Learn about
Gonorrhea
Gonorrhea is a bacterial STD caused by Neisseria gonorrhoeae that can infect the genitals, rectum, and throat. It is among the most commonly reported infectious diseases in the US, with approximately 700,000 new cases annually. What makes gonorrhea particularly concerning in 2025 is the dramatic rise of antibiotic-resistant strains — making prompt, accurate diagnosis and correct first-line treatment more important than at any point in the antibiotic era. Untreated gonorrhea causes serious reproductive complications and increases HIV transmission risk.
Gonorrhea Symptoms
Many people with gonorrhea — particularly women — have no symptoms. When symptoms do appear, they typically occur 1–4 days after exposure, which is a shorter window than chlamydia. In men: yellow-green penile discharge and burning on urination are the most common presentations. In women: increased vaginal discharge, burning on urination, or pelvic pain — but most women are asymptomatic. Rectal gonorrhea (from anal sex) may cause discharge, bleeding, or pain, or nothing at all. Pharyngeal (throat) gonorrhea from oral sex is usually asymptomatic but occasionally causes sore throat. Because the discharge from gonorrhea can look similar to chlamydia, laboratory testing is required to distinguish them.
Gonorrhea Transmission
Gonorrhea spreads through vaginal, anal, or oral sex with an infected partner. It can infect the urethra, cervix, rectum, and throat — meaning a urine test alone will not detect rectal or pharyngeal infections. Site-specific swabs are needed for people who engage in anal or oral sex. Gonorrhea can also be passed from a pregnant person to their baby during childbirth, causing neonatal conjunctivitis that can lead to blindness if untreated. Condoms substantially reduce but do not eliminate transmission risk.
Gonorrhea Treatment
The current CDC-recommended treatment is a single intramuscular injection of ceftriaxone 500mg (or 1g if body weight exceeds 150kg). Dual therapy with azithromycin, previously standard, is no longer recommended due to widespread azithromycin resistance. Because gonorrhea resistance patterns evolve rapidly, treatment should follow current CDC guidelines — confirm with your provider that you're receiving the recommended regimen. All sexual partners from the past 60 days should be tested and treated. Retest 1–2 weeks after treatment if pharyngeal infection was present, as cure rates at this site are lower.
Gonorrhea Health Risks
Untreated gonorrhea ascends into the reproductive tract in women, causing PID with risks of infertility and ectopic pregnancy. In men, it can cause epididymitis. Disseminated gonococcal infection (DGI) — gonorrhea spreading via the bloodstream to joints, skin, and rarely the heart — occurs in 0.5–3% of cases and requires hospitalization and IV antibiotics. Gonorrhea substantially increases the risk of both acquiring and transmitting HIV. The growing prevalence of antibiotic-resistant strains means untreated or inadequately treated gonorrhea may be harder to clear with subsequent courses.
Gonorrhea Prevention
Consistent condom use substantially reduces gonorrhea transmission but does not eliminate it — throat and rectal infections can occur in areas not covered by a condom. Regular screening is the most effective preventive measure: the CDC recommends annual gonorrhea screening for all sexually active women under 25, and for MSM at all exposure sites (urethra, rectum, throat) at least annually, with more frequent testing (every 3–6 months) for those with multiple partners. There is currently no vaccine for gonorrhea.
Gonorrhea Diagnosis
Gonorrhea is diagnosed by nucleic acid amplification test (NAAT) — the gold standard for sensitivity and specificity. For urogenital infection: urine sample (men) or vaginal swab. For rectal and pharyngeal infection: site-specific swabs are required. A urine test will not detect rectal or throat gonorrhea. Rapid point-of-care tests are available but less sensitive than lab-based NAAT. Culture testing is used when antibiotic resistance testing is needed. The window period is typically 1–2 weeks after exposure.
Gonorrhea Complications
PID from ascending gonorrhea affects approximately 10–15% of women with untreated infection and is a leading preventable cause of infertility and ectopic pregnancy in the US. Epididymitis in men can cause chronic pain and fertility impacts in severe cases. DGI — gonorrhea in the bloodstream — causes septic arthritis, dermatitis, and rarely endocarditis or meningitis. Neonatal gonococcal ophthalmia, acquired during delivery, can rapidly progress to corneal ulceration and blindness without prompt treatment. Gonorrhea increases HIV acquisition and transmission risk two-to-threefold.
Gonorrhea Post-Diagnosis Advice
Receive the full ceftriaxone injection — oral antibiotics are not adequate first-line treatment for gonorrhea in 2025. Abstain from sex for 7 days after treatment and until all recent partners have been treated. Notify all sexual partners from the previous 60 days so they can be tested and treated. Retesting is recommended 1–2 weeks after treatment for pharyngeal infections (cure rates are lower at this site) and at 3 months after any gonorrhea diagnosis to catch reinfection. If symptoms persist after treatment, return to your provider immediately — this may indicate treatment failure from an antibiotic-resistant strain requiring a different regimen.
Gonorrhea Myths & Facts
Myth: Gonorrhea only affects the genitals. Fact: Gonorrhea commonly infects the throat and rectum through oral and anal sex, and these sites are usually asymptomatic — a urine test alone will miss them.
Myth: If I don't have symptoms, I don't have gonorrhea. Fact: Most women with gonorrhea have no symptoms; many men also carry it asymptomatically.
Myth: Gonorrhea is easy to cure with any antibiotic. Fact: Gonorrhea has developed resistance to multiple antibiotic classes; only current CDC-recommended regimens should be used.
Myth: I was treated before, so I can't get it again. Fact: Past infection provides no immunity. Reinfection from an untreated partner is common.
Gonorrhea FAQ
How long does it take for symptoms to appear?
When symptoms occur, they typically appear 1–4 days after exposure — faster than chlamydia. However, the majority of infections — particularly in women and in rectal or pharyngeal sites — cause no symptoms. The absence of symptoms does not mean no infection is present.
Can you get gonorrhea again after treatment?
Yes, and this is common. Past gonorrhea infection provides no immunity. If you're treated successfully but a partner remains untreated, reinfection can occur immediately after you resume sex. Partners from the previous 60 days all need to be tested and treated regardless of symptoms, and retesting at 3 months is recommended after any gonorrhea diagnosis.
