Yes — untreated gonorrhea can cause infertility in both women and men. In women, the bacteria can climb into the uterus and fallopian tubes and cause pelvic inflammatory disease, scarring the tubes. In men, infection can scar the epididymis. Prompt treatment cures the infection but cannot undo scarring already done.
test all exposed sites
500 mg IM, single shot
| Item | Value |
|---|---|
| Test method | NAAT — test all exposed sites |
| Treatment | ceftriaxone — 500 mg IM, single shot |
| Throat infection | harder to cure |
| Retest | 3 mo |
How gonorrhea threatens fertility — in both sexes
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which can infect the genitals, rectum, and throat CDC. Left untreated at a genital site, it can ascend the reproductive tract. The fertility risk comes from the body's inflammatory response. As immune cells fight the infection, the delicate tissue lining the reproductive plumbing heals with scar tissue, and scar tissue doesn't move sperm or eggs the way healthy tissue does.
In women, the classic complication is pelvic inflammatory disease (PID), infection that spreads from the cervix up into the uterus, fallopian tubes, and ovaries. The fallopian tubes are narrow and lined with tiny hairs that sweep an egg toward the uterus; when inflammation scars them, the tube can narrow or seal shut. That can block fertilization entirely or trap a fertilized egg, raising the risk of an ectopic (tubal) pregnancy, which is a medical emergency. PID can also cause chronic pelvic pain that lingers long after the bacteria are gone.
In men, this risk gets left out of the conversation, but it's real. Gonorrhea can cause epididymitis: inflammation of the epididymis, the coiled tube behind each testicle where sperm mature and are stored. If both sides scar and obstruct, sperm can't get out, and fertility drops. A swollen, painful testicle is the warning sign men shouldn't ignore.
Gonorrhea is curable. "Yes, the right treatment can cure gonorrhea" CDC Tx Guidelines, but antibiotics kill the bacteria; they don't reverse damage already done. So early detection matters. For the full picture of the infection itself, see our gonorrhea overview.
Symptoms — and why "no symptoms" is the trap
The infection most likely to scar your tubes or epididymis is often the one you can't feel. Many gonorrhea infections cause no symptoms at all; in women infections are "commonly asymptomatic," and "the majority of gonococcal infections of the pharynx are asymptomatic" CDC. A silent infection still does damage; you just don't know to treat it.
When symptoms do appear, they vary by site:
- Men typically notice burning with urination and a white, yellow, or green discharge from the penis; less often, swollen or painful testicles, which signals possible epididymitis and needs prompt care.
- Women, when symptomatic, may have painful or burning urination, increased vaginal discharge, or bleeding between periods. Lower-belly or pelvic pain can mean infection has already reached the uterus and tubes.
- Rectal infection can cause discharge, anal itching, soreness, bleeding, or painful bowel movements.
- Throat infection usually causes nothing noticeable at all.
Because so many infections are silent, you can't rely on how you feel to decide whether to test. The only way to know is to test.
Testing: catch it before it scars
The preferred test is a NAAT (nucleic acid amplification test), which detects the bacterium's genetic material with high sensitivity (usually over 90%) and specificity (around 99%). For most people that means a first-catch urine sample — the first part of the stream, not midstream — or a vaginal swab, which patients can often collect themselves.
The single most common testing mistake is sampling only one site. If you've had oral or anal sex, ask for a throat swab and a rectal swab too, because urine alone misses infections living in the throat or rectum, and the guidance is to screen every anatomic site of exposure. Swabbing takes seconds and you can often collect them yourself. Not sure how long to wait after a possible exposure? See when to test after exposure, and when you're ready, get tested at every exposed site.
Reported gonorrhea has been declining lately — about 601,000 cases in 2023 (180 per 100,000), down from a 2021 peak CDC AtlasPlus, 2023. But rates vary enormously by place, from the national figure up to far higher numbers in Washington DC, Alaska, and Louisiana. What matters for you is local risk, not the national average.
Treatment: a single shot, and why pills aren't first-line
Current first-line treatment is ceftriaxone 500 mg as a single intramuscular injection for people under 150 kg, or 1 g for those who weigh 150 kg or more. It's an in-clinic shot, not take-home pills. If chlamydia hasn't been ruled out, a short course of oral doxycycline is added to cover it.
Why an injection instead of a pill? In 2020 the CDC shifted from dual therapy (ceftriaxone plus azithromycin) to ceftriaxone alone, and raised the dose MMWR, 2020. Azithromycin was dropped because resistance climbed fast — isolates with elevated azithromycin MICs rose from 0.6% in 2013 to 4.6% in 2018 — leaving the ceftriaxone injection as the lone first-line regimen. The oral antibiotics that once worked are no longer reliable, so you get the shot on-site rather than carry it home.
There are alternatives for specific situations — gentamicin plus oral azithromycin for a cephalosporin allergy, or oral cefixime if ceftriaxone is unavailable (but cefixime treats only urogenital and rectal infection, not the throat, and needs a follow-up test-of-cure). The full breakdown of regimens, doses, and resistance lives on our dedicated gonorrhea treatment page.
Two oral antibiotics — zoliflodacin (Nuzolvence) and gepotidacin (Blujepa) — were FDA-approved in December 2025 as single or short oral courses for uncomplicated urogenital gonorrhea FDA. They're the first new antibiotic classes for gonorrhea in over 30 years, but neither replaces the ceftriaxone injection as first-line yet — they're reserve options for resistance scenarios.
Three things after treatment matter for both your health and your fertility. Notify and treat partners from the prior 60 days. Abstain from sex for the full week after the shot so you don't pass it back and forth. And retest about 3 months later, because reinfection is common. Treatment at public clinics is often free or low-cost, with the injection given the same visit.
Throat infection: harder to clear
Pharyngeal gonorrhea is tougher to cure than genital infection — even fully susceptible throat infections failed ceftriaxone a small but real fraction of the time, which is why a test-of-cure 7–14 days later is advised for the throat treatment-failure review. The pharynx also acts as a resistance breeding ground, where gonorrhea can pick up resistance genes from harmless throat bacteria, and these symptomless infections can persist for weeks. Ceftriaxone-resistant strains aren't hypothetical; the resistant FC428 strain emerged in Japan and has spread internationally WHO. Rare but serious complications like disseminated gonorrhea, where bacteria spread to the bloodstream, joints, and skin, are another reason not to leave an infection untreated.
Prevention that actually protects fertility
The most reliable protection is correct, consistent condom use every time, alongside mutual monogamy with a tested partner; abstinence is the only certain method. Regular screening of every exposed site catches silent infection before it scars. And after treatment, abstaining from sex for the week afterward keeps you and a partner from re-infecting each other.
What about DoxyPEP — a dose of doxycycline taken after sex? It cuts chlamydia and syphilis by more than 70%, but it's much less effective against gonorrhea and the results have been inconsistent CDC DoxyPEP, 2024. The CDC does not recommend DoxyPEP specifically to prevent gonorrhea, partly over concern about driving tetracycline resistance. For gonorrhea, lean on condoms and testing instead.
When to see a clinician
Get evaluated promptly if you have penile discharge or burning, new pelvic or lower-abdominal pain, unusual vaginal discharge or bleeding between periods, or rectal symptoms after anal sex. Don't wait on a swollen, painful testicle — that can be epididymitis, and it needs prompt treatment, because the fertility damage happens while you wait. Also test if a partner was diagnosed, even if you feel fine, since the infection most likely to harm fertility is the one with no symptoms.