Gonorrhea spreads through vaginal, anal, and oral sex with someone who carries the bacterium Neisseria gonorrhoeae. It passes when infected genital, rectal, or throat fluids and mucous membranes make contact, and penetration isn't required. A pregnant person can also pass it to a baby during delivery. You cannot catch it from toilet seats, towels, or casual contact.
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 is actually transmitted
Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that lives on the warm, moist mucous membranes lining the genitals, rectum, and throat CDC. It moves from one person to another when those membranes, or the fluids on them, make direct contact during sex. The bacterium is fragile outside the body and dies quickly on dry surfaces, so sex is essentially the only way it travels.
Vaginal and anal sex
Penis-in-vagina and penis-in-anus sex are the highest-volume routes. The bacterium colonizes the cervix, urethra, or rectal lining, and infected secretions transfer to the receptive partner's mucous membranes. Rectal infection often causes no symptoms at all, so it spreads without warning unless someone tests that specific site.
Oral sex
Oral sex transmits gonorrhea in both directions: the throat can be infected from genital contact, and a throat infection can seed a partner's genitals. Pharyngeal (throat) gonorrhea is almost always symptomless and can linger for weeks, so people carry and pass it without ever feeling sick. The throat also breeds resistance, where gonorrhea picks up resistance genes from harmless throat bacteria, and untreated pharyngeal infection can persist for up to 16 weeks CDC.
Mother to baby at delivery
A baby can acquire gonorrhea passing through the birth canal of a person with an untreated infection. The classic neonatal outcome is a serious eye infection (ophthalmia neonatorum, conjunctivitis that can threaten sight if untreated). Screening pregnant people for gonorrhea is part of routine prenatal care, and a positive test should always be treated before delivery.
How gonorrhea is NOT spread
The bacterium can't survive long away from the body's mucous membranes, so the routes people most often worry about simply don't transmit it:
- You can't get gonorrhea from a toilet seat. The bacterium doesn't live on cold, dry porcelain.
- Towels, sheets, and washcloths don't transmit it; it dies as the fabric dries.
- Casual contact like hugging, shaking hands, or sharing a bathroom or office carries no risk.
- Sharing food, cups, or utensils doesn't spread it; saliva alone isn't an efficient route.
- Swimming pools and hot tubs don't transmit gonorrhea.
Gonorrhea needs living bacteria moving from one mucous membrane to another during sex. Take that direct contact away and there's no realistic path of infection.
Who's at higher risk
Reported gonorrhea has actually been falling: about 601,000 cases in 2023, or 180 per 100,000 people, down from a 2021 peak of 214 per 100,000 CDC AtlasPlus, 2023. But the burden isn't spread evenly. Rates vary enormously by place. In 2023 they ran from the national 180 per 100,000 up to 853 in Washington DC, 311 in Alaska, and 288 in Louisiana.
The USPSTF directs the most attention to younger sexually active women: it recommends screening sexually active women, including pregnant persons, who are 24 or younger, and those 25 and older at increased risk (2021, Grade B) USPSTF, 2021. For men, the evidence was judged insufficient to make a general screening call (Grade I), which is not the same as saying men aren't at risk. People with new or multiple partners, those who don't use condoms consistently, men who have sex with men, and anyone with a partner who has tested positive all carry elevated risk and should test the sites they expose.
How to reduce your risk
No single tool is perfect, but layering a few cuts risk substantially:
- Condoms, used correctly every time, are the most practical barrier for vaginal, anal, and oral sex.
- Mutual monogamy with a partner who has tested negative removes new exposure; abstinence is the only fully certain method.
- Regular screening of every exposed site — genital, rectal, and throat — catches the silent infections that drive spread.
- Treating partners and pausing sex after treatment matters: abstain from sex for 7 days after the injection so you don't pass the infection back and forth CDC STI Tx Guidelines.
What about DoxyPEP?
DoxyPEP — taking 200 mg of doxycycline within 72 hours after sex — reduces chlamydia and syphilis by more than 70%, but it's much less effective against gonorrhea, around 50% in one trial and inconsistent across others CDC DoxyPEP, 2024. The CDC does not recommend DoxyPEP specifically for preventing gonorrhea, partly because of concern it could drive tetracycline resistance in N. gonorrhoeae. Don't rely on it as your gonorrhea strategy.
If you think you've been exposed
Testing the sites you exposed is the only way to know, and timing matters. See when to test after exposure for the window period, then get tested.
When to see a clinician
Get checked promptly if you have new genital or rectal discharge, burning with urination, bleeding between periods, pelvic pain, or a sore throat that follows oral sex with a new partner. Don't wait on a swollen, painful testicle. That can signal epididymitis (inflammation of the tube behind the testicle that stores sperm), which needs prompt care because it can threaten fertility.
Untreated gonorrhea causes real harm. In women it can climb to cause pelvic inflammatory disease (PID, infection of the uterus and tubes), fallopian-tube scarring, ectopic pregnancy (a pregnancy implanted outside the uterus, which is dangerous), infertility, and chronic pelvic pain. In either sex the bacteria can spill into the blood and joints — disseminated gonorrhea, which can be life-threatening and is managed very differently from a routine case, typically with hospitalization and intravenous antibiotics.
Gonorrhea is curable, and the right gonorrhea treatment clears it, though medicine can't reverse damage already done, which is the argument for testing early. First-line care is now a single ceftriaxone injection, after azithromycin was dropped from the regimen as resistance climbed; learn more about gonorrhea treatment and why resistance is reshaping it.