**4.1 Clinical manifestation**

Gonorrhea may have no symptoms, but some men may have a burning sensation when urinating; white, yellow, or green discharge from the penis; painful or swollen testicles, and some women may often have a painful or burning sensation when urinating; increased vaginal discharge/vaginal bleeding, which may have a risk of developing serious complications [24].

If gonorrhea is not appropriately treated, it can lead to pelvic inflammatory disease, infertility, and ectopic pregnancy. Pregnant women can pass the gonorrheal infection to their babies during childbirth, and the newborn can become blind or have life-threatening infections as a result [21].

Anorectal gonococcal infection shows a thick purulent discharge that is expressed from the anal crypts in response to external anal pressure. Nonspecific findings of mucosal erythema, edema, friability, and pus are noted in infected individuals with proctitis from rectal infection [4].
