To screen for and diagnose a gonorrhea infection
- For women, yearly testing is recommended if you are sexually active and younger than age 25, or 25 or older and at increased risk for gonorrhea; if you fall into one of these groups and are pregnant or considering pregnancy.
- For men, yearly testing is recommended if you are a man who has sex with men.
- When you have symptoms of gonorrhea, such as pain while urinating, vaginal discharge or vaginal bleeding between menstrual periods (for women), or unusual discharge from the penis, pain while urinating or painful, swollen testicles (for men)
- When your newborn has conjunctivitis
For women, vaginal swabs may be used to collect a sample for genital gonorrhea testing. A healthcare practitioner may use a swab or small brush to collect a sample of cells or fluid from the vagina during a pelvic examination. Sometimes, you may collect your own vaginal sample for testing (self-collection).
For men, a healthcare practitioner may use a swab to collect a sample from your urethra, the tube within your penis that allows urine to flow from your bladder.
Urine samples can be used to test both men and women. As you begin to urinate, collect the initial portion of your urine stream (first-catch) in a container provided by the healthcare practitioner or laboratory.
Sometimes, a healthcare practitioner may use a swab or brush to collect a sample from other areas that may be infected, such as the rectum, throat or eye.
Tell the healthcare practitioner about any use of antibiotics or, if you are a woman, douches or vaginal creams. You may be asked to avoid using these within 24 hours before testing vaginal samples since they may affect test results. Menstruation will not affect results. You may be instructed to wait one to two hours after you last urinated before collecting the urine sample. Follow any instructions you are given.
Gonorrhea is a common bacterial sexually transmitted disease (STD) that can cause serious complications if not diagnosed and treated. Gonorrhea testing identifies if the bacteria Neisseria gonorrhoeae is the cause of your infection.
The recommended method for gonorrhea testing is the nucleic acid amplification test (NAAT) that detects the genetic material (DNA) of Neisseria gonorrhoeae. It is generally more sensitive and specific than other gonorrhea tests and can be performed on a vaginal swab on women or urine from both men and women, which eliminates the need for a pelvic exam in women.
Besides NAAT, another test to detect gonorrhea is a gonorrhea culture, which grows the bacteria. In men, a quick method that may be used in a clinic or healthcare provider's office is the gram stain, which allows the healthcare practitioner to look at a sample from your urethra for the presence of the bacteria using a microscope. While this method can diagnose gonorrhea, it is not sufficient to rule out an infection in asymptomatic men. This method is not reliable for samples from women since other bacteria normally found in your genital tract will look the same under the microscope.
Screening for, diagnosing, and treating gonorrhea is very important in preventing long-term complications and spread of the infection to others. The Centers for Disease Control and Prevention (CDC) estimates that about 1.14 million people in the U.S. get new gonorrheal infections each year. In the U.S., the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans.
Gonorrhea is generally spread through sexual contact (oral, vaginal, or anal) with an infected partner. Risk factors include having multiple sex partners, infection with another STD at the same time or previous STD infection, and not using a condom correctly and consistently.
While some men with gonorrhea will notice symptoms, many women do not. Women may mistake gonorrhea symptoms for a bladder infection or other vaginal infection. For men, symptoms usually appear within 2 to 5 days after infection but can take up to 30 days. Women who experience symptoms usually do so within 10 days of infection. Signs and symptoms of gonorrhea are similar to and can be confused with those caused by another STD, chlamydia, so tests for these infections are often done at the same time.
Gonorrhea can usually be treated with a course of antibiotics. If not diagnosed and treated, gonorrhea can cause serious complications.
In women, untreated gonorrhea infections may lead to pelvic inflammatory disease (PID), which can develop from several days to several months after infection and cause complications such as:
- Long-term (chronic) pelvic pain
- An increased risk of tubal (ectopic) pregnancy, which can be fatal
If you are infected while pregnant, you have an increased risk of miscarriage, premature rupture of the membranes, and your baby may be born early (premature) or with a low birth weight. You may pass the infection to your baby during childbirth. Untreated infants can develop eye infections.
In men, untreated gonorrhea can cause complications such as:
- Inflammation of your prostate gland
- Scarring of your urethra, possible narrowing or closing of the urethra
Untreated gonorrhea may also spread to your blood (septicemia) or joints, progressing to a serious condition called disseminated gonococcal infection (DGI). DGI symptoms include fever, multiple skin lesions, painful swelling of joints (gonococcal arthritis), infection of the inner lining of the heart, and inflammation of the membrane covering the brain and spinal cord (meningitis). Symptoms of DGI in infants born to infected mothers include those associated with arthritis, meningitis and sepsis, a severe, life-threatening condition.
DGI can be successfully treated using antibiotics similar to those used for treating uncomplicated gonorrhea. However, antibiotic-resistant gonorrhea is a growing threat. (Read Antibiotic Resistance in Bacteria.)
