🧭 When to suspect

Gonorrhoea is a sexually transmitted infection (STI) caused by the Gram-negative diplococcus Neisseria gonorrhoeae. It is the second most common bacterial STI in the UK, with diagnoses at record levels in recent years, and it disproportionately affects gay, bisexual and other men who have sex with men (GBMSM), young people aged 15–24, people of Black Caribbean ethnicity, and those living in deprived areas.

The organism infects the columnar epithelium of the urethra, endocervix, rectum, pharynx and conjunctiva. A great many infections are asymptomatic – almost all pharyngeal and most rectal infections, and roughly half of endocervical infections, cause no symptoms at all. The two clinical skills in primary care are to have a low threshold to test (including extra-genital sites), and to take a culture before treating and refer to sexual health services.

Site of infection	Typical features
Penile urethra	Mucopurulent (green/yellow) discharge and dysuria in over 90%, appearing 2–5 days after exposure; epididymo-orchitis is rare.
Endocervix / female urethra	Altered or increased discharge in about half; lower abdominal pain in about a quarter; dysuria without frequency. Intermenstrual or post-coital bleeding is uncommon. Often asymptomatic.
Rectum	Mostly asymptomatic; occasionally anal discharge or perianal discomfort.
Pharynx	Predominantly asymptomatic; sometimes a mild sore throat. Harder to eradicate than genital infection.
Conjunctiva	Unilateral or bilateral red eye with profuse (hyper-purulent) discharge – an ophthalmic emergency.

Raise suspicion particularly in a young, sexually active person with purulent discharge or dysuria, anyone whose partner has an STI, those reporting new or multiple partners or condomless sex, and GBMSM. Recent travel to or a partner from the Asia-Pacific region matters, as ceftriaxone resistance is more common there.

Source: BASHH 2025 · UKHSA

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