Some of the links included in this information lead to content created by other organisations and may not be available in Welsh.
Gonorrhoea is a bacterial sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It is transmitted through condomless vaginal, oral or anal sex, or through genital contact with an infected partner, even if the person has no symptoms. Gonorrhoea is one of the most common bacterial STIs worldwide.
Gonorrhoea can cause symptoms in the genitals, anus, throat, or the conjunctiva (a thin membrane that protects the eye).
Symptoms can vary depending on which part of the body is affected. Symptoms are more common with penile urethral infections, while infections in other sites (endocervical, rectal or pharyngeal) are more likely to be asymptomatic.
Typical symptoms in the genitals include:
pain or burning when urinating,
a thick green or yellow discharge from the penis or vagina.
If symptoms of gonorrhoea do occur, they usually appear within two weeks of being infected, but sometimes they don't appear until many months later.
Untreated infection can also lead to complications such as pelvic inflammatory disease, ectopic pregnancy, infertility, and systemic infections including disseminated gonococcal infection. Gonorrhoea can also increase the risk of getting other STIs, including HIV.
The World Health Organization (WHO) recognises gonorrhoea as a major global public health problem. Antimicrobial resistance to gonorrhoea has increased in recent years, making treatment more challenging. Many classes of antibiotics are now ineffective, making gonorrhoea a multidrug resistant pathogen.
Gonorrhoea is most commonly diagnosed in people aged 15 to 24 and in gay, bisexual and other men who have sex with men (GBMSM). However, anyone who has unprotected sex with an infected partner or is exposed to infected penile or vaginal discharge can get the infection.
In 2023, over 5,000 people in Wales were diagnosed with gonorrhoea.
In November 2023, the Joint Committee on Vaccination and Immunisation (JCVI) recommended introducing a targeted vaccination programme to protect those at greatest risk of gonorrhoea.
Readiness for the programme is expected from July 2025. The vaccine will be available opportunistically through specialist sexual health services, primarily to GBMSM who are at higher risk of gonorrhoea infection. Vaccination Programme Wales will advise Sexual Health Clinics nearer to the time when vaccinations can commence.
Risk criteria include:
a bacterial STI diagnosis in the last year, or
having five or more sexual partners in the last three months.
Eligibility will be assessed on an individual basis, considering individual circumstances and risk.
The vaccine may also be offered to other individuals with similar risk factors, such as those with gonorrhoea incidence comparable to the eligible GBMSM group. This may include sex workers who engage in condomless sex and others assessed to have a similar risk level.
Any offer of vaccination should be based on an individual assessment by a sexual health professional.
Currently, there are no licensed vaccines specifically for gonorrhoea. However, the JCVI recommends the off-label use of the 4-component meningococcal (4CMenB) vaccine for individuals at highest risk of gonorrhoea. The 4CMenB vaccine is licensed to help prevent meningococcal B disease in individuals aged 2 months and older and is currently used in the routine childhood programme.
Neisseria gonorrhoeae (the bacteria causing gonorrhoea) is closely genetically related to Neisseria meningitidis (the bacteria causing meningococcal disease). Therefore, the 4CMenB vaccine offers some cross-protection against gonorrhoea. Studies have reported 30-40% protection against gonorrhoea in people at high risk when the vaccine is offered for protection against meningococcal B disease.
While the 4CMenB vaccine may reduce the chance of gonorrhoea infection, it does not provide complete protection. The vaccine’s main benefit is thought to be at a community level, contributing to a reduction in overall gonorrhoea cases. It's important for those at high risk to get vaccinated, even with modest effectiveness, since previous gonorrhoea infection doesn't protect against reinfection.
There is no evidence of the 4CMenB clearing active gonorrhoeal infection. Therefore, infections should be managed according to the British Association for Sexual Health and HIV (BASHH) guidelines Bashh guidelines (external site)
Bexsero is the only licensed 4CMenB vaccine available in the UK. It is an inactivated injectable vaccine in a pre-filled syringe presentation. Since protection against gonorrhoea is not a licensed use of the 4CMenB vaccine, JCVI advice is based on off-label use.
Two doses are required. The second dose can be given after at least four weeks. There is no maximum time limit between doses, and the second dose can be given at the next clinic visit, whether it is three, six or 12 months later. If there is a longer interval, the primary schedule does not need to be restarted.
Refer to the Gonorrhoea: the green book chapter - GOV.UK (external site) and the Welsh Medicines Advice Service (external Site) for further information.
Vaccination programme recommendations from the Joint Committee on Vaccination and Immunisation (JCVI) and Welsh Government policy can be found at the links below.
Online courses and training materials about a number of vaccines and diseases can be accessed via the E-learning page.
Further immunisation training information and resources are provided on the Immunisation training resources and events page.
PGD templates for vaccines can be found on the Welsh Medicines Advice Service page
The Complete Routine Immunisation Schedule includes information about routine and non-routine vaccinations.
Vaccination surveillance information can be found on the pages below