Overview
Gonorrhoea is a bacterial infection passed on through sexual contact. It can infect the genital tract, the rectum, the throat and the eyes, and a mother can pass it to her baby during birth.
Many people have no symptoms, particularly women and people with throat or rectal infection, which is how it spreads unnoticed. It is curable, but WHO warns that resistance to the antibiotics used to treat it is rising, and that there is a risk of gonorrhoea becoming untreatable.
Disease Summary
- Category
- Infectious Disease
- Cause
- Neisseria gonorrhoeae
- Transmission
- Sexual contact, and from mother to baby at birth
- Body System
- Urinary System
- Preventable
- Yes
- Curable
- Yes
Symptoms
Common Symptoms
Many infections cause no symptoms at all. Where symptoms occur, they usually begin within two weeks of exposure.
Often No Symptoms at All
This is particularly true of infections in women and of throat and rectal infections, which is how gonorrhoea spreads without anyone knowing.
Discharge From the Penis or Vagina
Often thick and yellow or green. In men this is usually the first thing noticed.
Pain or Burning When Passing Urine
A common symptom in both men and women.
Bleeding Between Periods or After Sex
A symptom in women that is easily attributed to other causes.
Pain in the Lower Abdomen
In women this can indicate the infection has spread upwards to the womb and tubes.
Painful or Swollen Testicles
In men this indicates the infection has spread and needs prompt treatment.
Anal Discharge, Itching or Pain
Rectal infection often causes no symptoms at all, but can cause these when it does.
Sore Throat
Throat infection is usually symptom-free, which is why it is often missed unless specifically tested for.
Danger Signs
Seek urgent medical attention immediately if any of the following symptoms develop.
Severe Lower Abdominal Pain With Fever in a Woman
This suggests the infection has spread to the womb, tubes and ovaries, which can damage fertility and needs urgent treatment.
Severe Testicular Pain and Swelling
This indicates spread within the reproductive tract and needs same-day assessment.
Red, Swollen Eyes in a Newborn
Gonorrhoea passed to a baby at birth causes severe eye infection that can lead to blindness. This is an emergency.
Joint Pain With Fever and a Rash
This can mean the infection has spread through the bloodstream, which requires hospital treatment.
Symptoms That Do Not Settle After Treatment
This may mean the infection is resistant to the antibiotic used, and needs reassessment rather than repeating the same treatment.
Diagnosis
Testing Rather Than Waiting for Symptoms
Because so many infections cause no symptoms, testing is how gonorrhoea is found. Regular testing is recommended for anyone with ongoing risk.
Testing Every Exposed Site
Genital, rectal and throat sites are tested according to the person’s sexual practices, because an infection at one site tells you nothing about the others.
Examination
Looking for discharge, tenderness and signs that the infection has spread upwards.
Culture for Antibiotic Sensitivity
Growing the bacteria allows the laboratory to test which antibiotics still work. WHO treats this as increasingly important given rising resistance.
Testing for Other Infections at the Same Time
Chlamydia, syphilis and HIV are commonly tested for alongside, because they frequently occur together.
Laboratory Tests
Molecular Test
The most sensitive test and the one used most often. It can be done on a urine sample for genital infection, which avoids a swab.
Culture
Grows the bacteria. This is the test that also allows antibiotic sensitivity to be measured, which is why it is still used despite being slower.
Antibiotic Sensitivity Testing
Shows which antibiotics will work against this particular infection. WHO reports rising resistance, which makes this increasingly necessary.
Tests for Other Sexually Transmitted Infections
Chlamydia, syphilis and HIV are tested for at the same time, because they frequently occur together.
Eye Swab in a Newborn
Where a newborn has a red, discharging eye, this identifies the cause and allows immediate treatment to prevent blindness.
Treatment
Injectable Antibiotic Treatment
WHO names cephalosporin antibiotics as the treatment for gonorrhoea. The specific choice is set by national guidelines and changes as resistance patterns change.
Additional Oral Treatment Where Indicated
An additional antibiotic is sometimes given, particularly where chlamydia has not been excluded.
Test of Cure
Confirms the infection has cleared. Particularly important for throat infection and wherever resistance is suspected.
Treating Sexual Partners
WHO names partner notification and testing among the core prevention measures. Without it, reinfection is near certain.
Eye Ointment for Newborns
WHO lists antibiotic eye ointment for newborns among prevention measures. It prevents the severe eye infection that can cause blindness.
Prevention
Use condoms consistently and correctly
WHO lists consistent condom use first among prevention measures for gonorrhoea.
Test regularly if you have ongoing risk
Because most infections cause no symptoms, regular testing is the only reliable way to find them.
Tell partners so they can be tested and treated
WHO names partner notification and testing among the core prevention measures.
Antibiotic eye ointment for newborns
WHO lists this among prevention measures. It prevents the eye infection that can blind a baby.
Complete treatment and avoid sex until cleared
Avoiding sexual contact until treatment is complete and partners are treated prevents the infection bouncing back.
Never self-treat with leftover antibiotics
Incorrect treatment leaves the infection in place and drives the resistance WHO is warning about.
Risk Factors
People With Ongoing Sexual Risk
WHO identifies the groups in which prevalence is highest.
