What Is Gonorrhea?

Gonorrhea is a common sexually transmitted infection (STI), meaning it is spread through sexual contact. It's a bacterial infection that can affect your eyes, mouth, throat, reproductive organs, genitals, or rectum (the lowest portion of your large intestine, closest to your anus).

Gonorrhea is the second most common bacterial STI in the United States, based on self-reports. According to the World Health Organization (WHO), there were about 82.4 million cases worldwide in 2020. In the United States, there were about 710,000 cases reported in 2021. More than half of these cases are people aged 15-24.

Gonorrhea is often asymptomatic, meaning you don't experience any symptoms. However, if left untreated, gonorrhea can lead to serious health complications.

Locations

Gonorrhea can infect the mouth, throat, eyes, reproductive organs, urethra (the tube that transports urine out of your body), or rectum. Diagnosis depends on the location of the infection, but the infection can spread from one area of your body to another.

Rectal Gonorrhea

Rectal gonorrhea occurs in the rectal or anal area. It's commonly contracted through anal intercourse, but it can spread to the genital area.

Oropharyngeal Gonorrhea

Oropharyngeal gonorrhea occurs in the mouth or throat. It's most commonly transmitted by having oral sex with someone who has an active gonorrheal infection in their penis. However, you can get oropharyngeal gonorrhea through oral contact with any genitalia. It can also be passed through kissing someone who has oropharyngeal gonorrhea.

Urogenital Gonorrhea

Urogenital gonorrhea affects the urinary and reproductive systems. It often affects the urethra.

It can also affect parts of your reproductive system. External reproductive organs or glands include the penis, prostate (a gland located between the bladder and penis), and epididymis (a duct behind the testes that transports sperm). Internal reproductive organs include the cervix (the lower part of the uterus that connects the uterus and vagina), uterus, and fallopian tubes (tubes that transport eggs from the ovaries to the uterus). All of these organs can be affected by urogenital gonorrhea.

Conjunctival Gonorrhea

Conjunctival gonorrhea occurs in the eye or eyes. This type of gonorrhea is more common in babies.

Newborns are at a higher risk because they're exposed to genital secretions as they pass through the birth canal during delivery. Conjunctival gonorrhea occurs in 30% to 50% of babies whose mothers have gonorrhea during childbirth.

Gonorrhea Symptoms

You may not experience any symptoms of gonorrhea. Symptoms can vary based on the type of gonorrhea, as well as the reproductive organs you have.

Rectal Gonorrhea Symptoms

Rectal gonorrhea is often asymptomatic. Symptoms may include:

• Rectal discharge or pain
• Rectal bleeding
• Painful bowel movements
• Anal itching
  

Oropharyngeal Gonorrhea Symptoms

Oropharyngeal gonorrhea is typically asymptomatic. Symptoms may include:

• Scratchy or sore throat
• Swollen lymph nodes (small bean-like structures that help fight infections)
• Difficulty swallowing 
  

Urogenital Gonorrhea Symptoms

Over 50% of people with internal reproductive organs like a cervix, uterus, or fallopian tubes are asymptomatic. If they have symptoms, they might be mistaken for a vaginal or bladder infection.

Possible symptoms include:

• Painful urination
• Abnormal vaginal discharge
• Pain with sexual intercourse
• Vaginal itching
• Vaginal bleeding outside of the normal menstrual period
• Lower abdomen or pelvic pain

More than 90% of people with external reproductive organs like a penis, testicles, or a prostate have symptoms. The most common signs of gonorrhea include:

• Painful urination
• Penile discharge or itching
• Testicular pain or swelling on one side
  

Conjunctival Gonorrhea Symptoms

Conjunctival gonorrhea symptoms might include:

• Eyelid swelling
• Eye discharge
• Eye redness 
• Eye tenderness
• Vision loss

Causes

Gonorrhea is caused by the bacteria Neisseria gonorrhea. Anyone who engages in sexual activity can get gonorrhea. It's typically transmitted through oral, vaginal, or anal sex, with or without ejaculation. You are also at a slight risk of getting gonorrhea during non-intercourse sexual intimacy or through unwashed sex toys.

Diagnosis

In addition to taking your medical history, your healthcare provider will most likely ask you for a urine sample (peeing in a cup). The lab will look for signs of gonorrhea in your urine using nucleic acid amplification testing (NAAT). NAAT can detect very minor amounts of a virus or bacteria.

NAATs have made it easier to detect gonorrhea through urine testing. However, your healthcare provider may also perform a culture test. This checks your sensitivity to various antibiotics, which might be used to treat gonorrhea. A culture is a lab test that looks at your sample in a petri dish to check for bacterial growth.

