Gonorrhoea is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It can infect the genitals, the rectum and the throat, and it often causes no symptoms at all, especially in women. When symptoms do appear, the most typical are burning when you urinate and an unusual discharge from the penis or vagina.
The good news: gonorrhoea is curable. It is diagnosed with a simple urine test or swab, and in the US the standard treatment is a single injection of the antibiotic ceftriaxone. Prompt testing and treatment protect your fertility, your partners and your long-term health.
Key takeaways
- 543,409 gonorrhoea cases were reported in the US in 2024 (provisional CDC data), and the infection is very common among people aged 15 to 24.
- Most women and many people with rectal or throat infections have no symptoms, so regular screening matters more than waiting for signs.
- A NAAT on a first-void urine sample (men) or a vaginal swab (women), plus throat or rectal swabs after oral or anal sex, is the test of choice.
- The CDC recommends one shot of ceftriaxone 500 mg (1 g from 150 kg, or 330 lb); azithromycin alone is no longer recommended.
- Two new oral antibiotics, zoliflodacin and gepotidacin, were approved by the FDA in December 2025, and drug resistance is closely watched worldwide.
What is gonorrhoea?
Gonorrhoea is a bacterial infection passed through sexual contact. The bacterium likes moist mucous membranes: the cervix and urethra, the rectum, the throat and, more rarely, the eyes. The CDC calls it the second most commonly reported bacterial communicable disease in the US, after chlamydia, and estimates that about 1.57 million new infections occur each year, far more than the number of cases reported.
Gonorrhoea says nothing about a person's worth. Anyone who is sexually active can get it, and a past infection does not protect you from catching it again.
How common is gonorrhoea?
According to provisional CDC surveillance data published in September 2025, 543,409 cases were reported in the US in 2024, a rate of 159.8 per 100,000 people. Cases fell 9.6% from 2023 and are well below the 2021 peak of 710,151 cases. Worldwide, the World Health Organization (WHO) estimates 82.4 million new infections among adults aged 15 to 49 in 2020.
How is gonorrhoea transmitted?
Gonorrhoea spreads through vaginal, anal or oral sex without a condom with a partner who has the infection. A pregnant person can also pass it to the baby during childbirth.
Risk is higher for people under 25, people with a new partner or several partners, people whose partner has other partners or an STI, and gay, bisexual and other men who have sex with men. The CDC also asks clinicians to note any recent sexual contact abroad, because resistant strains are more common in some regions.
Having gonorrhoea often goes hand in hand with other STIs. That is why a diagnosis usually leads to testing for chlamydia, syphilis and HIV at the same time.
Gonorrhoea symptoms
MedlinePlus notes that symptoms most often appear 2 to 5 days after infection, although in men they can take up to a month. WHO gives a range of 1 to 14 days. Many people never notice anything, yet they can still pass the infection on and develop complications.
Gonorrhoea in women
The CDC states that most women with gonorrhoea have no symptoms. When symptoms occur, they are often mild and easily mistaken for a bladder or vaginal infection:
- pain or burning when urinating;
- more vaginal discharge than usual, sometimes yellow, greenish or foul-smelling;
- bleeding between periods or after sex;
- pain during sex.
Severe lower belly pain with fever can mean the infection has spread to the uterus and fallopian tubes. Burning symptoms have many causes, as our guide to vaginal burning and its causes explains, so a test is the only way to know.
Gonorrhoea in men
Men are more likely to notice symptoms. The most common are:
- burning or pain when urinating, and needing to urinate more often or more urgently;
- a white, yellow or green discharge from the penis;
- a red or swollen opening at the tip of the penis;
- painful or swollen testicles, which is less common.
These signs can look like a urinary tract infection, but in a young, sexually active man, discharge and burning call for an STI test.
Rectal and throat infections
Rectal gonorrhoea may cause no symptoms or may cause discharge, anal itching, soreness, bleeding or painful bowel movements. Throat (pharyngeal) gonorrhoea usually causes no symptoms; when it does, WHO lists redness, pain and a sore throat. Because these infections are often silent, testing at each site of exposure is important.