CDC guidelines currently recommend therapy with two antibiotics to treat all uncomplicated gonococcal infections among adults and adolescents in the United States. If your symptoms do not resolve after treatment, a healthcare practitioner may need to order a repeat gonorrhea test to determine whether antibiotic treatment cured your infection. If it did not, the practitioner may order susceptibility testing to help determine the likelihood that a different antibiotic(s) will cure your infection.
Currently, there is no reliable technology that can determine antibiotic susceptibility without first culturing Neisseria gonorrhoeae. However, the widespread use of the more sensitive nucleic acid amplification test (NAAT) for gonorrhea has replaced routine culture in most laboratories. Culture and susceptibility testing are only performed in large reference laboratories or public health laboratories that are monitoring antimicrobial resistance.
How is the test used?
A definitive diagnosis is important because signs and symptoms of gonorrhea can resemble chlamydia and the two infections require different antibiotic treatment. Since the disorders have similar symptoms, healthcare practitioners often test for Neisseria gonorrhoeae and Chlamydia trachomatis, the bacteria that causes chlamydia, at the same time.
Repeat testing is recommended to ensure that treatment has been effective. This is done about three months after you have completed treatment.
When is it ordered?
Because many infected people do not have any noticeable symptoms, a number of health organizations recommend regular gonorrhea screening for certain people.
All sexually active women younger than age 25 and sexually active women age 25 and older who are at increased risk should get yearly screening for gonorrhea, according to the U.S. Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG). The U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) also recommend routine screening for these women (the USPSTF says age 24 and younger).
Examples of risk factors for gonorrhea infection include:
- Previous gonorrhea infections, even if you were treated
- Having other STDs, especially HIV
- Having new or multiple sex partners
- Having a sex partner diagnosed with an STD
- Using condoms inconsistently
- Exchanging sex for money or drugs
- Using illegal drugs
- Living in a detention facility
For pregnant women, the CDC recommends screening women less than 25 years old and older women at risk for gonorrhea during the first trimester or first prenatal visit. Those who remain at risk should be retested during the third trimester. Those women diagnosed with gonorrhea should be treated and then retested within 3 months. (See Pregnancy for more information.)
The CDC recommends that men who have sex with men have gonorrhea screening at least annually. Health organizations do not recommend routine screening for sexually active, heterosexual males. Healthcare practitioners may recommend screening to you when there is a high number of cases (prevalence) of STDs in your community.
For women, if symptoms occur, they may include:
- Bleeding between your menstrual periods and after sexual intercourse
- Abdominal pain
- Painful during sex
- Pain while urinating and/or urinating more often
- Abnormal vaginal discharge
Men may have no noticeable symptoms. If they do, they may include:
- A white, yellow or greenish discharge from your penis
- Pain or burning when urinating
- Pain, tenderness, and swelling of your testicles
Both men and women can get an infection in their rectum and may be tested when they have symptoms such as itching, inflammation, pain, discharge, and/or bleeding from the rectum.
Testing for both chlamydia and gonorrhea may be done when your newborn has symptoms of conjunctivitis, such as redness and swelling of the eye, and discharge.
Women or men treated for gonorrhea should be retested three months after their treatment.
What does the test result mean?
A positive test indicates you have an active gonorrhea infection that requires treatment with antibiotics.
A negative test means only that there is no evidence of infection at the time of the test. If you are at an increased risk of infection, it is important that you have screening tests performed on a yearly basis to check for possible infection.
If you are infected, your sexual partner(s) should be tested and treated as well.
How long does it take to get results?
It depends on the lab performing the test and the method used to diagnose your infection. Nucleic acid amplification (NAAT) methods can give results in one day to a few days. Cultures take longer and results are typically reported in three to five days. For males, gram stains can be done rapidly during your clinic or office visit, but results are not as reliable as NAAT.
Where can I get tested?
How can gonorrhea be prevented?
The most reliable ways to avoid infection with gonorrhea or any sexually transmitted disease are to abstain from oral, vaginal, and anal sex or to be in a long-term, mutually monogamous relationship with an uninfected partner. People who are sexually active should correctly and consistently use condoms to reduce the risk of infection with gonorrhea and other STDs.
How is gonorrhea treated?
The U.S. Centers for Disease Control and Prevention (CDC) currently recommends that an infected person be prescribed two antibiotics. These two drugs are taken at the same time to lower the chance that your gonorrhea infection will be resistant to treatment. If your symptoms continue, then your healthcare practitioner may need to perform additional "tests for cure" and susceptibility testing to guide further treatment. You should refrain from having sex until treatment has been completed and should be re-tested three months after treatment.
If I get treated, can I get gonorrhea again?
Should I tell my partner that I have gonorrhea?
Does having gonorrhea put me at greater risk for other STDs?
Is there anything else I should know?