The standard treatment for uncomplicated gonorrhea is a single intramuscular injection of ceftriaxone, given in the clinic. Oral-only regimens have been dropped because the bacteria became resistant to them. The shot cures the infection at all sites, though throat infections need a follow-up test to confirm clearance.
| Item | Cases per 100,000 |
|---|---|
| 2021 | 214 |
| 2022 | 194.4 |
| 2023 | 179.5 |
The essentials: what gonorrhea is and why treatment changed
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which can colonize the genitals, the rectum, and the throat CDC About Gonorrhea. Treatment cures it, but medicine clears the bacteria without undoing damage that's already happened. Scarring of the fallopian tubes, for instance, won't reverse, so catching it early matters.
The drug itself has changed. For years, doctors prescribed two medicines together: ceftriaxone plus oral azithromycin. As of the 2020 CDC update, the recommended regimen is ceftriaxone alone, because the gonococcus stayed highly susceptible to ceftriaxone while resistance to azithromycin climbed MMWR 2020. Azithromycin was dropped over antimicrobial-stewardship concerns and rising reduced susceptibility, and the ceftriaxone dose was raised. You can no longer treat gonorrhea with a bottle of take-home pills.
Resistance drives everything here. Gonorrhea has steadily outrun sulfonamides, penicillin, tetracyclines, fluoroquinolones, and cefixime. Cephalosporins like ceftriaxone are one of the last reliably effective classes left, and even cephalosporin susceptibility is slowly slipping. That history is why clinicians guard ceftriaxone so carefully.
Symptoms: what gonorrhea actually feels like
Many gonorrhea infections cause no symptoms at all, which is the main reason it spreads. In women, infections are commonly asymptomatic, and the majority of throat infections produce no symptoms whatsoever. You can carry and pass it on while feeling completely fine, and testing is the only way to know.
When symptoms do appear, they differ by site:
- In men: burning during urination; a white, yellow, or green discharge from the penis; and, less commonly, swollen or painful testicles. A painful testicle can signal epididymitis, inflammation of the coiled tube behind the testicle that stores sperm, which can threaten fertility if ignored.
- In women: painful or burning urination, increased vaginal discharge, and bleeding between periods. Symptoms are often mild and mistaken for a bladder or yeast infection.
- Rectal infection: discharge, anal itching, soreness, bleeding, or pain during bowel movements. These follow receptive anal sex and are easy to miss without a swab.
- Throat infection: usually silent. Pharyngeal gonorrhea can persist for weeks without a sore throat, which matters for both detection and resistance.
Testing: how gonorrhea is diagnosed
The preferred test is a NAAT (nucleic acid amplification test), which detects the bacterium's genetic material with high sensitivity (usually above 90%) and high specificity (around 99%) CDC STI Guidelines. A urogenital sample is a first-catch urine (the first part of the stream) for men and women, or a vaginal swab for women. Patient-collected swabs are acceptable, and self-collection is routine at many clinics.
Swab every site you've exposed. A urine test will miss a throat or rectal infection entirely. If you've had oral or anal sex, ask specifically for a throat or rectal swab, a quick painless pass with a cotton-tip, or the infection goes undiagnosed and untreated. Screening all anatomic sites of sexual exposure is the standard. For more on sample types and reading results, see our guide to the gonorrhea test, and if you're counting the days since a hookup, check the right when to test after exposure before assuming a negative is final.
In practice, testing is fast and low-drama: you pee in a cup, hand over any swabs, and you're done. You can get tested at a public health clinic, many of which offer it free or at low cost.
Treatment: the ceftriaxone injection and the alternatives
The recommended treatment is ceftriaxone 500 mg given as a single intramuscular injection for people under 150 kg; for people 150 kg or more, the dose is 1 g CID 2020 summary. That one shot covers urogenital, anorectal, and pharyngeal infection. If chlamydia hasn't been ruled out, and the two often travel together, doxycycline 100 mg by mouth twice daily for 7 days is added to cover it.
