Let's face it: there's nothing “super” about the sexually transmitted infection (STI) gonorrhea. But, over the past decade or so, there has been a rise in occurrence of a superbug form of gonorrhea, nicknamed “Super Gonorrhea.” Unlike regular gonorrhea, super gonorrhea is antibiotic and antimicrobial resistant, making treatment somewhat of a puzzle and sparking a sense of urgency in finding a new way to address gonorrhea infections.

Gonorrhea symptoms vary from person to person, with some remaining asymptomatic for long periods of time, so it can be tricky to know if you are infected. This is why regular STI testing is recommended, even if you are in a committed monogamous relationship. There are also a few symptoms you should be on the lookout for, so let's dive in! 

doctor discussing sti test results with patient

How is gonorrhea spread?

Gonorrhea is a sexually transmitted infection (STI) that is contracted through vaginal, oral, or anal sex. It can also be passed if the bacteria (Neisseria gonorrhoeae) makes contact with the eyes, or from mother to baby during childbirth. The amount of time that passes between initial infection and the onset of symptoms can vary a great deal. It is also entirely possible, particularly for women, to have gonorrhea without experiencing any symptoms. 

Common symptoms of gonorrhea

The three primary symptoms of gonorrhea in women are burning with urination, spotting between periods, and abnormal vaginal discharge. What's tricky about these symptoms is that they are fairly consistent with other gynecological concerns. Spotting between periods, for example, is common, especially in women entering perimenpause and women with hormonal imbalances. So, it doesn’t always register as a huge red flag for patients or their doctors. 

Similarly, not all women are equipped with the knowledge of what their vaginal discharge should look like, making it difficult to track changes or notice when things are off. It is often not until women begin trying to conceive that they start paying attention to what's showing up in their underwear and when. 

Burning with urination, on the other hand, is a symptom that, because of its unpleasantness, is difficult to ignore. Still, it still can take a long time for women to consider getting tested for gonorrhea because burning with urination is so commonly associated with urinary tract infections (UTI).

Men are more likely than women to experience outward symptoms of gonorrhea, and the onset is usually closer to the time of infection. Men may experience discharge, enlarged testicles, and burning with urination. For both men and women, it is also possible to have symptoms that affect the anus such as itching, bleeding, and discharge — particularly if the bacteria was passed through anal sex. 

Super gonorrhea: How is it different? 

As far as symptoms go, super gonorrhea typically presents in the same way as regular gonorrhea. The difference is it's resistant to antibiotic and antimicrobial treatments. What this means is that, as the infection lives within a person’s body, it is able to develop beyond the initial infection and enter into the bloodstream causing more severe symptoms and health consequences. A person with a gonorrhea infection is much more likely to contract HIV; women with gonorrhea may experience reproductive challenges and infertility; and in some cases, gonorrhea can even become life threatening, making the lack of a reliable treatment option incredibly concerning. 

The good news is that there is work being done by the Global Antiboitic Research and Development Partnership to develop new treatments. And according to the World Health Organization, the meningococcal type B vaccine is showing some promise in protection against gonorrhea infection.

Another important piece of the puzzle is STI prevention and lessening the overall “burden” of gonorrhea on the population. This is where quality sex education about transmission and regular testing comes into play. 

Where did super gonorrhea come from?

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Gonorrhea has been around for centuries. Some theories suggest it originated within cattle, but it has been a part of the human experience dating back to Ancient Rome and likely before. The problem is, super gonorrhea seems to be developing in response to several modern treatment factors. In an interview with the World Health Organization, Dr. Teodora Wi explains that the development of this superbug is likely a result of several confounding factors, such as overuse of antibiotics, poor quality antibiotics, genetic adaptations (mutations) that make the bacteria more drug resistant, and co-infections.

The bottom line? If you are experiencing burning with urination, spotting between periods, and/or abnormal vaginal discharge (especially if you're dealing with all three), it may be a sign that your body is fighting off some unwanted bacteria 'down there,' and it's always a good idea to get it checked out with a healthcare provider.

Head to your doctor and ask for an STI test. If it ends up being negative, you may still be grateful that you are on the path to figuring out what's actually going on. Lastly, remember to always listen to your body’s signals, because the sooner you identify the problem, the more likely drugs are to be effective against a potential gonorrhea infection. 

Johanna Modak is a writer specializing in women's health, nutrition, femtech, and women's sports.