Gonorrhea, commonly referred to as “the clap,” is a sexually transmitted infection (STI) that frequently goes undiagnosed and untreated. Because of this, an infected individual can unwittingly transmit it to others during oral, vaginal, or anal sex.
Studies have shown that a large percentage of people with gonorrhea are asymptomatic (with few or no symptoms) and can continue to be infectious for weeks and even months. Left untreated, gonorrhea can lead to potentially serious complications like miscarriage, ectopic pregnancy, infertility, sepsis, and human immunodeficiency virus).
By recognizing the signs of gonorrhea—and better understanding your risk of infection—you can get tested and seek treatment, often with a single dose of antibiotics.
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “male,” “female,” “men,” and “women” as the sources use them.
Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhea that can readily establish an infection in the mucous membranes lining the throat, vagina, penis, and anus. During sex, the bacterium attaches to these membranes and rapidly makes copies of itself.
The three predominant routes of transmission for gonorrhea are:
N. gonorrhoeae can also be transmitted to a newborn as it passes through the birth canal of a pregnant person with untreated gonorrhea.
Gonorrhea is one of the most common STIs in the United States, causing around 1.5 million new infections each year. While anyone who is sexually active can get gonorrhea, some people are at greater risk than others.
Young people are more likely than other adults to acquire gonorrhea, with infections peaking between the ages of 20 and 24, when sexual activity is often at its highest. In the United States, males are affected 40% more than females, particularly men who have sex with men (MSM).
Beyond age and sex, the risk factors for gonorrhea mirror those of other common STIs. These include:
There are also risk factors specific to gonorrhea that increase not only your vulnerability to infection but also your risk of getting an antibiotic-resistant strain of N. gonorrhoeae (see section Gonorrhea Complications below).
While younger adults are more likely to get gonorrhea, older sexually active adults are more likely to get an antibiotic-resistant strain. This is because the risk of reinfection increases with age, which, in turn, increases the odds of acquired resistance.
Other key risk factors include:
The symptoms of gonorrhea can differ from one person to the next, with some exhibiting what are known as classic signs of an infection and others having mild or no symptoms at all. Symptoms also differ significantly between males and females.
Gonorrhea in people with a penis is most often recognized when the urethra (the tube through which urine and semen exit the penis) is affected. Symptoms include:
Symptoms of gonorrhea will most often appear two to five days after infection. However, it can take up to a month for symptoms to appear in some men, during which time the infection can be passed to others.
Gonorrhea symptoms in people with a vagina are usually mild and easily mistaken for a urinary tract infection (UTI) or vaginal infection. These include:
Most symptomatic women will develop urinary or vaginal symptoms within 10 days of infection.
N. gonorrhoeae passed to the rectum through anal or oral sex can cause symptoms like:
Symptoms of pharyngeal gonorrhea are less common or noticeable than gonorrhea in other parts of the body. If symptoms develop, they are often described as “cold-like” and may include:
Gonorrhea can also cause an eye infection known as gonococcal conjunctivitis (GC) if infected semen or vaginal fluid gets into the eye. The symptoms are characteristic of pink eye (conjunctivitis), causing eye inflammation and the rapid onset of:
GC is referred to as gonococcal ophthalmia neonatorum when it occurs in newborns.
In some groups, gonorrhea is far more likely to be asymptomatic or “silent.”
This is especially true among women, Nearly 50% of women will have no symptoms at all. Of those who do have symptoms, only around 1 in 10 have an abnormal vaginal discharge (one of the main reasons why women seek STI screening).
In stark contrast, only around 6% of men who get gonorrhea from vaginal sex are asymptomatic, while 80% will experience urethral discharge.
It is for this reason that the CDC recommends annual gonorrhea testing for sexually active women under 25 as well as sexually active women 25 years of age and older.
Similarly, the Centers for Disease Control and Prevention (CDC) recommends a minimum of once-yearly screening for MSM, who account for the majority of pharyngeal and anorectal infections. As with vaginal gonorrhea, gonorrhea of the throat and rectum are more often asymptomatic.
