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Gonorrhea: Understanding an increasingly complex infection
Gonorrhea is a very common sexually transmitted infection (STI). While it is treatable, its main challenge today is its growing ability to resist antibiotics.
This is why a professional consultation and proper screening are crucial to receive the right treatment and ensure a complete cure.
Transmission, Incubation, and Screening
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How is it transmitted?
Gonorrhea is transmitted during unprotected sexual intercourse (oral, vaginal, or anal) with an infected person. -
When do symptoms appear?
If they manifest, symptoms generally appear 2 to 7 days after infection. -
When to get a screening test?
The infection is usually detectable by a lab test approximately 7 days after a potential exposure. Testing before this delay could produce a false negative result.
Do you always have symptoms with gonorrhea?
No, and that is a pitfall. Like chlamydia, many infected people (especially women) have no symptoms. This is what facilitates its spread.
When symptoms do appear, they can include:
For women or people with a vagina:
- Yellowish vaginal discharge
- Burning sensation when urinating
- Pain during sexual intercourse
For men or people with a penis:
- Pus-like discharge (yellow or greenish) from the penis
- Intense burning sensation when urinating
- Pain in the testicles
A throat or rectal infection is also possible. Although it is often asymptomatic, it can sometimes cause local pain, discomfort, or a painful straining sensation in the rectum (tenesmus).
The treatment: why is an injection often necessary?
Because of antibiotic resistance, simple pills are often no longer sufficient to reliably cure gonorrhea.
The first-choice treatment is therefore an intramuscular injection of ceftriaxone, a powerful antibiotic from a different class that remains highly effective against the bacteria.
- Why is the injection superior?
It allows for a very high and rapid concentration of the medication in the bloodstream, which is crucial for overcoming resistant strains. It also bypasses the digestive system, ensuring 100% of the dose is absorbed.
Sometimes, an oral antibiotic treatment is added to the injection, especially if a co-infection with chlamydia is suspected.
Alternatives to the injectable treatment are possible, but they are reserved for situations where the injection cannot be administered. These oral treatments have a lower effectiveness rate, notably because of the bacteria's resistance and the difficulty for the antibiotic to reach a sufficient concentration in all infection sites (throat, rectum). People who receive an oral alternative must absolutely present for their test-of-cure.
I've received my treatment. What are the next steps?
How long am I still contagious?
It is recommended to wait 7 days after receiving the injection (and after finishing the oral treatment, if there is one) before resuming any sexual activity. This waiting period also applies to all treated partners.
The test-of-cure: an important step
Because of the risks of resistance, a test-of-cure a few weeks after treatment is often necessary to confirm that the infection is completely gone. This is an important step for your health.
Partner notification
Notifying recent partners is essential so they can get screened and treated, and to break the cycle of transmission. Online tools exist to send anonymous notifications by text or email, such as this one (available in French only): notificationITSS.
Prevention: a combined approach
- The condom: Remains the most effective protection against gonorrhea.
- Regular screening: The only way to detect silent infections.
- Doxy-PEP: May offer partial protection against gonorrhea, but it is not guaranteed due to resistance. It is an option to be discussed on a case-by-case basis.
In addition to safe sex practices, a vaccine usually prescribed for meningitis B has recently shown preventive effectiveness against gonorrhea.
Administered in two doses, this vaccine could reduce the risk of contracting the infection by up to 30 to 40% upon contact with an infected person.
However, the vaccine is not covered by RAMQ or by private insurance plans. Contact a pharmacist from our team for more information, or speak to your doctor if you are interested.
