Treatment and Therapy
Gonorrhea Treatment: The Complete Guide
Gonorrhea is treated with a single 500 mg intramuscular injection of ceftriaxone — the only CDC-recommended regimen in the United States as of the 2021 STI Treatment Guidelines. If chlamydia hasn't been ruled out, doxycycline is added. Most people feel improvement within 24 to 48 hours, though a small number of infections — particularly pharyngeal ones — need a follow-up test to confirm the infection has cleared.
In my practice, gonorrhea treatment questions almost always come with some anxiety attached — patients want to know it's actually gone, and whether the antibiotics they read about online are still what doctors use. The short answer is that treatment has changed meaningfully in the past several years because of antibiotic resistance, so it's worth understanding what current, evidence-based treatment actually looks like.
What Is the Standard Treatment for Gonorrhea?
As of the CDC's current clinical guidance, uncomplicated gonorrhea of the cervix, urethra, rectum, or throat is treated with a single 500 mg intramuscular dose of ceftriaxone for patients under 150 kg (a higher 1 g dose is used for patients above that weight). This replaced the older dual-therapy approach that paired ceftriaxone with azithromycin — a change driven by rising azithromycin resistance and concerns about unnecessary antibiotic exposure to other bacteria in the body.
If chlamydial infection hasn't been excluded by testing at the time of treatment, doxycycline 100 mg twice daily for 7 days is added, since co-infection with chlamydia is common enough that treating empirically makes clinical sense.
Why Treatment Changed: The Antibiotic Resistance Story
Neisseria gonorrhoeae has a well-documented history of developing resistance to nearly every antibiotic class used against it — sulfonamides, penicillin, tetracycline, fluoroquinolones, and most recently, reduced susceptibility to azithromycin. This is why the CDC now recommends ceftriaxone monotherapy at a higher dose rather than the dual-therapy regimen used until 2020, and why clinicians are told to stay alert for treatment failures rather than assume any regimen will remain effective indefinitely.
Treatment Era | Regimen | Why It Changed |
|---|---|---|
Pre-2010 | Cefixime or ceftriaxone alone | Cefixime resistance emerged |
2010–2020 | Ceftriaxone 250mg + azithromycin 1g | Dual therapy to prevent resistance |
2021–present | Ceftriaxone 500mg (monotherapy) | Rising azithromycin resistance; antimicrobial stewardship |
Do I Need a Test-of-Cure?
For uncomplicated urogenital or rectal gonorrhea treated with the recommended ceftriaxone dose, a test-of-cure generally isn't necessary unless symptoms persist. Pharyngeal (throat) gonorrhea is the exception — a test-of-cure 7 to 14 days after treatment is recommended regardless of regimen, since throat infections have historically responded less reliably to treatment. Everyone treated for gonorrhea should be retested around 3 months later, not to check that treatment worked, but because reinfection from an untreated partner is common.
What About Partners?
Every sexual partner from the 60 days before symptom onset (or diagnosis, if asymptomatic) should be tested and treated, regardless of whether they have symptoms. Many clinics offer expedited partner therapy (EPT), which allows a prescription or medication to be given to the partner without requiring them to be examined first — an option specifically intended to reduce reinfection rates.
When to Seek Urgent Care
Go to the ER immediately if you develop joint pain, swelling, and a skin rash after gonorrhea exposure — possible signs of disseminated gonococcal infection
Call your doctor within 24 hours if symptoms haven't improved 3 to 5 days after treatment
Call your doctor within 24 hours if you experience new or worsening pelvic pain with fever after treatment
Seek same-day evaluation if you are pregnant and have a confirmed or suspected infection
Frequently Asked Questions
Can gonorrhea be treated with oral antibiotics instead of an injection?
The injectable ceftriaxone regimen is the only CDC-recommended first-line treatment. If injection truly isn't possible, a single 800 mg oral dose of cefixime can be considered, but it's a second-choice option — your healthcare provider will determine what's appropriate for your situation.
Is gonorrhea curable?
Yes, with the correct antibiotic regimen, gonorrhea is curable. However, past infection provides no immunity, so reinfection from an untreated or new partner is entirely possible.
How long after treatment can I have sex again?
You should wait at least 7 days after completing treatment, and until all partners have also been treated, to avoid reinfecting each other.
What if ceftriaxone doesn't work?
Confirmed treatment failures are rare in the U.S., but any case of persistent symptoms after correct treatment (with reinfection ruled out) should be reported and reevaluated, since it may indicate a resistant strain.
Can I be allergic to the treatment?
Cephalosporin allergies exist but are uncommon. If you have a documented severe penicillin or cephalosporin allergy, tell your provider — alternative regimens exist, though they are generally considered less reliably effective.
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Dr. Michael Thompson is an expert in sexually transmitted diseases with extensive clinical and research experience. He leads campaigns advocating for early diagnosis and prevention of diseases like HIV and gonorrhea.