What are the symptoms of gonorrhea in sexually active individuals?

Symptoms of Gonorrhea

Gonorrhea frequently presents asymptomatically in women while men typically develop urethral discharge and dysuria, making sex-based clinical differences critical for diagnosis and screening strategies. 1

Clinical Manifestations by Sex

Men

• Most urethral infections produce symptoms that prompt men to seek treatment, typically presenting with:
  • Penile discharge 2
  • Dysuria (painful urination) 2
  • Symptoms appear early enough to seek curative treatment before serious sequelae develop, though not always before transmitting infection to others 3

Women

• The majority of gonococcal infections in women are asymptomatic until complications develop 3, 1
• When symptomatic, women may present with:
  • Mucopurulent vaginal discharge 2
  • Pelvic pain 2
• Asymptomatic infections frequently progress to pelvic inflammatory disease (PID) before detection 1

Complications and Systemic Manifestations

Pelvic Inflammatory Disease

• Both symptomatic and asymptomatic PID can result from untreated gonorrhea 3
• PID causes tubal scarring leading to infertility or ectopic pregnancy, representing the most serious morbidity concern 3, 1

Disseminated Gonococcal Infection

• Gonorrhea may disseminate systemically, causing synovial and skin manifestations 2
• Can lead to septic arthritis when N. gonorrhoeae enters the bloodstream and infects joints 4

Extragenital Sites

• Pharyngeal infections are common, particularly in adolescents, and are often asymptomatic 5, 6
• Anorectal infections occur and may be asymptomatic 5, 6
• Conjunctival infections can occur 5
• Oral gonorrhea is rare and nonspecific, ranging from slight erythema to severe ulceration with pseudomembranous coating 7

Neonatal Infections

• Neonates can develop gonococcal conjunctivitis and scalp abscesses 2
• Rare complications include gonococcal sepsis, arthritis, and meningitis 4

Critical Clinical Pitfalls

• The asymptomatic nature of infection in women is the primary reason gonorrhea control relies heavily on screening rather than symptom-based diagnosis 3
• Physical examination findings are nonspecific and cannot reliably distinguish gonococcal from other infections 8
• Women aged <25 years are at highest risk and require annual screening regardless of symptoms 3, 1
• The mild or absent symptoms in early infection do not prevent serious long-term reproductive complications 8