Gonorrhea is a common sexually transmitted infection caused by bacteria that target the mucous membranes of the genital tract, rectum, and throat. In the United States alone, over 543,000 cases were reported in 2024. The infection is curable with antibiotics, but it often produces no symptoms, meaning many people carry and spread it without knowing.
How Gonorrhea Spreads
The bacteria pass from person to person through vaginal, anal, and oral sex. Any contact with infected mucous membranes can transmit the infection, even without ejaculation. A pregnant person with gonorrhea can also pass it to their baby during delivery, which can cause serious eye infections in the newborn.
You can reduce your risk by using condoms consistently and correctly during every sexual encounter. Consistent condom use has been shown to lower the risk of gonorrhea transmission, though no barrier method is 100% effective. Being in a long-term, mutually monogamous relationship with someone who has tested negative is another reliable way to avoid it. Regular screening matters too, especially because the infection so often flies under the radar.
Why Most People Don’t Notice Symptoms
This is one of gonorrhea’s most dangerous features. Roughly 90% of women with a genital infection have no symptoms at all. In men, the asymptomatic rate is also surprisingly high, estimated between 56% and 87%. That means the majority of infected people feel completely fine and have no reason to suspect anything is wrong without a test.
When symptoms do appear in men, the most common signs are a burning sensation while urinating and a white, yellow, or green discharge from the penis. Less commonly, the testicles become painful or swollen.
Women who develop symptoms often mistake them for a bladder or vaginal infection. The signs can include painful urination, increased vaginal discharge, and bleeding between periods.
Rectal infections, which can occur in anyone who has receptive anal sex, may cause discharge, anal itching, soreness, bleeding, or painful bowel movements. They can also be completely silent. Throat infections from oral sex are typically asymptomatic as well.
How It Infects the Body
The gonorrhea bacterium is highly specialized. It uses different strategies to invade tissue depending on the site of infection. In the male urethra, the bacteria latch onto specific receptors on the cell surface, triggering the cells to essentially pull the bacteria inside. In the female cervix, the process is different: the bacteria use hair-like projections on their surface (called pili) to overcome the natural repulsion between their cell wall and human tissue, then trigger the cervical cells to ruffle their membranes and engulf the bacteria.
This ability to use multiple invasion strategies is part of what makes the bacterium so successful. It can also rapidly change its surface proteins, helping it dodge the immune system and making vaccine development extremely difficult.
What Happens Without Treatment
Left untreated, gonorrhea can cause serious and sometimes permanent damage. In women, the bacteria can travel upward from the cervix into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID). PID can scar the fallopian tubes, leading to chronic pelvic pain, ectopic pregnancy, and infertility. This damage can happen even from “silent” infections that never caused noticeable symptoms.
In men, untreated gonorrhea can lead to epididymitis, a painful inflammation of the tube that carries sperm from the testicle. In rare cases, this too can affect fertility.
The bacteria can also enter the bloodstream and spread throughout the body, a condition known as disseminated gonococcal infection. This can cause joint pain, skin lesions, and, in severe cases, infection of the heart valves or the lining of the brain.
Testing and Diagnosis
The standard test for gonorrhea is a nucleic acid amplification test, or NAAT. It works by detecting tiny amounts of bacterial DNA or RNA in a urine sample or a swab from the infected site (cervix, urethra, rectum, or throat). NAATs are highly accurate, with sensitivity above 90% and specificity at 99% or higher, meaning false positives and false negatives are both rare.
For men with obvious symptoms like urethral discharge, a simple microscope examination of the discharge can confirm the diagnosis on the spot. But this quick method doesn’t work well for asymptomatic men, and it’s unreliable for infections of the cervix, throat, or rectum. In those cases, a NAAT is the right test.
Because gonorrhea and chlamydia frequently occur together and share similar symptoms, testing for both at the same time is standard practice.
How Gonorrhea Is Treated
Gonorrhea is treated with a single injection of an antibiotic, currently a type of cephalosporin. It’s a one-time shot, and for uncomplicated infections of the genitals, rectum, or throat, that single dose is the complete treatment. If a chlamydia co-infection hasn’t been ruled out, a week-long course of a second oral antibiotic is added.
Treatment is straightforward, but there’s an important catch: you should avoid sexual contact for seven days after treatment and until any sexual partners have been treated as well. Reinfection is common, and getting gonorrhea once does not protect you from getting it again.
The Growing Threat of Drug Resistance
Gonorrhea has progressively developed resistance to nearly every antibiotic ever used against it. Resistance to ciprofloxacin, once a go-to treatment, now stands at 95% globally. That drug is essentially useless against gonorrhea today.
More alarming is the trend with the current frontline treatments. Between 2022 and 2024, resistance to the primary injectable antibiotic used worldwide rose from 0.8% to 5%. Resistance to its oral backup climbed from 1.7% to 11%. Those numbers are still low enough that current treatments work for the vast majority of cases, but the trajectory is concerning. Resistance to another commonly used antibiotic, azithromycin, held steady at about 4%.
The World Health Organization has flagged drug-resistant gonorrhea as a serious public health threat, with resistant strains appearing in an increasing number of countries. New antibiotics are in development, but for now, the best defense is prevention, prompt testing, and completing treatment exactly as prescribed. Using antibiotics unnecessarily or incompletely accelerates resistance.
Who Should Get Tested
Because the infection is so often asymptomatic, routine screening is the only way to catch most cases. Annual screening is generally recommended for sexually active women under 25 and for older women with risk factors like new or multiple partners. Men who have sex with men benefit from screening at least once a year, and every three to six months if they have multiple partners. Anyone who has been diagnosed with another STI or who has a partner with gonorrhea should also be tested.
The 2024 U.S. case count of 543,409 actually represents a 10% decline from the year before, marking the third consecutive year of falling numbers. But those figures only capture diagnosed cases. Given that the majority of infections produce no symptoms, the true number of people infected at any given time is certainly higher.