• Uncomplicated gonorrhoea causes no symptoms in up to 50% of women.
• Where present, symptoms usually develop within 10 days.
• Genital infection is most common and causes:
• Increased or altered vaginal discharge in up to 50% of women.
• Pain or difficulty urinating (dysuria) in 12% of women. Urgency or frequency are uncommon.
• Intermenstrual bleeding, sometimes triggered by intercourse (less commonly).
• Pelvic or abdominal pain, with possible pain on intercourse (dyspareunia), if there is ascending infection (see the CKS topic on Pelvic inflammatory disease).
• Rectal gonorrhoea may occur, but tends to cause symptoms (anal pruritus, pain and spasm of the anal sphincter [tenesmus], purulent discharge, or bleeding) that are less severe than in men.
• Pharyngeal infection is asymptomatic in 90% of women, but it may cause overt pharyngitis.
• Examination may show:
• Most commonly, purulent or mucopurulent endocervical discharge, or easily induced endocervical bleeding. However, this is not a sensitive predictor of cervical infection (occurring in less than 50% of women).
• Less commonly, purulent discharge from the urethra.
• Abdominal tenderness if pelvic inflammatory disease is present.
• Diagnosis of gonorrhoea is confirmed by positive identification of Neisseria gonorrhoeae through culture, which requires an endocervical swab.
• Nucleic acid amplification tests, which require a first-pass urine sample, may also be used initially depending on local protocols, although culture will also usually be required for confirmation.
• See the CKS topic on Vaginal discharge for further information.

[BASHH, 2005b; Handsfield and Sparling, 2005; Bignell et al, 2006]