Gonococcal Urethritis is the inflammation of the urethra, the tube that carries urine from the bladder out of the body. This specific form of urethritis is caused by the bacterium Neisseria gonorrhoeae, which is responsible for the sexually transmitted infection (STI) known as gonorrhea. The infection primarily affects the mucous membranes of the genital tract. It remains a commonly reported STI globally.
The Cause and Transmission
The infectious agent is the bacterium Neisseria gonorrhoeae, a gram-negative diplococcus. It thrives in moist, warm areas and primarily targets the epithelial cells lining the urogenital tract, rectum, and throat. Since the bacteria cannot survive long outside the human body, transmission requires direct contact.
The spread occurs predominantly through unprotected sexual contact, including vaginal, anal, and oral intercourse. Transmission can happen even without ejaculation, as the bacteria are present in pre-ejaculate, semen, and vaginal fluids. An infected person can pass the bacterium to a partner even if they are asymptomatic. Rarely, a pregnant person with an untreated infection can pass the bacterium to the newborn during childbirth, often causing an eye infection in the infant.
Recognizable Signs
Symptoms, when they appear, typically occur within two to fourteen days after exposure. In individuals with penises, Gonococcal Urethritis is often symptomatic. The most frequent signs include a burning sensation or discomfort during urination, known as dysuria.
This discomfort is usually accompanied by a noticeable discharge from the tip of the penis. The discharge is typically thick, pus-like, and may appear yellow, white, or greenish. If the infection progresses, it can lead to complications such as epididymitis, which causes pain or swelling in one or both testicles.
A significant challenge is the high rate of asymptomatic presentation, especially in individuals assigned female at birth. While the infection can affect the cervix (cervicitis), the urethritis component may cause only mild or non-specific symptoms, such as increased vaginal discharge or a slight burning sensation upon urination. Because symptoms are often absent or subtle, many infected individuals unknowingly spread the bacterium, emphasizing the importance of routine testing.
Medical Management and Cure
Diagnosis requires laboratory testing because symptoms can mimic other infections. Diagnosis relies primarily on Nucleic Acid Amplification Tests (NAATs), which detect the genetic material of Neisseria gonorrhoeae. Samples are typically collected via a non-invasive urine specimen or through a swab taken from the urethra, throat, or rectum.
Uncomplicated Gonococcal Urethritis is treated with antibiotics, which are highly effective when administered correctly. Current guidelines recommend a single, high-dose intramuscular injection of ceftriaxone. The standard dosage is 500 mg for most adults, though 1 gram may be administered to individuals weighing 150 kilograms or more.
Historically, treatment involved dual therapy. However, due to concerns over antibiotic resistance, ceftriaxone monotherapy is now preferred for uncomplicated cases. If a concurrent Chlamydia trachomatis infection has not been ruled out, a second oral antibiotic, such as doxycycline, is added to the regimen. N. gonorrhoeae has a concerning ability to develop resistance, requiring continuous monitoring of treatment effectiveness by public health officials.
Patients must abstain from sexual contact for seven days following treatment completion to prevent reinfection and transmission. All sexual partners from the preceding 60 days should be evaluated, tested, and treated promptly to interrupt the chain of infection. A follow-up test, known as a test of cure, is generally recommended for patients treated for pharyngeal (throat) infections.
Prevention Strategies
The most dependable method for avoiding Gonococcal Urethritis is abstinence from oral, anal, and vaginal intercourse. For sexually active individuals, consistent and proper use of barrier methods, such as external or internal condoms, significantly lowers the risk of transmission. These devices create a physical barrier against the exchange of bodily fluids.
Prevention also involves limiting the number of sexual partners and engaging in a mutually faithful relationship with a partner who has tested negative for STIs. Open communication about sexual health history and testing status is important. Regular STI screening is recommended, particularly for individuals with new or multiple partners, or for sexually active women younger than 25. Early detection allows for quick treatment, preventing spread and avoiding long-term health complications.