Left untreated, gonorrhea can lead to potentially serious—and even life-threatening—complications in people of any sex, including:
One of the most concerning complications of gonorrhea is antibiotic resistance.
Historically, antibiotic resistance occurred when people treated for gonorrhea failed to complete the prescribed course of antibiotics. This allowed incidental mutations of N. gonorrhoeae to persist rather than being killed, some of which were resistant to antibiotics.
As these resistant bacteria were passed from person to person and through entire populations, they became even more resistant as they continued to mutate. By 2020, the resistance rate to once-useful antibiotics like ciprofloxacin and tetracycline had risen to over 44% and 65%, respectively.
To curb the rise in antibiotic resistance, public health officials today use potent, single-dose antibiotics to clear gonorrhea infections. Even so, isolated cases of ceftriaxone-resistant N. gonorrhoeae have been reported due to unchecked infection and reinfection rates.
If this continues, a person infected for the first time with gonorrhea may one day pick up a strain that cannot be cured with available antibiotics.
In the past, gonorrhea was commonly diagnosed with a bacterial culture (in which a bacterial sample is “grown” in the lab) and Gram staining (a method of staining to help identify bacteria under the microscope).
Today, the primary form of diagnosis is polymerase chain reaction (PCR). These are tests that can detect genetic evidence of N. gonorrhoeae from either a urine sample or a swab of fluids from the genitals, rectum, or throat.
PCRs are the preferred method of testing as they are easy to administer and have a high level of accuracy. Their sensitivity is over 90% (meaning it can identify people with a disease 90% or more of the time) and a specificity of 99% or higher (meaning it can identify people without the disease 99% or more of the time).
While lab-based PCRs typically take one to three days to return a result, a rapid test called the Binx Health IO CT/NG Assay can diagnose gonorrhea in as little as 20 minutes. The test, cleared for use by the Food and Drug Administration (FDA) in 2021, has a sensitivity and specificity equal to that of traditional PCR tests.
In November 2023, the FDA authorized the first at-home test, called the Simple 2 Test, which allows you to mail in a urine sample or vaginal swab to a lab to see if you have gonorrhea or chlamydia, another STI.
The test can be purchased online for $99. Insurance may cover some of the cost.
The CDC recommends Chatgpt meme that you get tested for gonorrhea if you have symptoms of gonorrhea, or if you’ve had sex with a person of unknown status who you believe to have gonorrhea.
Due to the high rate of asymptomatic infections, the CDC also recommends annual gonorrhea screening for the following at-risk groups:
While some PCR tests can detect N. gonorrhoeae within two days of infection, healthcare providers will often advise you to wait a week before getting tested.
This is because the concentration of N. gonorrhoeae can be significantly lower in certain parts of the body (such as the throat) and higher in others (such as the urethra). Bacterial concentrations can also be lower if you have mild or no symptoms.
Testing prematurely can lead to a false-negative result. This is when you have the infection, but the test is negative.
The testing and treatment of gonorrhea can often be administered at the same visit and facility. This includes public health clinics, many of which offer free or low-cost STI testing. Organizations like Planned Parenthood may also offer affordable testing and treatment.
The preferred form of treatment for uncomplicated gonorrhea is a single intramuscular (IM) injection of an antibiotic called ceftriaxone. The injection is given into the upper part of the buttocks.
Studies have shown a single shot of ceftriaxone is over 99% effective in curing gonorrhea of the genitals or rectum. Pharyngeal gonorrhea is somewhat harder to treat, with studies suggesting a cure rate of around 90%.
Other antibiotics may be used if you are allergic to ceftriaxone or cannot take it for other reasons. The doses are prescribed in milligrams (mg) or grams (g).
| Indication | Treatment |
|---|---|
| Preferred option | Ceftriaxone 500 mg IM injection in a single dose |
| For people allergic to ceftriaxone | Gentamicin 240 mg IM in a single dose plus azithromycin 2 g (2,000 mg) taken orally (by mouth) in a single dose |
| If neither option is available | Cefixime 800 mg taken orally in a single dose |
| For people weighing over 150 kg (330 lb) | Ceftriaxone 1 g (1,000 mg) IM injection in a single dose |
If a rapid test is unavailable, treatment may be given presumptively (before results are back) to avoid losing a person who may not return for their results.
