Gonorrhoea: symptoms, transmission, testing and treatment

Gonorrhoea is a sexually transmitted infection (STI) caused by a bacterium. It is cured with antibiotics, usually a single injection, but the bacterium is becoming resistant to more and more medicines, so it should always be treated by a health professional.

It is very common. The World Health Organization (WHO) estimates there were 82.4 million new infections worldwide in 2020 among adults aged 15 to 49. In Europe, the European Centre for Disease Prevention and Control (ECDC) recorded 106,331 cases in 2024, a 303% rise since 2015. Anyone who is sexually active can get it, whatever their sex or orientation.

What it is

It is caused by the bacterium Neisseria gonorrhoeae, also called the gonococcus. It lives on moist mucous membranes: the urethra, the cervix, the rectum, the throat and sometimes the eyes. It does not survive well outside the body.

Symptoms and when they appear

According to WHO, when symptoms occur they usually appear 1 to 14 days after contact, although they can take longer. Many people notice nothing, especially women and people with a throat infection. The most common symptoms are:

• Burning or pain when you pee.
• Discharge from the penis, or yellow or green vaginal discharge.
• Pain in the lower tummy and, less often, bleeding between periods.
• Pain or swelling in the testicles.
• Pain, itching or discharge from the bottom, if the rectum is infected.
• A sore throat, or red, painful eyes with pus.

Having no symptoms does not mean the infection is mild: it can still be passed on and cause complications.

How it spreads – and how it doesn't

It spreads through vaginal, anal or oral sex without a condom with someone who has the infection, even if they have no symptoms. It can also pass on through sharing sex toys that have not been washed or covered with a new condom. Touching your eyes with fingers that have infected fluid on them can carry it to the eyes. During birth, it can pass to the baby.

It does not spread through hugging, towels, cups, toilet seats or swimming pools, because the gonococcus does not survive well outside the body. If you have anal sex, our tips on safe anal sex may help.

Testing: when and how

The test is simple. It can be a urine sample or a swab from the urethra, vagina, rectum or throat, depending on the kind of sex you have had. Sometimes you can take the swab yourself.

After a risk, the infection can take up to two weeks to show up on a test. If you test earlier, you may be asked to repeat it. If you have symptoms, get checked now. Because gonorrhoea often appears alongside other STIs, you will usually be tested for chlamydia, HIV and syphilis too. If you have new partners, test at least once a year: see how often to get tested for STIs.

Treatment and antibiotic resistance

Gonorrhoea is cured with antibiotics. WHO and the CDC now recommend a single injection of an antibiotic from the cephalosporin group as the first choice. Some countries add a second antibiotic in tablet form. Treatment is sometimes given before results come back.

• When to have sex again: WHO and the CDC advise waiting 7 days after treatment, and until your partners have been treated too.
• Test of cure: you are often asked to test again one to two weeks later, especially if the infection was in the throat.
• Retest at three months: the CDC recommends it because reinfection is common.

Antibiotic resistance is a growing problem. WHO warns that gonorrhoea could become very hard to treat. That is why you should never self-medicate or use leftover antibiotics: they may not work and they encourage resistance.

Complications if it isn't treated

Without treatment, the infection can spread to the womb and fallopian tubes and cause pelvic inflammatory disease, with pain and a risk of ectopic pregnancy and infertility. In men it can inflame the testicles or prostate, narrow the urethra and sometimes affect fertility. In the eyes it can cause severe conjunctivitis. Rarely, it spreads through the blood and affects the skin and joints. It also raises the risk of getting HIV.

Gonorrhoea and pregnancy

In pregnancy it can increase the risk of premature birth and low birth weight. During birth it can reach the baby's eyes and, without treatment, cause blindness. That is why testing and treatment before birth are recommended. Many hospitals also put antibiotic ointment in newborns' eyes.

Prevention

• Use a condom for vaginal and anal sex, and a condom or dental dam for oral sex. Used correctly every time, it prevents most infections.
• Do not share sex toys or, if you do, wash them and put a new condom on them.
• Get tested regularly and tell recent partners if you are diagnosed.
• There is no specific vaccine. The MenB (meningococcal B) vaccine gives some partial protection, and in the UK the NHS now offers it to some gay, bisexual and other men who have sex with men at higher risk. Ask your clinic whether it is an option for you.

When to get help

Book an appointment with your GP or a sexual health clinic if you have symptoms, a partner tells you they have gonorrhoea or another STI, you have had sex without a condom with a new partner, or you are pregnant. Get urgent help if you have red eyes or pus on your eyelashes, a fever, painful or swollen joints, or a rash. Your visit is confidential, and the clinic can help you tell partners without naming you.