Complications of untreated gonorrhoea
Untreated gonorrhoea can cause lasting harm. Antibiotics stop the infection, but they cannot undo damage that has already happened.
- In women: pelvic inflammatory disease (PID), which can scar the fallopian tubes and lead to ectopic pregnancy, infertility and long-term pelvic pain. MedlinePlus also mentions abscesses in the uterus and abdomen.
- In men: a painful infection of the tubes attached to the testicles (epididymitis), which rarely causes infertility, and scarring or narrowing of the urethra.
- In anyone: untreated gonorrhoea may increase the chance of getting or passing on HIV. Our guide to HIV symptoms, testing and treatment explains why HIV testing is offered at the same visit.
Disseminated gonococcal infection
Rarely, the bacteria enter the bloodstream. This disseminated gonococcal infection (DGI) usually shows up as skin lesions, joint pain, inflamed tendons or a hot, swollen joint (septic arthritis), sometimes with fever. In rare cases it can infect the heart valves or the lining of the brain. DGI is treated in the hospital with intravenous or intramuscular ceftriaxone.
How is gonorrhoea diagnosed?
Diagnosis is simple and usually painless. A clinician asks about symptoms and the type of sexual contact, then collects samples from the sites that may be infected.
The gonorrhoea test: NAAT on urine or swabs
The test of choice is a nucleic acid amplification test (NAAT), which detects the bacterium's genetic material. The CDC notes that NAATs are more sensitive than culture and can be done on the widest range of samples. The best urogenital samples are a first-void urine sample for men (the first part of the stream, without cleaning beforehand) and a vaginal swab for women, which you can often collect yourself. After oral or anal sex, throat and rectal swabs are added.
The same sample is usually tested for chlamydia too. Gonorrhoea and chlamydia tests are often grouped with blood tests for syphilis, HIV and hepatitis in an STI panel and serology tests.
Culture, Gram stain and rapid tests
A culture grows the bacteria from a swab of the cervix or urethra. It is less sensitive than a NAAT, but it is the only way to test which antibiotics still work (antimicrobial susceptibility testing). The CDC requires culture when treatment may have failed. Our article on drug-resistant gonorrhoea and what your test shows explains how labs look for resistance.
In men with symptoms, a Gram stain of urethral discharge gives a fast result and is more than 95% sensitive and more than 99% specific. Point-of-care NAATs and, since 2025, an FDA-authorised home test for women can also give results quickly.
Clues on a routine urine test
A standard urinalysis done for urinary symptoms may show signs of inflammation, such as leukocytes in urine. It cannot diagnose gonorrhoea, though: only a specific gonorrhoea test can.
Gonorrhoea tests at a glance
This table sums up the main tests, based on CDC guidance, MedlinePlus and the FDA.
| Test | Sample | What it tells you | Limits |
|---|---|---|---|
| NAAT (lab) | First-void urine (men), vaginal swab (women), throat or rectal swab | Gonorrhoea present or absent; most sensitive test | No information on antibiotic resistance |
| Point-of-care NAAT | Urine or swab | Result during the visit | Not available everywhere |
| Home test for women (FDA, 2025) | Self-collected vaginal swab | Result in about 30 minutes; correctly identified 100% of positive and 99.1% of negative gonorrhoea samples | A positive result needs a visit for treatment |
| Culture with susceptibility testing | Swab of the cervix or urethra (also throat or rectum) | Which antibiotics still work; early result within 24 hours, confirmed within 72 hours | Less sensitive than NAAT; needs rapid transport |
| Gram stain | Urethral discharge in men with symptoms | Bacteria inside white blood cells; more than 95% sensitive, more than 99% specific | A negative result does not rule out infection in men without symptoms; not used for cervix, throat or rectum |
How to read your gonorrhoea test result
- Positive (detected): you have gonorrhoea at the site tested. You need treatment, and your recent partners need testing and treatment too.
