I. Intro

The Centers for Disease Control and Prevention (CDC) estimates that approximately 1.4 million new gonorrhea cases occur each year in the United States. About half of these new cases occur in young people between the ages of 15 and 24. Although more than one million new cases occur each year, only 583,405 cases were reported to the CDC in 2018.

This guide provides an overview of gonorrhea testing, including why the test is done, what type of sample is required, and when the test should be performed. It also contains information on the signs and symptoms of gonorrhea, detailed information about how gonorrhea is spread, common treatment options for gonorrhea, and answers to some of the most frequently asked questions about gonorrhea testing.

General Information
Infectious OrganismGonorrhea, Neisseria gonorrhoeae infection
Other Commonly Used Names“The Clap” or “The Drip”
Testing Collection MethodUrine test, oral swab, anal swab, cervical swab, urethral swab, throat swab
Transmission/RiskOral sex, anal sex, or vaginal

II. Overview of Gonorrhea Testing

The purpose of a gonorrhea test is to determine if an individual has been infected with N. gonorrhoeae bacterium.

According to MedlinePlus, gonorrhea testing should be performed at the following times or under the following circumstances:

  • Yearly testing for any woman who is under the age of 25
  • Annual testing for men who have sex with male partners
  • When an older woman is sexually active and has any of the following risk factors: has sex without using condoms, or without using condoms correctly; has had gonorrhea in the past; has been diagnosed with another STD; has multiple sex partners; has had sex with a partner who has an STD
  • In men and women who have any of the symptoms of gonorrhea

In many cases, a urine sample is used to test for gonorrhea; however, another type of sample may be required depending on the patient’s symptoms. For example, if an individual has the symptoms of a gonorrhea infection in the rectum, a rectal swab may be used to determine if N. gonorrhoeae is present in the rectal canal. Cervical swabs, oral swabs, and urethral swabs may be used to determine if an individual has N. gonorrhoeae in the cervix, throat, or urethra (urine canal), respectively. Women shouldn’t douche or use vaginal creams within 24 hours of sample collection, as these products can interfere with the testing process. Antibiotic use can also affect the test results, so anyone taking antibiotics should inform the ordering physician before providing a sample for gonorrhea testing.

 

III. How a Gonorrhea Infection Works

Gonorrhea is spread through sexual contact with an infected person. Sexual contact includes oral sex, anal sex, and vaginal sex. It’s also possible for a pregnant woman to give gonorrhea to her baby when she gives birth. Transmission occurs when a baby passes through a vaginal canal infected with N. gonorrhoeae bacterium. In babies, gonorrhea can cause pneumonia, eye infections, blood infections, or infections in the joints.

IV. The Symptoms of Gonorrhea

Symptoms in Women

  • A higher-than-normal amount of vaginal discharge
  • Pain while urinating
  • Burning sensation while urinating
  • Abnormal vaginal bleeding

Symptoms in Men

  • Burning sensation while urinating
  • Green, yellow, or white penile discharge
  • Swollen testicles
  • Pain in the testicles

Symptoms of Rectal Infections

  • Pain while having a bowel movement
  • Anal itching
  • Rectal bleeding
  • Rectal discharge
  • Sore feeling in the rectal area

V. Testing for Gonorrhea

The gonorrhea test checks for the presence of N. gonorrhoeae in a urine sample or a sample from the rectum, cervix, throat, or urethra. Several laboratory procedures are used to determine if the N. gonorrhoeae bacterium is present in the sample. For example, Gram staining is used to confirm the presence of a gram-negative bacterium, which is a type of bacteria that appears red or pink after it has been stained with a violet dye, treated with decolorizer, and stained a second time with a red dye.

Laboratory professionals also run an oxidase test, an acid-production test, an enzyme substrate test, and a nitrate reduction test to determine the exact strain of Neisseria present in the sample. The oxidase test is used to determine if the bacterium in the sample produces a certain type of protein complex. If N. gonorrhoeae is present, the oxidase test is positive. The acid-production test is used to determine if the bacterium in the sample produces acid from several types of carbohydrates. N. gonorrhoeae only produces acid from glucose, the main form of sugar in the human body. The enzyme substrate test and the nitrate reduction test provide more information to help laboratory professionals determine if the sample contains N. gonorrhoeae or another strain of Neisseria.

How Samples Are Collected

Urine Samples

In many cases, the individual is asked to provide a clean-catch urine sample. The clean-catch method prevents bacteria from contaminating the sample and making it difficult to make an accurate diagnosis. Due to differences in the anatomy of the urinary system, the procedure is slightly different for men and women.

Before providing a clean-catch urine sample, a man must cleanse the head of his penis thoroughly. This helps remove bacteria, preventing contamination of the sample. Once the head of the penis is clean, the man should allow a small amount of urine to flow into the toilet. Then, he puts the collection cup under his urine stream and continues urinating until the cup is about half full.

Prior to collecting a urine sample, a woman has to cleanse around the opening to her urethra and between her vaginal lips, which are also called the labia. Cleansing these areas removes the bacteria found in urine, vaginal discharge, and other fluids. The rest of the collection procedure is the same from a woman as it is for a man: the woman lets a small amount of urine flow into the toilet, places a collection cup under the urine stream, and continues urinating until the cup is half full.

Throat Swab

A throat swab, also known as a pharyngeal swab, may be used to collect a sample if an individual has signs of a gonorrhea infection in the throat. A medical professional uses a long cotton swab to collect a sample from the back of the throat. Although the collection process doesn’t hurt, it may cause some gagging as the swab brushes against the tonsils and triggers the gag reflex.

