Gonorrhea Symptoms: Dysuria, Discharge & Asymptomatic Carriage

Neisseria gonorrhoeae causes gonorrhea. Symptom profile differs by sex and site.

Men (Urethral)

• Dysuria (burning urination) — hallmark.
• Purulent urethral discharge (white/yellow/green).
• Frequency, urgency.
• Epididymitis (testicular pain/swelling) if ascending.

Women (Cervical/Urethral)

• Often asymptomatic (50–70%).
• Increased vaginal discharge, intermenstrual bleeding.
• Dysuria, pelvic pain (PID if ascending).

Extragenital

• Rectal: discharge, tenesmus, pain (MSM).
• Pharyngeal: usually asymptomatic; sore throat possible.
• Conjunctivitis: neonates (ophthalmia neonatorum) or autoinoculation.

Diagnosis & Treatment

• NAAT (urine, swabs) — gold standard.
• Culture for antimicrobial susceptibility (rising resistance).
• CDC 2021 regimen: Ceftriaxone 500 mg IM (1g if ≥150 kg) + Doxycycline 100 mg BID × 7 days (chlamydia coverage).
• Test of cure: pharyngeal (14 days); others if symptoms persist.
• Partner treatment (EPT where legal).

Screen annually if sexually active <25 or risk factors. Dual therapy combats resistance.