- Negative (not detected): no gonorrhoea was found in that sample. A negative urine test does not cover the throat or rectum, so ask whether those sites should be tested.
- Positive after treatment: this is usually a new infection or leftover genetic material from dead bacteria, not a treatment failure. A NAAT done too soon can stay positive for a while; your clinician decides whether a culture is needed.
If you were exposed very recently and the test is negative, ask your clinician whether and when to repeat it.
Gonorrhoea treatment
Gonorrhoea is treated with antibiotics, and treatment works best when it starts early. Never use leftover antibiotics or someone else's medicine: many older antibiotics no longer work against gonorrhoea.
The recommended regimen: one ceftriaxone shot
Since December 2020, the CDC has recommended a single intramuscular injection of ceftriaxone for uncomplicated gonorrhoea of the genitals, rectum and throat. Ceftriaxone is a cephalosporin antibiotic, first approved in 1984. If chlamydia has not been ruled out, a 7-day course of doxycycline is added.
| Situation | CDC regimen |
|---|---|
| Uncomplicated genital, rectal or throat infection, weight under 150 kg (330 lb) | Ceftriaxone 500 mg, one intramuscular injection |
| Same, weight 150 kg (330 lb) or more | Ceftriaxone 1 g, one intramuscular injection |
| Chlamydia not ruled out | Add doxycycline 100 mg by mouth twice a day for 7 days |
| Cephalosporin allergy (genital or rectal infection) | Gentamicin 240 mg intramuscular plus azithromycin 2 g by mouth, single doses |
| Ceftriaxone not available (genital or rectal infection) | Cefixime 800 mg by mouth, single dose |
| Gonococcal eye infection (conjunctivitis) | Ceftriaxone 1 g intramuscular, single dose |
A true penicillin allergy rarely rules out ceftriaxone: the CDC puts the cross-reaction with third-generation cephalosporins at under 1%. Our guide to penicillin allergy and testing explains how this is checked. Gonorrhoea of the eye needs a higher dose, and the CDC advises considering specialist advice; read more about conjunctivitis and its causes.
Why azithromycin and older pills are no longer used alone
Gonorrhoea has become resistant to one antibiotic after another. The CDC stopped recommending fluoroquinolones such as ciprofloxacin in 2007 and moved cefixime to second line. Isolates with reduced susceptibility to azithromycin rose almost tenfold after 2013, reaching 5.1% in 2019, so azithromycin monotherapy is not recommended. Decreased susceptibility to ceftriaxone or cefixime remained rare in the US, under 0.1% of isolates in 2019.
After treatment: sex, partners and retesting
- Wait 7 days after treatment before having sex, and until all your partners have been treated.
- Tell everyone you had sex with in the 60 days before your symptoms or diagnosis (or your most recent partner, if longer ago) so they can be tested and treated. In many US states, expedited partner therapy lets your clinician give you a prescription or medicine for your partner.
- A test of cure is not needed for genital or rectal infections treated with the recommended regimen. For throat gonorrhoea, the CDC recommends a test of cure 7 to 14 days after treatment.
- Retest about 3 months after treatment, even if your partners were treated, because reinfection is common.
- If symptoms last more than a few days after treatment, go back to your clinician.
Gonorrhoea in pregnancy and in newborns
The CDC recommends screening at the first prenatal visit for pregnant people under 25 and for those 25 and older at increased risk, with retesting in the third trimester if risk continues. Treatment in pregnancy is the same ceftriaxone shot, with treatment for chlamydia if it is not ruled out; gentamicin is avoided because of risks to the fetus. Our guide to blood tests during pregnancy describes the other prenatal checks.
A baby exposed during delivery can develop a severe eye infection, usually 2 to 5 days after birth, which can lead to blindness if untreated. That is why US newborns receive erythromycin eye ointment shortly after birth, a step required by law in most states.
How to prevent gonorrhoea
- Use condoms correctly every time you have vaginal, anal or oral sex.
