Gonorrhea is a common bacterial sexually transmitted infection caused by Neisseria gonorrhoeae, which can infect the genitals, rectum, and throat. It spreads through vaginal, anal, and oral sex. Many people have no symptoms. A single ceftriaxone injection cures it, but treatment can't undo damage 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 |
What is gonorrhea?
Gonorrhea is an infection caused by the bacterium Neisseria gonorrhoeae, which colonizes the moist linings (mucous membranes) of the urethra, cervix, rectum, throat, and eyes CDC. It's one of the most frequently reported STIs in the United States. Reported cases have been falling lately. Roughly 601,000 cases were reported in 2023, about 180 per 100,000 people, down from a 2021 peak of 214 per 100,000 CDC AtlasPlus, 2023. Rates swing enormously by location: in 2023 they ranged from the national figure up to 853 per 100,000 in Washington, DC, 311 in Alaska, and 288 in Louisiana.
Antibiotics cure gonorrhea, but medicine only clears the bacteria. It cannot reverse scarring or other permanent damage that an untreated infection has already caused, so catching it early matters.
Symptoms — and the silent reality
Gonorrhea is frequently silent. Many infections cause no symptoms at all. In women, urogenital infection is commonly asymptomatic, and most throat (pharyngeal) infections cause nothing noticeable CDC STI Treatment Guidelines. People pass it on without knowing, and screening is how most infections get found.
When symptoms do appear, they differ by anatomy:
- Men: burning with urination; a white, yellow, or green discharge from the penis; less often, a swollen or painful testicle.
- Women: most have no symptoms, but some notice painful or burning urination, increased vaginal discharge, or bleeding between periods.
- Rectal infection (any sex): discharge, anal itching, soreness, bleeding, or painful bowel movements.
- Throat infection: usually nothing, which is part of why it goes untreated and can linger.
There's no reliable published figure for how long after exposure symptoms start, and official CDC and USPSTF pages don't state a fixed symptom-onset window. If you're trying to time a test rather than wait on symptoms, see our guide on when to test after exposure.
How gonorrhea spreads
Gonorrhea passes through vaginal, anal, and oral sex when infected fluids or mucous membranes make contact. It does not survive on toilet seats or in pools — it needs direct mucosal contact. A pregnant person can also pass it to the baby during childbirth, which is one reason pregnant patients are screened USPSTF, 2021. Because the throat and rectum can carry the infection silently, oral and anal sex spread it just as readily as vaginal sex, and a throat infection can persist for weeks while feeling perfectly normal.
How gonorrhea is tested
The preferred test is a nucleic acid amplification test (NAAT), which detects the bacterium's genetic material with high accuracy — sensitivity is usually above 90% and specificity around 99%. A urogenital sample is a first-catch urine for men and women, or a vaginal swab for women; throat and rectal sites need their own swabs, and patient-collected swabs are acceptable. The most common testing mistake is sampling urine only. If you've had oral or anal sex, an untested throat or rectum will hide the infection, so ask for every exposed site to be tested. For the full walkthrough of methods and result timing, see our gonorrhea test guide.
Who should be screened? USPSTF (2021, Grade B) recommends screening all sexually active women 24 or younger, women 25 and older at increased risk, and pregnant people. For men the evidence is insufficient to make a general recommendation (Grade I), though men with symptoms or known exposure should still be tested. Testing is free or low-cost at public health clinics, and you can get tested or compare testing providers to find an option near you.
How gonorrhea is treated
First-line treatment is a single intramuscular shot of ceftriaxone — 500 mg for people under 150 kg, or 1 g for people who weigh 150 kg or more CDC MMWR, 2020. This is given in the clinic, not as take-home pills, and it covers urogenital, rectal, and throat infections. If chlamydia hasn't been ruled out, a short course of oral doxycycline is added, since the two infections often travel together.
