Gonorrhea is cured with a single injection of ceftriaxone given in a clinic — 500 mg into the muscle for most adults, or 1 g for people weighing 150 kg or more. If chlamydia hasn't been ruled out, a short course of doxycycline pills is added. Oral antibiotics alone no longer work reliably.
| Item | Cases per 100,000 |
|---|---|
| 2021 | 214 |
| 2022 | 194.4 |
| 2023 | 179.5 |
How gonorrhea is treated now
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which can settle in the genitals, rectum, or throat. The good standard-of-care answer to whether it's curable: yes, the right treatment clears the infection — but no medicine can reverse scarring or other permanent damage already done, so timing matters.
The current first-line regimen is a single dose of ceftriaxone 500 mg given as an intramuscular (IM) injection, which covers urogenital, anorectal, and pharyngeal infection at once CDC STI Guidelines. People weighing 150 kg or more get 1 g instead. If a chlamydia test hasn't excluded co-infection, your clinician adds doxycycline 100 mg by mouth twice daily for 7 days, because the two infections travel together so often.
This is a real change from how gonorrhea was treated for years. The 2020 update moved from dual therapy (ceftriaxone plus azithromycin) to ceftriaxone alone, and raised the ceftriaxone dose from 250 mg to 500 mg MMWR 2020. Azithromycin was dropped for two reasons: antimicrobial-stewardship and microbiome concerns, and fast-rising resistance — isolates with elevated azithromycin MICs (≥2.0 µg/mL) climbed more than sevenfold, from 0.6% in 2013 to 4.6% in 2018. The bacterium stays highly susceptible to ceftriaxone, so a single shot now carries the whole job.
If you're allergic to cephalosporins or ceftriaxone isn't available
For a documented cephalosporin allergy, the alternative is gentamicin 240 mg IM plus azithromycin 2 g by mouth, both as single doses. If ceftriaxone simply isn't stocked, cefixime 800 mg as a single oral dose is an option — but with an important limit: cefixime reliably treats only urogenital and anorectal gonorrhea, not throat infection, so a test-of-cure is recommended afterward. These are backups, not the preferred path.
What treatment is actually like
The reality surprises people who expect a pill bottle: it's a shot, given on-site, not antibiotics you take home. The ceftriaxone injection goes into a large muscle — usually the upper outer buttock or thigh — and stings briefly. You're done in one visit for the gonorrhea itself, though you may also leave with doxycycline pills if chlamydia coverage is needed.
Cost and access are usually easier than people fear. Public health clinics and many community clinics give the injection free or low-cost, and you don't fill a prescription elsewhere — the medicine is administered before you leave. A common mistake is skipping the throat or rectal swab: ask to test every site you've exposed, because a urine-only gonorrhea test can miss an infection sitting in the throat or rectum.
After treatment, abstain from any sex for 7 days. That window lets the antibiotic finish its work and keeps you from passing the infection back and forth with an untreated partner.
Your partners need treatment too
Treating only yourself almost guarantees reinfection. Anyone you had sex with in the prior 60 days should be notified, tested, and treated. They should also abstain from sex for 7 days after their own treatment.
When a heterosexual partner can't get to a clinic in person, expedited partner therapy (EPT) — handing off cefixime 800 mg orally for that partner — is an option where it's legally permissible. EPT isn't ideal for everyone, since it skips an exam and site-specific testing, but it beats leaving a partner untreated. If you're unsure how the infection moves between people, see can you get gonorrhea from oral sex or kissing?.
Follow-up, retesting, and test-of-cure
Most people with genital or rectal gonorrhea don't need a routine test-of-cure after the standard injection — ceftriaxone works that reliably. The throat is the exception.
Pharyngeal (throat) gonorrhea is genuinely harder to eradicate. Even fully susceptible throat infections failed ceftriaxone about 4.6% of the time, so a test-of-cure is advised 7–14 days after treatment, with culture preferred where available or a NAAT otherwise Clin Infect Dis, 2020. The throat is also a resistance breeding ground: gonorrhea picks up resistance genes from harmless throat bacteria, and pharyngeal infection is usually symptomless and can persist for up to 16 weeks — widening the window for problems.
Separately, everyone treated for gonorrhea should retest about 3 months later. This isn't checking whether the cure worked — it catches reinfection, which is common. If you used cefixime instead of ceftriaxone, a test-of-cure is also recommended.