Possible sample sites for NAAT and culture testing include:

• Vaginal or cervical swab
• Urethral swab
• Rectal swab, if you have symptoms of rectal gonorrhea
• Throat swab, if you have symptoms of oropharyngeal gonorrhea

Gonorrhea Treatment

The treatment for gonorrhea is a one-time intramuscular (IM) injection of antibiotics. An IM injection is a shot in your muscle. Experts recommend Rocephin (ceftriaxone), a broad-spectrum antibiotic. The dose is 500 milligrams (mg) for teenagers and adults who weigh less than 150 kg (330 lbs) or 1000mg (1 gram) for people who weigh 150 kg (330 lbs) or more.

Rocephin (ceftriaxone) is 95% to 99% effective for uncomplicated gonorrhea, meaning the gonorrhea has not spread to other organs.

If you have an allergy to cephalosporins (the class of antibiotics that Rocephin is part of), your healthcare provider might prescribe a single 240 mg IM dose of Garamycin (gentamycin) plus a single two-gram oral dose (taken by mouth) of Zithromax. If Rocephin is unavailable, they might prescribe a single 800 mg oral dose of Pancef or Caricef (cefixime).

Chlamydia (an STI caused by Chlamydia trachomatis bacteria) is often treated along with gonorrhea because it’s common to have both STIs at the same time. It chlamydial infection has not been excluded (meaning you could have it), you will likely receive a prescription of Vibramycin (doxycycline), 100 mg orally twice a day for seven days. These antibiotics are safe to take during pregnancy.

You will need to finish the entire prescription of antibiotics, even after symptoms resolve. This decreases the risk that the bacteria will become resistant to the antibiotic.

Your sexual partner or partners will also need treatment so they do not re-infect you or infect others. During treatment, you need to restrain from all sexual activities until seven days after you and your sexual partners complete treatment and after all symptoms resolve.

Your healthcare provider may instruct you to retest three months later, or one to two weeks after completing treatment for oropharyngeal gonorrhea. Retesting ensures the gonorrhea is gone and monitors you for potential reinfection.

Prevention

You can take preventative measures to lower your risk of contracting gonorrhea. These include:

• Practicing safer sex by using barrier devices such as condoms, dental dams, and gloves
• Avoiding all forms of sexual activity with anyone who has a diagnosis of or symptoms of gonorrhea
• Limiting sexual partners or remaining in a monogamous relationship 
• Getting regular STI screenings, especially because you might not have any symptoms

Experts recommend yearly STI screening for people with internal reproductive organs like a cervix, uterus, and fallopian tubes who are sexually active and under the age of 25 or over the age of 25 with risk factors.

Risk factors for gonorrhea include:

• A diagnosis of another STI 
• Sexual activity with a partner who has gonorrhea or another STI
• Multiple sexual partners
• New sexual partners
• Sexual partners who engage in sexual activity with others
• Not using condoms correctly when engaging in any form of sex
  

If you're pregnant, your healthcare provider will likely screen you for gonorrhea during your first prenatal visit. They will repeat screening in the last trimester if you're at a higher risk of contracting it. Taking antibiotics before delivery helps prevent a pregnant person from passing gonorrhea to their child.

Related Conditions and Complications

About 10-40% of people with gonorrhea also have chlamydia. They're also at a higher risk of contracting human immunodeficiency virus (HIV). This connection is likely because behaviors that put you at risk for gonorrhea put you at risk for other STIs.

If left untreated, gonorrhea can lead to serious complications. If it spreads to the uterus or fallopian tubes, it can cause pelvic inflammatory disease (PID). This is an infection that can cause damage to these internal reproductive organs. While PID is treatable, it can lead to:

• Chronic abdominal pain
• Scarring of the fallopian tubes
• Increased risk of ectopic pregnancy (an unviable pregnancy that grows and develops in the fallopian tubes rather than the uterus)
• Infertility

It can also cause infertility in people with external reproductive organs like a penis, testicles, or a prostate, as well as increase the risk of:

• Epididymitis: Inflammation of the epididymis, a duct behind the tests that sends sperm to the vas deferens
• Prostatitis: A condition that involves inflammation of the prostate, a gland that helps make semen
• Proctitis: Inflammation of the rectal lining

An infant who contracts gonorrhea during childbirth might experience complications, including blindness, joint infection, or a serious blood infection.

Living With Gonorrhea

Gonorrhea is the second most common STI. You might not experience any symptoms, but it can lead to complications if left untreated, This is why regular screening and testing are so important, especially if you're at a higher risk of contracting it.

Finishing the entire round of antibiotics and retesting several months afterward helps ensure you no longer have gonorrhea or related STIs. You'll also need to inform your sexual partners of your diagnosis so they can get treatment. This helps prevent the spread of gonorrhea, as well as reinfection.