- People with new or multiple partners
- Men who have sex with men
- Sex workers and their clients
- Adolescents and young adults in high-burden countries
Women, Because Infection Is Usually Silent
Symptom-free infection in women is the main route to serious complications.
- Most infections in women cause no symptoms
- Untreated infection can spread to the womb, tubes and ovaries
- This is a preventable cause of infertility and ectopic pregnancy
- Testing rather than symptoms is what finds it
Newborn Babies
A mother can pass the infection to her baby during birth.
- Babies born to mothers with untreated gonorrhoea
- Infection causes severe eye inflammation within days of birth
- Untreated, it can cause permanent blindness
- Antibiotic eye ointment at birth prevents it
People Living With HIV
The two infections interact and frequently occur together.
- Gonorrhoea increases the chance of acquiring and transmitting HIV
- Both are tested for together as standard practice
- Regular testing is recommended for people on HIV treatment
- Untreated gonorrhoea can be harder to clear
Complications
Pelvic Inflammatory Disease
Spread of the infection to the womb, tubes and ovaries. It causes lasting pain and is an important preventable cause of infertility.
Infertility and Ectopic Pregnancy
Scarring of the fallopian tubes after untreated infection can prevent pregnancy or cause a pregnancy to implant in the wrong place, which is life threatening.
Infection Within the Male Reproductive Tract
Painful swelling of the testicle, which can affect fertility if untreated.
Severe Eye Infection in a Newborn
Passed on during birth, it can cause permanent blindness within days without treatment.
Spread Through the Bloodstream
An uncommon but serious complication causing fever, joint pain, skin lesions and occasionally infection of the heart valves.
Increased HIV Risk
Gonorrhoea makes both acquiring and transmitting HIV considerably more likely.
When to Seek Medical Care
Any Unusual Discharge, or Pain on Passing Urine
These are the commonest symptoms and they deserve a test rather than a guess.
Lower Abdominal Pain With Fever in a Woman
This suggests spread to the reproductive organs and needs urgent treatment to protect fertility.
Painful or Swollen Testicles
This needs same-day assessment.
A Newborn With Red, Swollen or Discharging Eyes
This is an emergency. Untreated, it can cause blindness within days.
If a Partner Has Been Diagnosed, or After Any Unprotected Sex
Go for testing even if you feel completely well, because most infections cause no symptoms.
Prognosis
Gonorrhoea Is Curable
WHO names cephalosporin antibiotics as treatment, and CDC states that antibiotics cure the infection.
Resistance Is Rising Sharply
WHO reported that between 2022 and 2024, resistance to one main treatment rose from 0.8% to 5%, and resistance to an older oral option reached 95%. WHO warns of a risk of untreatable infection.
Complications Are Often Permanent
Tubal scarring, infertility and a baby’s sight loss are not reversed by treating the infection later.
Reinfection Is Common
Treatment gives no immunity, and untreated partners are the commonest reason the infection returns.
Differential Diagnosis
Chlamydia Infection
Causes an almost identical picture and frequently occurs at the same time. Both are tested for together.
Urinary Tract Infection
Causes burning on passing urine without discharge, and is separated by a urine test.
Other Causes of Vaginal Discharge
Thrush and bacterial vaginosis cause discharge without the burning and without the risk to fertility, and are separated by examination and testing.
Trichomoniasis
Another sexually transmitted infection causing discharge and irritation, separated by specific testing.
Other Causes of Pelvic Pain
Appendicitis, ovarian problems and ectopic pregnancy all cause lower abdominal pain and must be excluded, particularly where there is fever.
References
World Health Organization: Gonorrhoea
WHO fact sheet on transmission, symptoms, complications, treatment and prevention.
World Health Organization: Multi-drug resistant gonorrhoea
WHO fact sheet on antibiotic resistance in gonorrhoea and what it means for treatment.
CDC: About Gonorrhea
Symptoms, testing, treatment and complications of gonorrhoea.
CDC: Drug-Resistant Gonorrhea
How resistance has developed and what it means for how gonorrhoea is treated.
Frequently Asked Questions
Can gonorrhoea be cured?
Yes. WHO names cephalosporin antibiotics as the treatment and CDC states that antibiotics cure the infection. WHO warns, however, that resistance is rising and that there is a risk of untreatable infection, which is why the recommended treatment changes over time and why leftover antibiotics should never be used.
Can I have gonorrhoea without symptoms?
Yes, and this is common. Most infections in women cause no symptoms, and throat and rectal infections are usually silent in everyone. This is why testing, rather than waiting for symptoms, is what finds it.
Why does drug resistance matter?
Because it narrows the options. WHO reported that between 2022 and 2024 resistance to one of the main treatments rose from 0.8% to 5%, and resistance to an older oral option reached 95%. WHO warns of a risk of gonorrhoea becoming untreatable, which is why correct treatment and partner treatment matter for everyone, not just for you.
Can gonorrhoea affect fertility?
It can, if left untreated. Spread of the infection to the womb, tubes and ovaries causes scarring that can prevent pregnancy or cause a pregnancy to implant in the wrong place. Treating the infection early prevents this entirely.
Why do newborn babies get eye ointment?
To prevent the severe eye infection that gonorrhoea causes if passed on during birth, which can lead to permanent blindness within days. WHO lists antibiotic eye ointment for newborns among its prevention measures.