In this chapter, we will tell you about the signs of gonorrhea. Unlike symptoms, signs are visible. That means they can be seen by both the patient and the doctor.
They are objective changes caused by the disease process, unlike symptoms, which are subjective and only felt by the patient. Since signs can be seen by both a patient and their doctor, they are considered to be more reliable than symptoms in terms of the diagnostic process.
However, neither signs nor symptoms are enough to establish a final diagnosis, although they do indicate the right tactic for testing and early treatment. As in the previous chapter, the “What You Will Notice” section consists of:
Tables with concise information about signs of gonorrhea for different anatomic areas . Photos of gonorrhea signs with an explanation of what you should pay attention to FAQs from actual patients answered by a doctor who specializes in this area.
Let’s start!
Gonorrhea signs: penile and vaginal
This table summarizes penile and vaginal gonorrhea signs.
It is divided into 4 parts:
Common Signs – signs experienced by MOST infected people
Unusual Signs – signs experienced by SOME infected people (not specific to gonorrhea)
Most reliable signs – signs that are most specific to the condition that best explain the pathophysiology disease process.
Chances of not having signs – indicates the chances of evidencing no signs.
Pay special attention to the ways in which the number of gonorrhea-asymptomatic females compare that of males.
Common Symptoms
Unusual Symptoms
Most Reliable Symptoms
When symptoms appear
Chance of not having symptoms
Both genders
Thick green or yellow discharge
Male
Inflammation of penis (tip
Female
Bleeding between periods
Bleeding during sexual intercourse
Both genders
Systemic symptoms include fever and chills.
Male
Swollen, tender, and red scrotum
Painful testicle
Thick greenish or yellowish discharge
1-14 days after initial exposure
2-5 days on average
Male
1 in 10 gonorrhea-positive men have no signs, which means that 10% of males do not display signs or experience symptoms
Females
5 in 10 gonorrhea-positive women have no signs, which means that 50% of females do not display signs or experience symptoms.
Signs of oral and rectal gonorrhea
This table summarizes oral and rectal gonorrhea signs.
It is divided into 4 parts:
Common Signs – signs experienced by MOST infected people
Unusual Signs – signs experienced by SOME infected people (not specific to gonorrhea)
Most reliable signs – signs that are most specific to the condition that best explain the pathophysiology disease process
Chances of not having signs – indicates the chances of evidencing no signs.
Pay particular attention to high percentage of those who show no signs.
Common signs
Unusual signs
Most reliable signs
When signs appear
Chance of not having signs
Oral
Throat redness
White patches in the throat
Enlarged neck lymph nodes
Vomiting
Throat redness
Pus-filled white patches in the throat
Signs are not gonorrhea- specific but are most reliable.
7-21 days after exposure redness
In 90% of cases oral gonorrhea has no signs
Rectal
Anal discharge and/or bleeding
Itch
Enlarged groin lymph nodes
Diarrhea
Anal discharge and/or bleeding
Signs are not gonorrhea- specific but most reliable.
5-10 days post- exposure redness
In 84% of cases, rectal gonorrhea causes no signs.
Gonorrhea signs photos
Here we present some photos of gonorrhea signs obtained from other sources. We believe it’s helpful to see them so you can understand what we’re referring to in the tables. As with anything in life, the more you see, the more knowledge you gain, and you can begin noticing minor but important differences. Let’s take a look at some photos to clarify the ways in which lesions due to herpes, rather than some other condition, are identified.
Description
Penile gonorrhea
Note the yellowish green, thick discharge, redness and irritation at the tip of the penis
Here we summarize real patients’ questions, grouped by topic, and Dr. Fuzayloff’s answers to them. “Dr. F” (as his patients call him) has been an STD doctor for over two decades in Midtown Manhattan, NYC.
Commonality of gonorrhea signs.
The chance of having gonorrhea signs depends on the affected anatomic areas; they are more common in genital areas and less common in oral and rectal areas
Penile gonorrhea is symptomatic in 90% of cases.
Vaginal gonorrhea is symptomatic in 50% of cases.
Those with rectal gonorrhea have signs in only 16% of cases.
Oral gonorrhea result in the development of signs in only 10% of cases.
With most conditions leading to infections, symptoms (what you feel) appear a bit earlier than signs (what you see).
In the case of gonorrhea, there is no obvious time difference between the development of symptoms and signs. Depending on the affected area, people start to experience symptoms and signs at about the same time, immediately after the incubation period (a period between exposure and the appearance of the first symptoms and signs) ends.
Most initial gonorrhea symptoms and signs – redness and discharge – appear at the same time. Discharge is usually thick and very abundant with a green or yellowish color.
Progression of the signs of gonorrhea varies from person to person and depends on:
the presence of other STIs
overall immune status
Males
Males experience a very heavy discharge and redness at the tip of the penis. If left untreated, men will have inflammation of epididymis (a tube that stores and collects the sperm) within several weeks or months. The exact probability of epididymitis development is unknown, but it is estimated to be low. The chances for infertility are also very low.
Females
Females might have a similar thick and abundant discharge but pain and bleeding during sex (and in-between periods) are more common since gonorrhea usually has the greatest effect on the cervix (non-visible, internal part of the uterus) and not the vagina.
If left untreated, gonorrhea may progress and affect the reproductive female organs: ovaries and fallopian tubes. When that happens, the patient will have lower abdominal pain (pelvic area) and occasional fever, which are the signs of pelvic inflammatory disease (PID)
10-20% of infected females may develop PID. This process may take weeks and even months.
About half of women who experience at least three episodes of pelvic inflammatory disease (PID) will become infertile (due to post-inflammatory scarring processes).
Reliable signs of gonorrhea seen in different anatomic areas.
The term “reliable” here means that medical professionals place the greatest confidence in these signs being indicative of the disease process for that condition. Since gonorrhea can affect different areas of the body (point of contact), we will talk about each area separately.
Genital gonorrhea
The most reliable sign is a thick purulent discharge from the vagina or penis. The discharge is the result of the body’s immune response to the gonorrhea infection that enters the mucosa cells of urethra or vagina. The discharge, which is of a greenish/yellowish color and abundant, is specific to gonorrhea.
Oral gonorrhea
Most people with oral gonorrhea remain asymptomatic, with only 10% showing any signs or symptoms and, even among that group, symptoms are not specific to gonorrhea. Gonorrhea should be considered if the patient’s history indicates it. Of all the symptoms, the most reliable for oral gonorrhea is significantly red tonsils covered with white spots (pus).
Rectal gonorrhea
Similar to oral gonorrhea, only 16% of those infected with rectal gonorrhea are symptomatic. Even those who are symptomatic will only experience non-specific rectal pain, discharge and bleeding, symptoms that may be attributed to another condition. Again, medical professionals should suspect gonorrhea if the patient’s history indicates it.
Gonorrhea signs: Are they enough to establish a diagnosis?
No.
Signs as well as symptoms can only suggest the infection but not establish a diagnosis of gonorrhea. Signs are more reliable than symptoms but are still insufficient since many conditions affecting the same area can present similarly. In combination with symptoms, signs are helpful in that they can suggest early testing and treatment.
Urine and discharge smell with gonorrhea
Urine
There is no scientific evidence of gonorrhea changing the odor of the urine. Moreover, doctors do not usually rely on that odor during the diagnostic process since the smell of urine mostly depends on the food and drinks that have been consumed.
Discharge
People with gonorrhea may have foul-smelling discharge. However, this is not the main characteristic of that discharge. The specific color (yellowish greenish), consistency(thick) and abundance of discharge are more specific to gonorrhea than smell.
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