- A long-term, mutually monogamous relationship with a partner who has tested negative lowers the risk.
- Get tested regularly if you are at risk, and ask partners to get tested too.
- Gay and bisexual men and transgender women who had a bacterial STI in the past year can discuss doxycycline post-exposure prophylaxis (doxy-PEP) with their clinician.
Who should be screened, and how often
The US Preventive Services Task Force (2021) recommends gonorrhoea screening for all sexually active women 24 or younger, including during pregnancy, and for women 25 and older at increased risk. It found too little evidence to recommend routine screening of men. The CDC adds that sexually active gay and bisexual men should be tested at least once a year at every exposed site, and every 3 to 6 months if they are at higher risk, for example when taking HIV pre-exposure prophylaxis (PrEP).
When to see a doctor
See a clinician or a sexual health clinic as soon as possible if:
- you notice burning when you urinate, an unusual discharge, bleeding between periods or after sex, or testicular pain;
- a partner tells you they have gonorrhoea or another STI, even if you feel well;
- you are pregnant and may have been exposed;
- your symptoms last more than a few days after treatment.
Get urgent care, or call 999 in an emergency, if you have severe lower belly pain with fever, a hot and swollen joint with fever, a spreading rash with fever, or a stiff neck with severe headache. These can signal pelvic inflammatory disease or an infection that has spread. Blood tests such as CRP may be ordered to measure inflammation, but the diagnosis rests on examination and specific tests.
Latest scientific advances in gonorrhoea
Two new oral antibiotics approved by the FDA (December 2025)
On December 12, 2025, the FDA approved two new pills for uncomplicated urogenital gonorrhoea. Zoliflodacin (Nuzolvence) is a single 3-gram dose of granules dissolved in water, for people 12 and older weighing at least 35 kg (77 lb). It is a first-in-class antibiotic that blocks the bacterial enzyme DNA gyrase at a different site from older drugs such as ciprofloxacin. In its phase 3 trial (NCT03959527, 930 participants, Lancet 2025), it cured 90.9% of urogenital infections versus 96.2% with ceftriaxone plus azithromycin, which met the non-inferiority goal. The most frequent side effects were headache (10%) and low neutrophil counts (7%), something that shows up on a white blood cell count.
Gepotidacin (Blujepa) is taken as two 3,000 mg doses 10 to 12 hours apart, for people 12 and older weighing at least 45 kg (99 lb). In the EAGLE-1 trial (NCT04010539, 628 participants, Lancet 2025), it cured 92.6% versus 91.2% with the standard treatment, with more stomach upset. The FDA reserved it for people with few or no other options. For you, this means a needle-free option may be offered in some situations, but ceftriaxone stays the recommended treatment in CDC guidance, and both pills are approved only for urogenital infections.
The meningitis B vaccine and gonorrhoea: hopes tempered by trials
The meningococcal B vaccine 4CMenB (Bexsero) protects against a bacterium closely related to gonorrhoea, and WHO notes possible cross-protection. Observational studies suggested it cut gonorrhoea by 33% to 47%, and in August 2025 England launched the world's first gonorrhoea vaccination programme for gay and bisexual men at higher risk. Randomised trials have since been disappointing. In the GoGoVax trial (NEJM 2026, NCT04415424, 587 men analysed), gonorrhoea rates were the same with vaccine or placebo (vaccine efficacy -0.5%). DOXYVAC in France (Lancet Infectious Diseases 2024, adjusted hazard ratio 0.78), MenGO in Australia (npj Vaccines 2026) and a Hong Kong trial (2026) found no statistically significant protection either. A large NIAID trial in the US, Malawi and Thailand (NCT04350138, 2,606 participants) was completed in July 2026; its results are awaited. The UK programme continues, and the UK Health Security Agency plans to share its monitoring data with its vaccine advisers in 2026 to 2027.
