Version July 2025
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INTRODUCTION —
Gonorrhea is a sexually transmitted infection that can affect both men and women. Approximately 700,000 people are infected with gonorrhea every year in the United States.
Common symptoms of genital tract gonorrhea include abnormal discharge from the vagina or penis, and pain with urination for either men or women. Persons who perform oral sex or have anal sex may have symptoms resulting from infection in those sites. Gonorrhea has potentially serious consequences if it is not treated, but this infection can be cured with antibiotics.
More detailed information about gonorrhea is available by subscription. (See 'Professional level information' below.)
GONORRHEA CAUSES —
Gonorrhea is caused by bacteria known as Neisseria gonorrhoeae. Gonorrhea can be spread from one person to another during oral, vaginal/penile, or anal sex. A man does not have to ejaculate to spread the infection. Insertive sex toys or objects may spread gonorrhea when shared between people. However, you cannot become infected with gonorrhea by touching objects, like a toilet seat.
Your risk of getting gonorrhea is greater if you have a new sexual partner, more than one sexual partner, or if you have other sexually transmitted infections.
GONORRHEA SYMPTOMS —
Symptoms of gonorrhea depend on where the infection is and whether you are male or female. However, some people have no symptoms at all. Because of this, people may not know they have gonorrhea unless they get tested, and so it is easy to spread infection.
Both men and women can develop infection of the throat, urethra (where urine exits the body), and rectum. In women, infection most commonly occurs in the cervix and can involve the uterus, fallopian tubes, and ovaries (figure 1). Infection in men in the urethra can spread to the prostate and the epididymis (figure 2).
Oral gonorrhea can cause a sore throat, but most infections of the throat cause no symptoms at all.
Women — In women, symptoms of gonorrhea can include the following, depending on the location of the infection:
●Vaginal itching or abnormal vaginal discharge
●Vaginal bleeding or spotting
●Pain or burning during urination
●Rectal discharge or constipation
●Pain with bowel movements
●Pain with intercourse
Men — The most common symptoms of gonorrhea in men include the following, depending on the location of the infection:
●Pain or discomfort with urination
●A milky discharge from the penis
●Pain and swelling in one testicle
●Rectal discharge or constipation
●Pain with bowel movements
However, it is important to remember that not everyone develops symptoms, so it is important to tell your provider what body parts you use for sex.
GONORRHEA DIAGNOSIS —
Testing for gonorrhea is usually done in a doctor or nurse's office or clinic. Tests that can be self-collected at home and sent to a laboratory for testing are increasingly available, but not all of them are accurate.
Tests can be performed on a urine sample, a swab of the vagina or cervix (in females), or a swab of the urethra (in males). Testing for oral or rectal gonorrhea can also be performed with a swab. Most clinics may provide results within one to three days, depending on the type of test performed. Some clinics use tests that can provide immediate results.
People who do a home test and receive a positive or indeterminate result should see a health care provider promptly. Even if the test is negative, they should still see a health care provider if they have symptoms or may have been exposed.
TESTING FOR OTHER SEXUALLY TRANSMITTED INFECTIONS —
If you or your sexual partner is diagnosed with a sexually transmitted infection, like gonorrhea, you should have testing for other infections, including HIV, chlamydia, trichomoniasis, and syphilis. Your doctor may also test you for hepatitis viruses. (See "Patient education: Testing for HIV (Beyond the Basics)" and "Patient education: Chlamydia (Beyond the Basics)" and "Patient education: Hepatitis B (Beyond the Basics)".)
GONORRHEA COMPLICATIONS —
If untreated, gonorrhea can lead to serious complications in both men and women, including:
●Women can develop pelvic inflammatory disease (PID) if gonorrhea spreads from the cervix to the uterus and fallopian tubes (figure 1). PID can scar the fallopian tubes and lead to infertility and an increased risk of ectopic pregnancy (when a pregnancy develops in the fallopian tube).
●Men with untreated gonorrhea can develop epididymitis (inflammation of the epididymis), which can lead to infertility. The epididymis collects sperm after it leaves the testis (figure 2).
●Both women and men can develop bloodstream infection from gonorrhea, which can be accompanied by a rash, joint infection, or arthritis. (See "Patient education: Joint infection (Beyond the Basics)".)
●People with gonorrhea are at higher risk of becoming infected with HIV. (See "Patient education: Symptoms of HIV (Beyond the Basics)".)
Infection during pregnancy — If you have (or think you may have) gonorrhea and are pregnant or want to get pregnant, it's important to get tested and treated as soon as possible. Untreated infection can cause serious problems in pregnancy, including miscarriage and premature birth. It's also possible to pass the infection on to your baby during delivery. This can cause conjunctivitis (red, swollen eyes that may ooze liquid) that can damage the baby's eyes and affect vision over time. Newborns infected with gonorrhea can have other symptoms and problems as well.
