Gonorrhea in Canada: What You Need to know

Jan. 18

Gonorrhea is the second most common bacterial STI in Canada (behind chlamydia). Within gay and bisexual men who have sex with men (gbMSM) communities, gonorrhea rates have been increasing. There is a higher prevalence of rectal and throat gonorrhea in gbMSM.

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What is Gonorrhea

Gonorrhea is a sexually transmitted infection (STI) caused by infection with the bacterium Neisseria gonorrhea. Gonorrhea can result in infertility. The bacteria infects the “wet” linings of the body. Gonorrhea can affect the genital tracts such as the urethra, epididymis, cervix, uterus, and fallopian tubes. It can also infect the mouth, throat, anus, rectum and in some cases the eyes.

How is it transmitted?

Gonorrhea can be passed from one person to another through sexual contact and sharing of sex toys. Condomless penetrative sex carry the highest-risk for transmission. Gonorrhea can be passed through oral sex when an individual has the infection in their mouth or throat, or when a person gives oral sex to someone with the infection on their genitals. Gonorrhea can also be passed through oral-anal contact (rimming). Other ways include sharing sex toys that have not been properly cleaned after being used on someone with gonorrhea. If semen or vaginal fluids are present while giving a hand job or fingering, gonorrhea can be transmitted. Gonorrhea can infect the eyes if the fluid comes into contact with the eyes, for example, rubbing the eyes after touching an infected body part or semen.

Factors that can increase gonorrhea risk

With the use of pre-exposure prophylaxis (PrEP) to prevent HIV, there was an observed increase in condomless sex amongst gay and bisexual men who have sex with men (gbMSM) populations, which can increase the transmission of gonorrhea.

There is also a higher prevalence of rectal gonorrhea with more than once-a-week rectal douching. It is recommended by experts to douche no more than two to three times a week.

Symptoms

Many people with gonorrhea have no symptoms (but they can still spread the infection to others!). If symptoms come up , they usually appear 2-7 days after infection. The severity of symptoms can vary. The symptoms of gonorrhea are similar to, and sometimes confused with, the symptoms of other STIs such as chlamydia.

Gonorrhea in the cervix: Increased or change in vaginal discharge, vaginal bleeding between menstrual periods, painful vaginal intercourse, painful urination and/or pain in the lower abdomen. Because these symptoms are often mild and not specific to gonorrhea, they may be mistaken for infections of vagina or bladder.

Gonorrhea in the urethra: Urethral discharge (white, yellow or green), painful urination, urethral itching, and testicular pain and swelling. Symptoms of gonorrhea may vary for trans people if they have had bottom surgery and depending on the type of surgery.

Gonorrhea in the rectum or anus: rectal or anal itching, pain, inflammation (proctitis), discharge and/or bleeding.

Gonorrhea in the throat: Often no symptoms, however, individuals with these infections may experience sore throat.

Gonorrhea in the eye: Gonorrhea in the eye can cause a condition called conjunctivitis (pink eye). Symptoms can include swollen eyelids, itchy, red eye, and a green, white or yellow discharge that may crust over the eye.

Complications

If gonorrhea is not detected and treated promptly, it can lead to complex and even serious infections. Gonorrhea in the urethra can result in inflammation of the epididymis (epididymitis), which is a tube in the testicle that stores and carries sperm. Epididymitis can sometimes result in infertility. Gonorrhea in the cervix can spread to the uterus and fallopian tubes and cause pelvic inflammatory disease (PID). This can result in chronic abdominal pain, infertility and an increased risk of ectopic pregnancy. An untreated eye infection caused by gonorrhea can cause scarring of the cornea and can result in vision damage.

If left untreated, the bacteria that cause gonorrhea can enter the bloodstream and spread through the body (disseminated gonorrhea). This can lead to arthritis, skin lesions and tenosynovitis (inflammation of sheath surrounding the tendons). In rare cases, disseminated gonorrhea may lead to meningitis as well as inflammation of the heart or liver.

HIV and Gonorrhea

Having gonorrhea can cause the amount of HIV in the genital and rectal fluids of a person with HIV to increase. This can increase the risk of passing on or getting HIV. However, evidence shows that if you are on an effective HIV treatment you do not pass on HIV sexually, even when they or their partners have an STI (Sexually Transmitted Infection). Rectal gonorrhea infection can be associated with higher risk of HIV transmission, and repeat rectal infections are a greater risk factor for HIV infection.

Testing

It is recommended that all sexually active gbMSM get routine screening for gonorrhea, whether or not suggestive symptoms are present. Testing for gonorrhea may include collecting urine, throat, and/or rectal samples, to cover the possible sites of exposure. In many cases, testing at all sites is warranted. Having had gonorrhea does not make you immune against future gonorrhea infections.

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Treatment

Gonorrhea can be cured easily with treatment using antibiotics.

However, effective treatment of gonorrhea can be a challenge because some strains of gonorrhea are resistant to some treatments. Treatment with two different kinds of antibiotics is recommended to increase the chances of treatment being effective, and to combat antibiotic resistance. Treatments may differ depending on the person’s risk factors, the site and complexity of the infection, the presence of antibiotic resistance, and drug contradictions (such as an allergy).

To make sure the infection has been cured following the treatment, it is recommended to get a test of cure (TOC) either with cultures 3-7 days after treatment or with NAAT swabs 2-3 weeks after treatment, for all infection sites.

Prevention

Using condoms correctly and consistently during insertive sex is one of the best ways to reduce transmission of gonorrhea. When sharing sex toys, cleaning the toy or putting a new condom on it between each use can reduce the risk of passing on gonorrhea by preventing the exchange of bodily fluids.

A person who has gonorrhea should avoid having sex until seven days after they have been treated and all symptoms have gone away. The notification, testing, and treatment of all sexual partners of an individual with gonorrhea all help to prevent the spread of gonorrhea.

Note that the use of PrEP (pre-exposure prophylaxis) does not prevent someone from getting or passing on gonorrhea.

Stigma

When possible, it helps to speak with sexual partner(s) about previous testing dates and results. However, stigma does exist surrounding gonorrhea and conversations regarding STIs, which can be a barrier to this discussion. You can choose when, where, and how to have this conversation about STIs in order to facilitate the most comfortable conversation possible. Your sexual partners’ regularity with testing, their sexual encounters, and other factors may be helpful in making an informed decision about the type of sex you want to have with them, and/or may lead you to get tested sooner than your typical screening schedule. There is no “right” or “wrong” decision. Taking care of your sexual health and well-being is crucial for satisfying sexual experiences and supporting your emotional, mental, and physical health.