Doxy-PEP: a smaller effect on gonorrhoea
In June 2024, the CDC recommended doxy-PEP: 200 mg of doxycycline taken within 72 hours after sex, for gay and bisexual men and transgender women with a bacterial STI in the past year. In the DoxyPEP trial (NEJM 2023, NCT03980223), gonorrhoea fell by about 55% (relative risk 0.45) in the PrEP group, far less than chlamydia (relative risk 0.12). The CDC summarises the effect on gonorrhoea as about 50%, and notes more tetracycline-resistant gonorrhoea in people taking doxycycline. In short: doxy-PEP helps, but regular testing remains essential.
Ceftriaxone resistance: what global surveillance shows
WHO calls ceftriaxone the last remaining option for first-line empiric treatment. Its Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) tested 2,491 isolates from nine countries in 2023: 3.8% were resistant to ceftriaxone, 3.6% to azithromycin and 95.3% to ciprofloxacin. All ceftriaxone-resistant strains came from Cambodia (15.3%) and Viet Nam (20.4%). Ceftriaxone-resistant strains have also been reported in Denmark, France, Japan and the UK. This is why clinicians ask about travel, why culture is requested when treatment fails, and why the new antibiotics are being introduced with careful monitoring.
Which tests can help?
If you are worried about gonorrhoea, the key test is a NAAT on urine or swabs, with throat and rectal swabs when relevant. A complete STI check usually adds:
- a chlamydia NAAT on the same sample;
- blood tests for syphilis (such as an RPR test), HIV and, depending on risk, hepatitis B and C;
- a urinalysis or urine culture if you have urinary symptoms, to look for another cause such as a bladder infection;
- a culture with susceptibility testing if symptoms persist after treatment or you were exposed abroad.
Other germs can cause similar burning and discharge, including ureaplasma, while sores point more toward herpes or syphilis. A good panel avoids guesswork.
Glossary
- Neisseria gonorrhoeae: the bacterium that causes gonorrhoea, also called the gonococcus.
- NAAT: nucleic acid amplification test, a lab test that detects the genetic material of a germ.
- Culture: growing bacteria from a sample in the lab, which allows antibiotic testing.
- Antimicrobial susceptibility testing: a lab test showing which antibiotics still kill a bacterial strain.
- Pharyngeal gonorrhoea: gonorrhoea of the throat, usually caught through oral sex.
- Pelvic inflammatory disease (PID): infection of the uterus, fallopian tubes or ovaries, which can cause infertility.
- Epididymitis: inflammation of the coiled tube behind the testicle.
- Disseminated gonococcal infection (DGI): rare spread of gonorrhoea through the blood to the skin, joints or other organs.
- Expedited partner therapy (EPT): giving a patient medicine or a prescription to pass on to a sex partner.
- Doxy-PEP: doxycycline taken after sex to lower the risk of some bacterial STIs.
Frequently asked questions
How is gonorrhoea transmitted?
Through vaginal, anal or oral sex without a condom with someone who has gonorrhoea, and from a pregnant person to the baby during birth. You can get it even if your partner has no symptoms.
What are gonorrhoea symptoms in females?
Most women have no symptoms. When present, they include burning when urinating, more or unusual vaginal discharge, bleeding between periods or after sex and pain during sex. Severe lower belly pain with fever suggests pelvic inflammatory disease and needs urgent care.
Is azithromycin effective in treating gonorrhoea?
Not on its own. Because resistance to azithromycin has risen, the CDC no longer recommends it alone for gonorrhoea. It is only used together with gentamicin when someone cannot receive a cephalosporin. The recommended treatment is one ceftriaxone injection.
Can gonorrhoea go away on its own in males?
Do not count on it. Symptoms may fade, but the infection can persist for weeks or months without you knowing, while you can still pass it on and develop complications such as epididymitis. Health authorities state that antibiotics are needed to cure gonorrhoea, so get tested and treated.
What is pharyngeal gonorrhoea?
It is gonorrhoea of the throat, caught through oral sex. It usually causes no symptoms, sometimes a sore throat. It is harder to cure than genital infection: the CDC treats it with ceftriaxone only and asks for a test of cure 7 to 14 days later.
