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Primary gonorrhea infection in Adult
See also in: Anogenital
Other Resources UpToDate PubMed

Primary gonorrhea infection in Adult

See also in: Anogenital
Contributors: Saami Khalifian MD, Susan Burgin MD, Paritosh Prasad MD
Other Resources UpToDate PubMed


Gonorrhea is a common sexually transmitted infection (STI) caused by the gram-negative intracellular diplococcus Neisseria gonorrhoeae. It is highly contagious and primarily spread through sexual contact, although it can also be passed to the fetus from a pregnant patient during childbirth or via indirect contact through sharing of contaminated objects. There appears to be a higher rate of gonorrheal infection in women than men, although the overall incidence is likely underreported.

The incubation period of N gonorrhoeae is short. The average time from infection to symptom onset is approximately 2-7 days. Risk factors for acquiring N gonorrhoeae include having a new sex partner, more than one sex partner (or a sex partner with concurrent partners), and a history of STIs (or a sex partner with a history of STIs). Other risk factors include inconsistent condom use (if not in a mutually monogamous relationship), young age, and substance abuse. Some subgroups of men who have sex with men (MSM) are at higher risk as well.

The endocervical canal is the most common site of infection in women. Symptoms typically include dysuria, vaginal discharge, bleeding, and menstrual pain. Pelvic inflammatory disease (PID) occurs in 20% of patients as a result of ascending endocervical infection. Clinical features of PID include lower abdominal and adnexal pain, fever, and leukocytosis. Rarely, PID can cause further peritoneal and hepatic inflammation, leading to right upper quadrant pain and gonorrheic perihepatitis (Fitz-Hugh-Curtis syndrome). Chronic untreated PID may lead to tubal scarring with resultant infertility or ectopic pregnancy.

In men, anterior urethritis is the most common presentation, with purulent urethral discharge and dysuria. Complications include epididymitis, vesiculitis, and prostatitis, which occur via local extension.

Proctitis and pharyngitis occurs in both sexes via direct mucosal infection, but the former is more prevalent in MSM. Notably, in men, clinical symptoms may disappear in approximately 6-8 months without treatment, which increases the risk for complications.

Systemic symptoms including fever, arthritis, tenosynovitis of large joints, and cutaneous pustules can occur from hematogenous dissemination. This occurs in less than 1% of patients. Risk factors for dissemination include menstruation and complement deficiency.

Related topics: disseminated gonorrhea, gonococcal cervicitis, gonococcal conjunctivitis


A54.9 – Gonococcal infection, unspecified

15628003 – Gonorrhea

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Last Reviewed:09/12/2021
Last Updated:09/19/2021
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Patient Information for Primary gonorrhea infection in Adult
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Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhea. It is a contagious infection spread by unprotected oral, vaginal, or anal sex with an infected partner. The bacterium can live in the mouth, semen or vaginal fluids of infected persons. It is possible to be infected without symptoms and continue to spread the infection.

If the infection is not treated, it can spread to other parts of the body, including the throat, joints, and eyes (potentially leading to blindness). Complications from gonorrhea infection include pelvic inflammatory disease (PID), which can affect fertility in women; inflammation of the testicles (epididymitis), which can lead to infertility in men; blindness in an infant infected during delivery; and widespread infection with a fever, rash, and joint pain.

Who’s At Risk

Anyone who is sexually active is at risk for gonorrhea as well as other sexually transmitted infections. Teens and young adults are at the highest risk for contracting gonorrhea; in the US, 75% of cases occur in those under 30 years old. Since there is no immunity developed in infection with gonorrhea, the infection can be acquired again if there is sexual contact with an infected person.

Signs & Symptoms

There may be no symptoms associated with gonorrhea, particularly in women.

Infection often starts with only mild symptoms of discomfort with urination. Later there may be frequent and painful urination or defecation; a thick, cloudy, or bloody discharge from the penis, vagina, or rectum; or pain with sexual intercourse. Throat infection may present a sore throat only.

Occasionally, the infection can spread throughout the body and presents with symptoms of fever, chills, swollen or painful joints, and small bumps that may be red or purple on the hands or feet. This is referred to as the arthritis-dermatitis syndrome.

Self-Care Guidelines

Gonorrhea is highly contagious and can have many serious side effects if left untreated. If you are sexually active and suspect you have been exposed to gonorrhea, you should seek medical care immediately. You should avoid any further sexual activity and notify any previous sexual partners.

Gonorrhea can be prevented by abstaining from casual sexual activity and using condoms correctly during any sexual contact. If you are in a long-term relationship, make sure that you know your partner's sexual history or ask that your partner is tested prior to engaging in sexual activity.

When to Seek Medical Care

  • There is a discharge from the vagina, penis, or rectum.
  • There is burning or pain during urination or defecation.
  • You are concerned or know that a sexual partner has similar symptoms or has been diagnosed with gonorrhea.


A sample of bodily fluid will be taken for cultures in a lab. Tests may also be done for other sexually transmitted infections that commonly occur at the same time as gonorrhea.

Antibiotics are prescribed for treatment. Because drug-resistant strains of bacteria are becoming common, it is extremely important that you finish all of the antibiotics and see the doctor again if your symptoms persist after treatment.


Bolognia, Jean L., ed. Dermatology, pp.1282-1287. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1105, 2205-2206, 2208-2209. New York: McGraw-Hill, 2003.
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Primary gonorrhea infection in Adult
See also in: Anogenital
A medical illustration showing key findings of Primary gonorrhea infection (Male) : Testicular tenderness, Urethral pus, Dysuria, Sexually active
Clinical image of Primary gonorrhea infection - imageId=1869503. Click to open in gallery.  caption: 'A milky urethral discharge.'
A milky urethral discharge.
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