test (all genitals)  
  • Swab (urethra) test if there is penile discharge
  • Swab (vagina and cervix) 
  • Swab (anus and throat) 
  • Some sexual health centres allow you the option of collecting some of your own swabs, and will provide instructions about how to do so.

When to Test

  • If you’re concerned about a potential exposure to gonorrhoea, it is recommended to test 1-2 weeks after exposure. An earlier test may not detect an infection. 
  • Test as part of your regular sexual health screening. If you provide uncovered/natural oral sex or kissing services, be sure to ask for a throat swab if one is not offered to you. 
  • Test if you have symptoms. 
  • Test if a sexual partner has tested positive for gonorrhoea. Your doctor may also recommend treatment at the time of testing due to having had sexual contact with someone with the infection. 

Other Info

  • Gonorrhoea will not go away by itself and it may cause severe complications if left untreated. 
  • Gonorrhoea is part of standard STI screening. You may have to ask the doctor or nurse to include anal or throat swabs. 
  • Sexual health clinic testing is often bulk billed, even if you don’t have Medicare, so the test will most likely be free. 
  • If you see a GP, you may pay a fee or be bulk billed. 

Treatment

Gonorrhoea is very treatable, and treatment is necessary – gonorrhoea doesn’t go away by itself. Here’s what you need to know about treating it.   

Treatment Method/s

  • Combination of a one-time antibiotic injection and single-dose oral antibiotic.
  • Some strains are becoming resistant to commonly used medications. Testing again two weeks after treatment, and again three months after treatment, will tell you whether your treatment has been successful. 

Costs and Other Information 

  • Inform a doctor if exposure to gonorrhoea occurred while overseas or from an overseas client, as many drug-resistant strains come from outside of Australia.
  • Treatment cost will depend on which antibiotic you are prescribed.
  • Sexual health clinic treatments are often bulk billed, even if you don’t have Medicare, so the treatment may be free. 
  • If you see a GP, you may pay a fee or be bulk billed.
  • Gonorrhoea is cured by effective treatment, but you do not develop immunity. It is possible to get gonorrhoea again.

How might this impact my work? 

Practical Considerations

  • Gonorrhoea is one of the most prevalent STI for sex workers, and because it’s not always detectable 
  • It is recommended that you do not have sex for 7 days after treatment
  • If you can’t avoid having sex, then using a condom will help lower the chance of transmitting gonorrhoea, but there is no guarantee.
  • Some antibiotics can reduce the effectiveness of oral contraception (‘the pill’). 
  • If you often get thrush when you take antibiotics, you may want to take probiotics during and after your treatment to help prevent this.
  • You should inform any recent doubles partners if you test positive for gonorrhoea.

Legal and Reporting Considerations

  • Some states and territories may have laws that criminalise sex working or having sexual contact while you have a BBV or STI. Check out our BBV, STI and the Law resource or contact your local sex worker peer organisation for more information. 
  • Contact tracing of previous sexual partners (also known as ‘partner notification’) is a consideration for some BBV and STI. It should be done with consideration of the unique transmission risk and privacy needs of sex workers. Your local sex worker peer organisation can advise on any partner notification process to ensure that it is appropriate for your circumstances. 
  • Gonorrhoea is a nationally notifiable disease in Australia, which means that diagnosed cases of gonorrhoea are anonymously reported to state or territory health departments.

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