Is gonorrhoea curable?
Yes. The right antibiotic cures gonorrhoea, usually with one injection. You can catch it again, so retest about 3 months later and make sure your partners are treated.
How long does gonorrhoea last?
Without treatment, it can last for weeks or months, often silently. With the right antibiotic, the infection usually clears within 7 to 14 days; see your clinician if symptoms last more than a few days after treatment. Wait 7 days after treatment, and until partners are treated, before having sex again.
Sources
- Centers for Disease Control and Prevention — Gonococcal Infections Among Adolescents and Adults, STI Treatment Guidelines 2021 — CDC, 2021 — cdc.gov
- Centers for Disease Control and Prevention — About Gonorrhea — CDC — cdc.gov
- Centers for Disease Control and Prevention — Sexually Transmitted Infections Surveillance, 2024 (Provisional) — CDC, 2025 — cdc.gov
- Centers for Disease Control and Prevention — Gonococcal Infections Among Neonates — CDC, 2021 — cdc.gov
- St Cyr S et al. — Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 — MMWR, 2020 — doi.org
- Bachmann LH et al. — CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial STI Prevention — MMWR Recomm Rep, 2024 — cdc.gov
- US Preventive Services Task Force — Chlamydia and Gonorrhea: Screening — USPSTF, 2021 — uspreventiveservicestaskforce.org
- MedlinePlus — Gonorrhea — National Library of Medicine — medlineplus.gov
- World Health Organization — Gonorrhoea (Neisseria gonorrhoeae infection) fact sheet — WHO, 2025 — who.int
- World Health Organization — Multi-drug resistant gonorrhoea fact sheet — WHO, 2025 — who.int
- US Food and Drug Administration — FDA approves two oral therapies to treat gonorrhea — FDA, 2025 — fda.gov
- US Food and Drug Administration — FDA grants marketing authorization of first home test for chlamydia, gonorrhea and trichomoniasis — FDA, 2025 — fda.gov
- UK Health Security Agency — National gonorrhoea vaccination programme using 4CMenB vaccine: frequently asked questions — GOV.UK, 2026 — gov.uk
- Luckey A et al. — Zoliflodacin versus ceftriaxone plus azithromycin for uncomplicated urogenital gonorrhoea: phase 3 trial — Lancet, 2025 — doi.org
- Ross JDC et al. — Oral gepotidacin for uncomplicated urogenital gonorrhoea (EAGLE-1) — Lancet, 2025 — doi.org
- Luetkemeyer AF et al. — Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections — N Engl J Med, 2023 — doi.org
- Molina JM et al. — Doxycycline prophylaxis and meningococcal group B vaccine to prevent bacterial STIs (ANRS 174 DOXYVAC) — Lancet Infect Dis, 2024 — doi.org
- Seib KL et al. — Meningococcal B Vaccine to Prevent Neisseria gonorrhoeae Infection (GoGoVax) — N Engl J Med, 2026 — doi.org
- Thng C et al. — Efficacy of the meningococcal vaccine against Neisseria gonorrhoeae: a randomised clinical trial (MenGO) — NPJ Vaccines, 2026 — doi.org
- Kwan TH et al. — Efficacy of the 4CMenB vaccine against gonorrhea among men who have sex with men in Hong Kong — Int J Infect Dis, 2026 — doi.org
- Maatouk I et al. — Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within WHO EGASP, 2023 — Lancet Reg Health West Pac, 2025 — doi.org
- National Institute of Allergy and Infectious Diseases — Efficacy of Meningococcal Group B Vaccine (Bexsero) in Preventing Gonococcal Infection (NCT04350138) — ClinicalTrials.gov — clinicaltrials.gov
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Further reading
- Chlamydia rash: real causes and when to test
- Leukocyte esterase in urine: what it means
- HIV blood test: how to read your results
- Human papillomavirus: symptoms, vaccine and tests
- Hepatitis C antibody test: what positive means
- Urinalysis results explained: read your report
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