Gonorrhea is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. While it is most often associated with the genital tract, the infection can also occur in the throat, a condition known as pharyngeal gonorrhea. This form of the infection is particularly notable because it is frequently silent, meaning it often presents with no noticeable signs or symptoms for the infected person. Understanding what pharyngeal gonorrhea looks like is complicated by this high rate of asymptomatic infection, but when signs do appear, they can easily be mistaken for more common illnesses like a cold or strep throat.
Recognizable Signs of Pharyngeal Gonorrhea
The majority of people with pharyngeal gonorrhea, estimated to be between 80% and 90% of cases, will not experience any symptoms. This makes visual inspection alone highly unreliable for diagnosis, emphasizing why regular testing is important for sexually active individuals. When symptoms do manifest, they typically appear within one to two weeks after exposure.
When the infection causes visible changes, the appearance can mimic a severe case of tonsillitis or pharyngitis. The back of the throat and tonsils may show redness and inflammation, often accompanied by a persistent sore throat or difficulty swallowing. A healthcare provider might observe pale-colored discharge or a yellowish-white exudate (pus) on the tonsils or in the throat. Swollen lymph nodes in the neck and flu-like symptoms, such as a fever, may also occur.
Understanding Transmission and Vulnerability
Pharyngeal gonorrhea is contracted through oral contact with infected genital or rectal secretions. The transmission occurs most commonly during unprotected oral sex with a partner who has a gonococcal infection in their urethra, vagina, or rectum. The exchange of these fluids allows the Neisseria gonorrhoeae bacteria to colonize the mucous membranes of the throat.
The delicate pharyngeal mucous membranes are susceptible to bacterial colonization. The throat can become an isolated site of infection, meaning a person can have pharyngeal gonorrhea without having an infection in the genital or rectal areas. Even without ejaculation, the presence of pre-ejaculatory fluid or vaginal secretions containing the bacteria is enough to transmit the infection. This site acts as a silent reservoir, allowing the bacteria to be passed on to others without the infected person being aware.
Clinical Testing and Confirmation
Because the majority of pharyngeal gonorrhea cases are asymptomatic and the visible signs are indistinguishable from other throat infections, clinical testing is the only way to confirm the diagnosis. The process requires the collection of a specific sample directly from the site of potential infection. A healthcare professional performs a pharyngeal swab, gently rubbing a sterile swab over the back of the throat and tonsils to collect cells and secretions.
The sample is then sent to a laboratory for analysis using Nucleic Acid Amplification Testing (NAAT). NAAT is the standard of care because it is a highly sensitive test that detects the genetic material (DNA) of the Neisseria gonorrhoeae bacteria. This method is significantly more reliable for detecting infections in the throat compared to older methods like bacterial culture. Standard rapid strep tests or general blood work will not detect this specific STI, so a person must explicitly request gonorrhea testing from the throat.
Curing the Infection and Re-Testing
The standard treatment for uncomplicated gonorrhea, including pharyngeal infections, involves dual antibiotic therapy. This approach ensures maximum effectiveness and addresses the growing concern of antibiotic resistance with Neisseria gonorrhoeae. The typical regimen consists of an injectable cephalosporin, such as ceftriaxone, combined with an oral antibiotic like azithromycin. This combination targets the bacteria through two different mechanisms to increase the chances of a complete cure.
Pharyngeal infections are considered more difficult to eradicate than those in the genital or rectal areas. For this reason, a follow-up test, known as a “Test of Cure” (TOC), is strongly recommended for all individuals treated for pharyngeal gonorrhea. This TOC should be performed 7 to 14 days after the treatment is completed to confirm that the infection has been successfully cleared. During the treatment period and until the infection is confirmed cured, it is advised to abstain from sexual contact to prevent transmitting the infection to partners or becoming reinfected.