Once treated for genital or anorectal gonorrhea, you do not need a “test of cure” (TOC) to see if the treatment worked.
On the other hand, people with pharyngeal gonorrhea should undergo a TOC in seven to 14 days as the infection is far more difficult to clear. If the initial treatment has failed, another round of antibiotics would be prescribed.
After that, anyone treated for gonorrhea should be retested in three months whether or not their partners have been treated. This helps check for gonorrhea reinfection, which affects one in seven treated individuals, often within three months.
Sexual partners should also be treated. Recommended options include:
Once you have been treated for genital or anorectal gonorrhea, you need to wait seven days before having sex. This ensures that the bacterium is completely cleared and your partner is safe from infection.
If you have been treated for pharyngeal gonorrhea, you need to wait until your TOC result is negative (meaning that there is no evidence of N. gonorrhea).
To avoid reinfection, any sexual partners you’ve had 60 days prior to your diagnosis must be treated. If they have not been treated and you have sex, there is a chance you can get gonorrhea again.
Every effort should be made to avoid reinfection, which increases the risk of severe complications and antibiotic resistance.
Short of complete abstinence, there are several ways to do this:
Preexposure prophylaxis, popularly known as PrEP, is a daily drug strategy used to reduce the risk of HIV from sex by around 99%. As effective as it is in preventing HIV, PrEP does not protect against any other STI.
Safer sex practices, including the consistent use of condoms, are still needed to keep you safe from gonorrhea, chlamydia, syphilis, and other common sexually transmitted infections.
People will often wonder if gonorrhea will clear on its own without treatment and whether they can forego treatment if they’ve acquired the infection.
While most cases of N. gonorrhoeae are self-limiting, the rate and duration of clearance are largely dependent on whether you are asymptomatic or symptomatic.
A 2023 study in Sexually Transmitted Infections reported the following rates of clearance among people with asymptomatic gonorrhea within eight days of an initial positive test:
This shouldn’t suggest that all asymptomatic infections will clear on their own or that an asymptomatic person is somehow less able to transmit the infection.
According to a 2018 review in Frontiers in Immunology, asymptomatic gonorrhea can persist for as long as 165 days, during which time a person can remain able to transmit the infection for weeks or months. In some cases, an asymptomatic infection may only be recognized when complications like PID or infertility develop.
Among people with symptomatic gonorrhea, symptoms can sometimes persist for up to a year and only be cleared with antibiotics.
Due to the wide variability in the natural course of gonorrhea, treatment is recommended whether you have symptoms or not. This reduces the spread of infection, including transmission during pregnancy, and prevents otherwise avoidable complications.
Consent for sex and protection from gonorrhea should involve mutual agreement. This includes a discussion about mutual screening of gonorrhea and other common STIs.
Conversations like this can be awkward and, if approached incorrectly, may even be misconstrued as a sign of infidelity or mistrust.
To avoid this, experts offer the following tips to make the discussion more productive:
By keeping the tone open, honest, and interactive—listening as much as you speak—you may become closer as a couple.
Gonorrhea, a sexually transmitted infection caused by the bacterium Neisseria gonorrhea, can be asymptomatic in many people. Up to 50% of women with gonorrhea have no symptoms, while the majority of anal or throat infections are also “silent.”
Whether silent or not, gonorrhea can be passed to others through oral, vaginal, or anal sex and lead to potentially severe complications—like infertility, pregnancy loss, and HIV—if left untreated.
A single injection of ceftriaxone can clear most gonorrhea infections, while the consistent use of condoms can go a long way toward preventing reinfection. People at increased risk may require routine STI screening; ask your healthcare providers which tests are recommended.
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