Gonorrhoea (the clap): symptoms, throat and anus, treatment and resistance

What is gonorrhoea?

Gonorrhoea (nicknamed the clap) is caused by a bacterium, Neisseria gonorrhoeae. It infects the urethra (the tube in the penis), the anus/rectum and the throat. WHO estimates 82.4 million new infections worldwide in 2020, with higher prevalence among men who have sex with men.

In France it is surging: +35% between 2022 and 2024 (+40% in men), about 25,800 diagnoses in community care in 2024 according to Santé publique France.

What are the symptoms?

WHO describes:

• in the penis: white, yellow or greenish discharge, burning when peeing, sometimes painful or swollen testicles. This is the classic “clap”, appearing within days;
• in the anus: discharge, bleeding, itching, pain, painful bowel movements — or nothing at all;
• in the throat: usually no symptoms, sometimes a sore or red throat.

The result: many throat and anal infections go unnoticed and keep circulating. Sexosafe points out that infections caught through oral sex are often symptom-free.

How is it transmitted?

Through anal penetration, oral sex (both ways), rimming and, less often, shared sex toys. An infected throat can pass it to a partner’s urethra during oral sex, and vice versa.

How is it tested?

By PCR on swabs: first-catch urine, anal swab, throat swab. If you have oral and anal sex, ask for all three sites. A urine test alone misses throat and anal infections. In France, testing is free without prescription at labs for under-26s.

How is it treated?

With an antibiotic from the cephalosporin family, usually a ceftriaxone injection (WHO’s preferred treatment). Then:

• 7 days without sex after treatment, according to WHO;
• tell your partners so they get tested and treated;
• a test of cure may be requested, especially for the throat.

Why all the talk about resistance?

Gonorrhoea has learned to resist most of the antibiotics used against it (quinolones, azithromycin and increasingly some cephalosporins). WHO considers it a major threat: very hard-to-treat strains already exist. That’s a reason never to self-treat with leftover antibiotics, and to use preventive doxycycline with caution (doxyPEP).

How to prevent it?

• Condoms for penetration, and for oral sex if you want to reduce risk;
• testing every 3 months with throat, anal and urine swabs if you have several partners;
• stop having sex if you have discharge or burning, and see a doctor quickly.

Untreated, gonorrhoea can cause testicular inflammation and, rarely, a spread infection; it also increases the risk of HIV transmission.