Gonorrhea: Causes, Symptoms, Treatments, and Prevention
Also known as: The clap, Gonococcal infection, Neisseria gonorrhoeae infection
What is gonorrhea?
Gonorrhea, sometimes still called “the clap” in casual speech, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It’s among the most common STIs worldwide and affects both women and men, at any age, and it’s most common in young adults. In the U.S., case rates rose for over a decade and then turned around, falling from 214.0 per 100,000 people in 2021 to 179.5 in 2023. The drop has been fastest among young adults and among women in their twenties. Left untreated, this infection can lead to serious complications, particularly affecting fertility.
Causes and risk factors
Gonorrhea is transmitted through unprotected sexual contact with an infected person: vaginal, anal, or oral-genital sex. A pregnant woman can also pass the infection to her baby during childbirth, which is why newborns are routinely given antibiotic eye ointment at birth. The bacterium doesn’t survive outside the body, so it isn’t spread through objects, toilet seats, or water.
The main risk factors include having multiple sexual partners, not using condoms, having previously had an STI, or being young and sexually active. A person who has been treated can be reinfected if exposed again.
Symptoms
Symptoms differ by sex and infection site, and can sometimes be completely absent.
In men, the most common signs are:
- Purulent discharge from the urethra (pus from the tip of the penis)
- Burning or pain during urination
- Redness or swelling at the urinary opening
In women, the infection is often mild or has no symptoms at all:
- Abnormal vaginal discharge, sometimes yellowish
- Bleeding between periods
- Pelvic pain or pain during sex
- Burning during urination
Rectal or throat infection is also possible and rarely produces specific symptoms. In women, an untreated infection can spread to the reproductive organs and cause pelvic inflammatory disease, a leading cause of infertility and pregnancy complications.
Diagnosis
Diagnosis is made by a doctor based on a local sample: a urethral, vaginal, rectal, or throat swab, depending on reported sexual practices. A urine test may also be done. These samples are analyzed in a lab by bacterial culture or PCR (nucleic acid amplification testing), a highly sensitive technique. Testing is recommended after unprotected sex or in the presence of suggestive symptoms, without waiting for them to worsen.
The U.S. Preventive Services Task Force recommends routine screening for all sexually active women 24 or younger, and for women 25 and older who are at increased risk. For men, the Task Force found the evidence insufficient to weigh the benefits and harms of routine screening, so testing decisions are based on symptoms and individual risk.
Available treatments
Gonorrhea is treated with antibiotics. Because of growing antibiotic resistance in Neisseria gonorrhoeae, current CDC guidance recommends a single 500 mg intramuscular injection of ceftriaxone for people weighing less than 150 kg (about 330 lb), and a single 1 g injection for those weighing 150 kg or more. Azithromycin is no longer recommended on its own. If chlamydia co-infection hasn’t been ruled out and the patient isn’t pregnant, doxycycline 100 mg twice daily for 7 days is added.
The treatment must be followed exactly, even without symptoms. It’s essential that recent sexual partners are also tested and treated to prevent ongoing spread. Sexual activity should be avoided until both partners have fully recovered.
A follow-up test to confirm the treatment worked is recommended for throat infections, 7 to 14 days after treatment. It isn’t routinely needed at other sites, but anyone diagnosed with gonorrhea should be retested about 3 months later, because reinfection is common.
Prevention and practical tips
Male or female condoms, used correctly at every sexual encounter, are central to preventing gonorrhea. Used properly, latex condoms greatly reduce, but do not eliminate, the risk of catching or spreading the infection. Polyurethane condoms are an option for people with a latex allergy.
Regular STI testing matters too, though there’s no single schedule that fits everyone. The U.S. Preventive Services Task Force found no studies establishing an ideal screening interval, and suggests a practical approach instead: get tested again whenever your sexual history shows new or persistent risk factors since your last negative result. CDC guidance does set a specific cadence for one group, recommending screening every 3 to 6 months for men who have sex with men who are at higher risk because of multiple or anonymous partners, or sex in combination with drug use. Informing sexual partners after a diagnosis is essential to stop transmission. Finally, regular medical follow-up and open conversation with a doctor or sexual health clinic support early, effective care.
When should you see a doctor?
See a doctor promptly if you notice unusual genital discharge, burning during urination, pelvic pain, or bleeding between periods, or if a sexual partner tells you they’ve tested positive for an STI. Because gonorrhea is often silent, especially in women and at rectal or throat sites, testing after unprotected sex is worthwhile even with no symptoms at all. Early treatment is simple and protects your fertility.
Sources
- MedlinePlus, U.S. National Library of Medicine health information on gonorrhea
- MedlinePlus: Condoms - male (medical encyclopedia), condom use against gonorrhea and polyurethane condoms as a latex-allergy alternative
- U.S. Preventive Services Task Force, chlamydia and gonorrhea screening recommendation
- StatPearls: Gonorrhea, NCBI Bookshelf (NIH National Library of Medicine), clinical overview and treatment
- Clinical Updates in Sexually Transmitted Infections, 2024 (NIH PMC), current CDC-aligned treatment guidance
- Why are gonorrhea case rates declining in the US? A research agenda (NIH PMC), national case-rate trends and recent declines
- Screening for Nonviral Sexually Transmitted Infections in Adolescents and Young Adults (NIH PMC), CDC screening intervals by risk group