What happens if gonorrhea goes untreated
Untreated gonorrhea doesn't stay quiet. In women it can ascend into the upper reproductive tract and cause pelvic inflammatory disease (PID, infection and inflammation of the uterus and tubes), which can scar the fallopian tubes and lead to ectopic pregnancy (a pregnancy that implants outside the uterus and can be dangerous), infertility, and chronic pelvic pain CDC.
In men, the common complication is epididymitis — inflammation of the coiled tube behind the testicle, which can affect fertility. A swollen, painful testicle is not a wait-and-see symptom; it needs prompt care, not a few days of hoping it settles.
In either sex, the bacteria can spill into the bloodstream and joints, causing disseminated gonococcal infection (DGI) — a body-wide illness with rash, joint pain, and fever that can become life-threatening. DGI is managed very differently from uncomplicated gonorrhea: typically hospitalization with ceftriaxone 1 g IM or IV every 24 hours. Gonorrhea can also be passed to a newborn at delivery, causing serious eye and other infections.
Why pills alone stopped working — and the new oral drugs
Gonorrhea has steadily outrun antibiotic after antibiotic — sulfonamides, penicillin, tetracyclines, fluoroquinolones, and cefixime have all lost ground, and cephalosporin susceptibility is slowly decreasing too. That's why a single ceftriaxone injection is described as the lone first-line regimen and cephalosporins as 'one last' effective class CDC, drug-resistant gonorrhea. Ceftriaxone-resistant gonorrhea isn't hypothetical: the FC428 strain emerged in Japan in 2015 and has spread internationally, and the WHO estimated 82 million new infections globally in 2020 WHO. No verified US clinical ceftriaxone treatment failures have been reported to date, and the CDC tracks resistance closely through programs now consolidated under CARGOS.
In December 2025 the FDA approved two oral antibiotics — the first entirely new antibiotic classes for gonorrhea in over 30 years. Zoliflodacin (brand Nuzolvence) is a single oral dose for uncomplicated urogenital gonorrhea in patients 12 and older weighing at least 35 kg; in Phase 3 testing it achieved about 91% microbiological cure and was non-inferior to the standard ceftriaxone-plus-azithromycin regimen, working through a novel mechanism on bacterial DNA gyrase FDA, Dec 2025. Gepotidacin (brand Blujepa) is an oral tablet for the same indication in patients 12 and older weighing at least 45 kg, but it's positioned as a reserve drug for when few or no other options exist FDA, Dec 2025.
Neither replaces ceftriaxone as first-line yet — they're tools for resistance scenarios, and used carefully they're expected to keep working longer. For a deeper look at the injection and the resistance picture, see our explainer on gonorrhea treatment.
| Situation | Treatment | Route | Test-of-cure? |
|---|---|---|---|
| Standard (under 150 kg) | Ceftriaxone 500 mg | Single IM injection | Not routine (except throat) |
| 150 kg or more | Ceftriaxone 1 g | Single IM injection | Not routine (except throat) |
| Chlamydia not excluded | Add doxycycline 100 mg twice daily, 7 days | Oral | Per gonorrhea site |
| Cephalosporin allergy | Gentamicin 240 mg IM + azithromycin 2 g oral | Single doses | Recommended |
| Ceftriaxone unavailable | Cefixime 800 mg (urogenital/anorectal only) | Single oral dose | Recommended |
Preventing gonorrhea going forward
What actually lowers risk in practice: use condoms correctly every time, get tested regularly at every exposed site, and make sure partners are treated. Abstaining for 7 days after the shot stops the back-and-forth ping-pong of reinfection. Mutual monogamy with a tested partner lowers risk, and abstinence is the only certain method.
DoxyPEP — a dose of doxycycline within 72 hours of sex — cuts chlamydia and syphilis by more than 70%, but it's much weaker against gonorrhea (around 50% in one trial, inconsistent across studies). The CDC does not recommend DoxyPEP specifically to prevent gonorrhea, partly over concern about driving tetracycline resistance in the bacterium CDC DoxyPEP 2024. Reported gonorrhea has actually been falling — roughly 601,000 cases in 2023 — though rates vary enormously by place CDC AtlasPlus.
When to see a clinician
Get evaluated if you have discharge, burning with urination, throat or rectal symptoms, or a known exposure — and don't sit on a swollen, painful testicle or new pelvic pain. If you're unsure how soon after contact a test will be accurate, check when to test after exposure. You can get tested for gonorrhea at clinics and at-home programs, and you can compare testing providers to find the right option for your situation.