Gonorrhea is treated with a single injection of ceftriaxone, a powerful antibiotic in the cephalosporin family. This is the only first-line treatment currently recommended by the CDC for uncomplicated gonorrhea infections, whether they occur in the genitals, rectum, or throat. The days of treating gonorrhea with a simple pill are largely over, thanks to the bacterium’s remarkable ability to develop resistance to antibiotics.
The Standard Treatment: One Injection
The current recommended treatment is a single 500 mg intramuscular injection of ceftriaxone for anyone weighing under 150 kg (about 330 lbs). If you weigh more than that, the dose is doubled to 1,000 mg. Either way, it’s a one-time shot, typically given in the upper outer area of the buttock or the thigh. You do not need to return for additional doses.
The injection itself can sting. To reduce the pain, ceftriaxone is commonly mixed with a 1% lidocaine solution (a local anesthetic) before being injected. The discomfort is brief, and most people describe it as a sharp pinch followed by some soreness at the injection site for a day or two.
This single shot covers gonorrhea infections at all common sites: the cervix, urethra, rectum, and throat. Throat infections have historically been harder to clear than genital ones, but ceftriaxone at this dose remains effective across all locations.
Why You May Also Get a Second Antibiotic
If your provider hasn’t confirmed whether you also have chlamydia, which co-occurs with gonorrhea frequently, you’ll likely be prescribed doxycycline as well: 100 mg taken by mouth twice a day for seven days. This isn’t treating the gonorrhea itself. It’s covering the strong possibility that chlamydia is present too, since the two infections often travel together and chlamydia test results can take a few days.
If your chlamydia test comes back negative, the doxycycline wasn’t harmful, just precautionary. If it comes back positive, you’re already being treated. This approach prevents a situation where an untreated chlamydia infection causes complications while everyone waits on lab results.
Why Older Antibiotics No Longer Work
Gonorrhea has burned through nearly every class of antibiotic thrown at it over the past several decades. The bacterium that causes gonorrhea, Neisseria gonorrhoeae, is exceptionally good at developing resistance, and the list of antibiotics it has rendered useless keeps growing.
Ciprofloxacin, a fluoroquinolone that was once a go-to oral treatment, now faces high-level resistance in many circulating strains. The WHO’s 2024 reference strains for gonorrhea show widespread ciprofloxacin resistance, with the majority of tested strains showing resistance levels so high the drug is completely ineffective. It hasn’t been a recommended treatment for years.
Azithromycin was previously part of the standard regimen as a second antibiotic paired with ceftriaxone. That dual-therapy approach was dropped when resistance to azithromycin began climbing. Multiple WHO reference strains now show azithromycin resistance, with some exhibiting extremely high-level resistance. Using it routinely would only accelerate the problem.
Even cefixime, an oral cephalosporin related to ceftriaxone, has lost ground. Several reference strains show high-level resistance to cefixime, which is why ceftriaxone delivered by injection, rather than an oral cephalosporin, remains the standard. The injectable route delivers a higher, more reliable concentration of the drug to the infection site.
What If You’re Allergic to Cephalosporins
If you have a confirmed severe allergy to cephalosporins (the drug class that includes ceftriaxone), treatment becomes more complicated. Your provider will need to select from a limited set of alternatives and may consult with an infectious disease specialist. The options in this scenario are narrower and considered less reliable than ceftriaxone, so accurate allergy history matters. Many people who believe they’re allergic to penicillin or related drugs can actually tolerate cephalosporins safely. If your allergy was mild or occurred long ago, your provider may recommend allergy testing before ruling out ceftriaxone entirely.
What to Expect After Treatment
Symptoms typically begin improving within a few days of the injection. You should avoid sexual contact for at least seven days after treatment and until any sexual partners have been treated as well. If you were given doxycycline for possible chlamydia, wait until you’ve finished the full seven-day course before resuming sexual activity.
For most uncomplicated infections, no follow-up test is needed if your symptoms resolve and you received the recommended treatment. However, if you had a throat infection, if your symptoms persist, or if you were treated with an alternative regimen, a follow-up test (sometimes called a “test of cure”) may be recommended. This is typically done at least seven days after treatment to avoid false positives from residual bacterial DNA.
Reinfection is common. Having gonorrhea once does not protect you from getting it again. If you’re re-exposed, you’ll need treatment again with the same regimen. Retesting about three months after treatment is generally recommended to catch reinfection early, even if you have no symptoms.
Why It Requires a Clinic Visit
Because the only reliable treatment is an injection, gonorrhea can’t be treated with a prescription you pick up at a pharmacy and take at home. You need to visit a clinic, urgent care, or your provider’s office to receive the shot. Many sexual health clinics and public health departments offer walk-in gonorrhea treatment, often at low or no cost. The entire visit is usually quick: once the diagnosis is confirmed (or if you’re being treated based on a partner’s positive result), the injection takes seconds and you can leave shortly after.