Gonorrhea compared to similar conditions: UTI, chlamydia, and BV

Here we summarize real patients’ questions, grouped by topic, and Dr. Fuzayloff’s answers to them. “Dr. F” (his patients’ name for him) has been an STD doctor for over two decades in Midtown Manhattan, NYC.

• I have a genital discharge. Is it a UTI or gonorrhea?

  With the information we have available, which is just what’s in your question, it’s most likely gonorrhea. Discharge is very uncommon with UTIs. UTI and gonorrhea are diagnosed at the same time in 20% of females, so the presence of discharge doesn’t rule out a UTI.

  
  

  To answer the question more precisely we would like to know more information:

  • Gender

    • UTI is considered first in females since it’s very common
    • For males, an STD needs to be ruled out first

  • Age

    • The younger you are, the more likely gonorrhea is

  • Sexual history

    • If you’ve recently had a new partner or unprotected sexual contact , that increases the risk of gonorrhea

  • Time since exposure

    • Gonorrhea has a longer incubation period: 3–7 days
    • UTI usually appears in one day

  • Evolution over time

    • Discharge characteristics: color, consistency, amount

  What I’m trying to say here is that it’s like a jigsaw puzzle: doctors put a lot of small pieces from a history and examination together to determine what diagnosis is most likely.

• I’m a 25-year-old male and I have a burning sensation when I urinate. Is this more likely to be UTI or gonorrhea? Why?

  It’s not possible to answer the question based on the information provided. All that can be said is that gonorrhea is statistically more likely because you’re a young male. We need to know a few more things need to be more accurate:

  Sexual history

  • Any new sexual partner recently?

    • If yes, that increases the likelihood of gonorrhea

  • Did you have unprotected sexual contact (including receiving oral sex)?

    • If yes, that increases the likelihood of gonorrhea.

  Symptoms

  • Any other symptoms besides burning? Any discharge? Staining of the underwear?

    • If yes, gonorrhea is more likely because UTI rarely causes discharge.

  • Is the burning sensation logical and predictable?

    • Both UTI and gonorrhea cause more intense burning with urination, when the inflamed area is irritated by urine. They rarely cause persistent pain or pain at a specific time of day (such as just before going to bed). If the signs and symptoms are not logical and predictable, there’s a chance they’re psychological. But that can’t just be assumed—testing needs to be done.

  Note: The factors discussed above guide a doctor toward a belief about what condition the patient has, but they don’t establish the diagnosis. Testing is always necessary.

• I am a female and I have a burning sensation when I urinate. Can I safely assume it’s a UTI?

  Most likely that’s a correct assumption. UTI is a common condition for females—almost 60% of women have been diagnosed with UTI at some point in their life. UTIs are 14 times more likely in females than in males.

  Why UTIs are common in females:

  Anatomic differences:

  • Women have a shorter urethra (the tube that excretes urine), so bacteria more easily enter the upper parts of the urinary tract.
  • The lower third of the urethra is continuously exposed to vaginal and anal bacteria since the vaginal, anal, and urethral openings are located close to each other.
  • Infectious agents from the penis are easily spread to the urethra during sexual intercourse.

  Residual urine:

  • Females don’t empty their bladder completely during urination, whereas men do. The residual urine in females creates conditions that are optimal for infection and contributes to further development of the disease.

  Nevertheless, we still need more information to be more confident it’s a UTI:

  Sex history

  • Any new partner recently? Unprotected sex (including receiving oral sex)?
    • If yes, gonorrhea and other STDs need to be ruled out.

  Additional symptoms

  • Any other symptoms, such as discharge, bleeding with intercourse, bleeding between periods?
    • If yes, suspicion that you have an STD is greater.

  The table below compares gonorrhea (and other STDs) and UTIs

  	Gonorrhea and other STDs	UTI
  History of UTI (especially during the last 3 months)
  Unprotected sex
  Short incubation period
  Pain during sex
  Bleeding during sex
  Vaginal discharge
  Bleeding between periods

  
  

  Note: The factors discussed above guide a doctor toward a belief about what condition the patient has, but they don’t establish the diagnosis. Testing is always necessary.