In 2020 the CDC moved from dual therapy (ceftriaxone plus azithromycin) to ceftriaxone alone, because the bacterium stays highly susceptible to ceftriaxone while azithromycin resistance was climbing fast — isolates with elevated azithromycin MICs rose more than sevenfold between 2013 and 2018. At the same time the recommended ceftriaxone dose was raised. For people with a cephalosporin allergy, or when ceftriaxone isn't available, alternative regimens involve gentamicin plus azithromycin, or oral cefixime. Cefixime treats only urogenital and rectal sites, not the throat, and needs a follow-up test-of-cure. The full regimens and dosing live in our gonorrhea treatment guide.
A couple of newer options arrived in December 2025: zoliflodacin (Nuzolvence) and gepotidacin (Blujepa), both oral pills approved for uncomplicated urogenital gonorrhea FDA, 2025. They're the first new antibiotic classes for gonorrhea in over 30 years, with zoliflodacin reaching about 91% microbiological cure in trials. Neither replaces ceftriaxone as first-line yet; they're held in reserve for resistance scenarios so their usefulness lasts.
What treatment actually involves in practice:
- You get the injection on-site the day of diagnosis, with no waiting for a prescription pickup.
- Abstain from sex for 7 days after the shot so you don't reinfect a partner or get reinfected.
- Partners from the prior 60 days need notifying and treatment; where in-person care isn't possible, expedited partner therapy (a prescription for the partner) may be an option for heterosexual couples.
- Throat infections are harder to clear, so a test-of-cure 7–14 days later is advised for pharyngeal gonorrhea. Even fully susceptible throat infections fail ceftriaxone a small but real percentage of the time.
- Retest about 3 months after treatment, because reinfection is common.
| Aspect | First-line (ceftriaxone) | Newer oral options (zoliflodacin / gepotidacin) |
|---|---|---|
| Form | Intramuscular injection in clinic | Oral pill |
| Sites covered | Urogenital, rectal, and throat | Uncomplicated urogenital only |
| Status | Standard first-line | Reserve / resistance scenarios |
| Resistance concern | Susceptibility decreasing but still effective; no verified US clinical failures to date | Novel mechanism expected to stay effective longer |
Complications if gonorrhea goes untreated
Left untreated, gonorrhea can move beyond the initial site and cause lasting harm. In women it can ascend into the reproductive tract and cause pelvic inflammatory disease (PID, infection of the uterus and fallopian tubes), which can scar the tubes and lead to ectopic pregnancy (a pregnancy implanting outside the uterus, a medical emergency), infertility, and chronic pelvic pain. In men it can cause epididymitis — inflammation of the coiled tube behind the testicle that stores and carries sperm — which can affect fertility if neglected. A swollen, painful testicle needs prompt care. We cover the fertility question in depth in does gonorrhea cause infertility in men & women?.
In either sex, the infection can spill into the bloodstream and joints — disseminated gonococcal infection (DGI), which causes fever, joint pain and swelling, and skin sores, and can be life-threatening. DGI is treated differently from uncomplicated gonorrhea, typically with hospitalization and higher-dose ceftriaxone. And a baby infected during delivery can develop a serious eye infection.
How to prevent gonorrhea
The methods that work are unglamorous but reliable: use condoms correctly every time, limit the number of partners or stay in a mutually monogamous relationship with a tested partner, and test regularly at every exposed site. Abstinence is the only certain method. After treatment, abstaining from sex for 7 days keeps you from bouncing the infection back and forth with a partner.
One thing that does not work well for gonorrhea is DoxyPEP — taking doxycycline within 72 hours after sex. It cuts chlamydia and syphilis substantially but is much less effective against gonorrhea, and the CDC does not recommend it for gonorrhea prevention, partly out of concern that it would drive tetracycline resistance in the bacterium CDC DoxyPEP, 2024.
When to see a clinician
See a clinician if you have burning with urination, unusual discharge, pelvic or testicular pain, rectal symptoms, or if a partner tells you they tested positive — even with no symptoms of your own. Because gonorrhea is so often silent, sexually active people in the screening groups should test routinely rather than waiting for something to feel wrong. If you develop a swollen testicle, fever with joint pain, or severe pelvic pain, seek care promptly.