In the United States, most newborn babies get antibiotic ointment put into their eyes soon after birth; this helps prevent infection with gonorrhea.
GONORRHEA TREATMENT —
Treatment of gonorrhea is the same for women and men. Most experts recommend a one-time antibiotic treatment given as a shot into the muscle. If people have complications from gonorrhea, a longer duration of antibiotics may be needed. There is an oral antibiotic for gonorrhea, but it may not be as effective as the shot and is not the best therapy. Experts also recommend treatment for chlamydia at the same time unless a test for chlamydia was done and was negative. (See "Patient education: Chlamydia (Beyond the Basics)".)
If you continue to have symptoms after getting treatment for gonorrhea, call your provider right away, as you could have an infection that is resistant to standard antibiotics.
If you were diagnosed with oral gonorrhea, experts recommend that you get a repeat swab of your throat approximately seven days after treatment to make sure that the infection has cleared, even if you have no symptoms.
If you have had gonorrhea before, you are at increased risk of getting it (or another sexually transmitted infection) again. You should see your health care provider three months (or if this is not possible, within one year) after your treatment to be retested.
Sexual partner treatment — Treatment is important for you and anyone you have had sex with recently. Your doctor or nurse might ask you to tell your sexual partner(s) to be tested and treated. In some cases, your doctor or nurse will give you a prescription for your partner.
You should not have sex until seven days after treatment. Your recent sex partner(s) should also not have sex until seven days after treatment. It is possible to be infected with gonorrhea more than once.
GONORRHEA PREVENTION —
The most effective way to prevent gonorrhea is to avoid sexual contact. Because this is not a realistic option for most people, the following tips are recommended to reduce the risk of getting or spreading gonorrhea:
●Use a condom every time you have sex. Sex toys should be thoroughly cleaned between use.
●Do not have sex if you or your sexual partner has an abnormal discharge or burning with urination, a genital rash or sore, or any other symptom that might suggest a sexually transmitted infection.
●Discuss testing for sexually transmitted infections with your doctor or nurse. Ask if you are due for gonorrhea screening.
●See your doctor or nurse if you have any symptoms of gonorrhea or another infection.
An antibiotic pill after sex may also lower the risk of getting gonorrhea. Doctors call this "post-exposure prophylaxis," or "PEP." This has only been proven effective in specific groups of people, including:
●Men who have sex with men
●Transgender women
If you are in either of these groups and at increased risk for gonorrhea, PEP might be an option. Your doctor can talk to you about the medicine and help you decide. While this approach has not been proven to prevent sexually transmitted infections in other groups, including cisgender women, your doctor can provide more information on whether this might be an option for you.
If you decide to take PEP, start taking it as soon as possible after having unprotected sex, and within three days. While PEP helps lower your risk of getting gonorrhea, it is still possible to get infected. The medicine can also cause side effects, such as stomach upset.
WHERE TO GET MORE INFORMATION —
Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Chlamydia and gonorrhea (The Basics)
Patient education: Sexually transmitted infections (The Basics)
Patient education: Avoiding infections in pregnancy (The Basics)
Patient education: Ectopic pregnancy (The Basics)
Patient education: Anogenital warts (The Basics)
Patient education: Pelvic inflammatory disease (The Basics)
Patient education: Syphilis (The Basics)
Patient education: Vaginal discharge (The Basics)
Patient education: Epididymitis and orchitis (The Basics)
Patient education: Anal pruritus (anal itching) (The Basics)
Patient education: Urethritis (The Basics)
Patient education: Bartholin gland cyst (The Basics)
Patient education: Mycoplasma genitalium (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Symptoms of HIV (Beyond the Basics)
Patient education: Testing for HIV (Beyond the Basics)
Patient education: Chlamydia (Beyond the Basics)
Patient education: Hepatitis B (Beyond the Basics)
Patient education: Joint infection (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Acute cervicitis
Pelvic inflammatory disease: Clinical manifestations and diagnosis
Disseminated gonococcal infection
Epidemiology and pathogenesis of Neisseria gonorrhoeae infection
Pelvic inflammatory disease: Pathogenesis, microbiology, and risk factors
Screening for sexually transmitted infections
Treatment of uncomplicated gonorrhea (Neisseria gonorrhoeae infection) in adults and adolescents
Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents
The following organizations also provide reliable health information:
●National Institute of Allergy and Infectious Diseases
(www.niaid.nih.gov/diseases-conditions/gonorrhea)
●Centers for Disease Control and Prevention
(www.cdc.gov/gonorrhea/about/?CDC_AAref_Val=https://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm)