Rectal Swab

If an individual has signs of a gonorrhea infection in the rectum, a rectal swab can be used to collect a sample and have it analyzed for the presence of N. gonorrhoeae. During the collection process, a medical professional inserts a long cotton swab approximately 1.5 inches into the anal canal. The swab is moved from side to side and then held in place for about 30 seconds to ensure an adequate sample is collected.

Cervical Swab

In women, an endocervical swab may be used to collect a sample from the cervix, which is the opening to the uterus. During the collection process, a medical professional inserts a long cotton swab into the endocervical canal. The swab is moved around for 20 to 30 seconds to ensure an adequate sample is collected. When the swab is removed, the medical professional must be careful not to touch the vaginal wall, as doing so could contaminate the sample.

Urethral Swab

If a medical professional believes that a sample should be collected from the urethra, the collection process is similar for men and women. A long cotton swab is inserted 2 to 4 centimeters into the male urethra and 1 to 2 centimeters into the female urethra. Once the swab is inserted, it must be rotated for at least 10 seconds to ensure an adequate sample is collected.

Options for Getting Tested

In most cases, gonorrhea testing is performed in some type of medical facility, such as a doctor’s office or hospital. Home testing is available, but only if the test will be performed on a urine sample. If a throat swab, rectal swab, urethral swab, or endocervical swab will be used, the sample must be collected by a medical professional.

VI. Treatment for Gonorrhea

Gonorrhea won’t go away on its own, so it’s important to seek treatment from a doctor or other licensed medical professional. The infection is usually treated with two antibiotics: azithromycin and ceftriaxone. Azithromycin is taken orally, while ceftriaxone is injected directly into one of the muscles. Azithromycin and ceftriaxone work in different ways, which makes it more likely that they’ll be able to eradicate N. gonorrhoeae.

In some individuals, ceftriaxone is combined with doxycycline instead of azithromycin. For people who are allergic to ceftriaxone, it’s possible to treat gonorrhea with gentamicin or gemifloxacin. Both medications are antibiotics, but gentamicin is injected while gemifloxacin is administered by mouth.

VII. Frequently Asked Questions

How is a gonorrhea test used?

A gonorrhea test is used to determine if N. gonorrhoeae is present in a urine sample or in a sample collected from the patient’s throat, rectum, or urinary system. The test can be used to confirm gonorrhea infection in a person who exhibits one or more symptoms of gonorrhea.

How can I order a gonorrhea test?

In most cases, a gonorrhea test is ordered by a doctor, nurse practitioner, physician assistant, or another licensed medical professional. Some laboratories do offer home testing kits, however. Anyone interested in home testing should order a kit and follow the instructions provided by the laboratory to collect a sample and send it to the lab for analysis.

What does a positive result for gonorrhea mean?

A positive result on a gonorrhea test indicates that an individual is infected with N. gonorrhoeae and needs to be treated with antibiotics to prevent the infection from getting worse or spreading to the person’s sexual partners. In a pregnant woman, a positive result indicates that treatment is necessary to prevent the spread of gonorrhea to a newborn baby.

What does a negative result for gonorrhea mean?

A negative result on a gonorrhea test indicates that an individual isn’t infected with N. gonorrhoeae. Even if a gonorrhea test is negative, that does not mean the individual has not been infected with a different type of bacteria. Further tests may be needed to make an accurate diagnosis and develop an appropriate treatment plan.

What’s important to know about gonorrhea?

Gonorrhea can be transmitted to other people via oral, anal, and vaginal sex. It can also be transmitted to a newborn baby if the baby’s mother has N. gonorrhoeae in her vaginal canal. Although gonorrhea can be treated with antibiotics, it’s important to know that it can cause serious complications in some individuals.

Without proper treatment, gonorrhea can damage the reproductive tract, leading to infertility in men and women. The bacterium that causes gonorrhea, N. gonorrhoeae, does not always remain confined to the initial site of infection. If it gets into the bloodstream, it can travel to other parts of the body, resulting in painful joint infections. Gonorrhea also increases the risk that a person will contract HIV/AIDS from an infected partner. In babies, the bacterium that causes gonorrhea can cause pneumonia, eye infections, and blood infections. Early treatment provides the best chance of preventing a newborn baby from contracting gonorrhea from its mother.

Finally, it’s important to know that gonorrhea can be prevented. Anyone sexually active should use condoms when engaging in anal or vaginal sex. Dental dams are available to reduce the risk of infection during oral sex. If a sexual partner has symptoms of gonorrhea, such as penile or vaginal discharge, refraining from sex with that partner can prevent the spread of the gonorrhea infection. Asking a partner to get tested for gonorrhea is another way to avoid this sexually transmitted disease. In addition to taking these steps, it is important for young people to get screened regularly, especially if they have any of the risk factors that make a gonorrhea infection more likely.

How long does it take to get results from a gonorrhea test?

It usually takes two to three days to receive the results of a gonorrhea test, depending on where the test is performed and how long it takes the person who ordered it to review the laboratory report and contact the patient with the results.

VIII. Additional Resources

  • The American Sexual Health Association explains the how and why of gonorrhea infections and answers a variety of FAQs on the subject.
  • If you’re looking for information in an easy-to-read format, the CDC offers printable basic fact sheets on gonorrhea symptoms and treatment options.
  • For those who are curious about the screening process, MedlinePlus discusses the gonorrhea test, including what happens during a test and what your results may mean.

 

IX. Sources