This is a shot given on-site, not pills you take home. Oral-only regimens are no longer reliable for gonorrhea, so plan to be treated in the clinic. Abstain from sex for 7 days after the injection so you don't re-pass the infection while it clears. We cover full regimens, alternatives, and what to expect in our deep dive on gonorrhea treatment.
There are backups when ceftriaxone won't work. For a documented cephalosporin allergy, the option is gentamicin 240 mg IM plus azithromycin 2 g orally, both as single doses. If ceftriaxone simply isn't available, cefixime 800 mg orally as a single dose is a fallback, but it treats only urogenital and anorectal gonorrhea and does not reliably cure the throat, so a test-of-cure is needed afterward.
| Scenario | Regimen | Sites covered |
|---|---|---|
| First-line, under 150 kg | Ceftriaxone 500 mg IM, single dose | Genital, rectal, throat |
| First-line, 150 kg or more | Ceftriaxone 1 g IM, single dose | Genital, rectal, throat |
| Chlamydia not excluded | Add doxycycline 100 mg orally twice daily for 7 days | Adds chlamydia coverage |
| Cephalosporin allergy | Gentamicin 240 mg IM + azithromycin 2 g orally, single doses | Genital, rectal |
| Ceftriaxone unavailable | Cefixime 800 mg orally, single dose (test-of-cure needed) | Genital, rectal only — not throat |
Why the throat is the hard case
Pharyngeal gonorrhea is tougher to cure than genital or rectal infection. Even fully susceptible throat infections failed ceftriaxone in a small share of cases, so a test-of-cure is advised for the throat: return 7 to 14 days after treatment, with culture preferred where available or a NAAT otherwise. The throat also acts as a resistance breeding ground, where gonorrhea can pick up resistance genes from harmless bacteria living there, and because pharyngeal infections are usually symptomless and can linger for weeks, that window stays open.
New oral antibiotics on the horizon
In December 2025 the FDA approved two new oral antibiotics, zoliflodacin (Nuzolvence) and gepotidacin (Blujepa), the first entirely new antibiotic classes for gonorrhea in over 30 years FDA 2025. Zoliflodacin is a single oral dose for uncomplicated urogenital gonorrhea in patients 12 and older weighing at least 35 kg; its Phase 3 trial achieved about 91% microbiological cure, non-inferior to the older ceftriaxone-plus-azithromycin regimen. Gepotidacin is an oral option reserved for cases where few or no other choices exist because of resistance FDA Blujepa. Neither replaces the ceftriaxone injection as first-line yet; they're held in reserve for resistance scenarios so their effectiveness lasts.
After treatment: partners, retesting, and reinfection
Treating you alone doesn't end the cycle. Sexual partners from the prior 60 days should be notified and treated, and you both abstain from sex for 7 days after treatment. Where in-person evaluation isn't possible and the law allows it, expedited partner therapy, cefixime 800 mg orally sent home for a heterosexual partner, is an option.
Plan to retest about 3 months after treatment. This isn't a test-of-cure; it's to catch reinfection, which is common because the original partner network is often the same. Curing the infection doesn't make you immune. Learn the practical signs and timing in our piece on gonorrhea reinfection.
Prevention: what actually works
Correct condom use every time is the most reliable everyday protection; mutual monogamy with a tested partner lowers risk; and abstinence is the only certain method. Regular screening of every exposed site rounds it out. After treatment, the 7-day abstinence rule keeps you from bouncing the infection back and forth with a partner.
One prevention tool that does not apply well here is DoxyPEP, a dose of doxycycline taken within 72 hours of sex. It cuts chlamydia and syphilis substantially but is much less effective against gonorrhea, and results have been inconsistent. The CDC does not recommend DoxyPEP specifically for gonorrhea prevention, partly out of concern it could drive tetracycline resistance in the gonococcus CDC DoxyPEP 2024.
When to see a clinician
See a clinician promptly if you have burning urination, an unusual genital discharge, rectal pain or bleeding, or any symptom after sex with a new or untreated partner. Don't wait on a swollen, painful testicle, since epididymitis needs prompt care. Get evaluated too if a partner tells you they tested positive, even if you feel fine, since silent infections are the rule rather than the exception.