Gonorrhoea
Symptoms, Causes & Treatment
Everything you need to know about gonorrhoea: its symptoms, how it spreads, why antibiotic resistance is a growing concern, and how to get tested and treated.
What Is Gonorrhoea?
Gonorrhoea is a bacterial sexually transmitted infection (STI) caused by Neisseria gonorrhoeae (also known as gonococcus). It is the second most commonly diagnosed bacterial STI in the UK after chlamydia, with cases rising significantly in recent years -- over 80,000 diagnoses annually.
Gonorrhoea most commonly infects the genital tract (urethra in men, cervix in women) but can also infect the rectum, throat, and eyes. It frequently co-occurs with chlamydia, so testing for both is standard practice.
A major public health concern is the emergence of antibiotic-resistant gonorrhoea. N. gonorrhoeae has progressively developed resistance to multiple antibiotic classes, and there is ongoing international concern about the possibility of untreatable gonorrhoea in the future. This makes correct diagnosis, culture-based antibiotic sensitivity testing, and adherence to treatment guidelines critically important.
Like chlamydia, untreated gonorrhoea can cause pelvic inflammatory disease, infertility, and ectopic pregnancy in women, and epididymo-orchitis in men. Disseminated gonococcal infection (DGI), though rare, can cause septic arthritis, skin lesions, and systemic illness.
What Are the Symptoms of Gonorrhoea?
Gonorrhoea symptoms appear 1‑4 days after exposure in symptomatic individuals. Up to 50% of women and 10% of men have no symptoms.
Purulent (pus-like) yellow-green urethral or vaginal discharge · Burning urination · Rectal discharge, pain, or bleeding · Sore throat (pharyngeal gonorrhoea) · Pelvic pain in women · Swollen or painful testicles · Up to 50% of women and 10% of men have no symptoms
Disseminated gonococcal infection (DGI): fever, joint pain, skin pustules · PID with systemic illness · Gonorrhoea in pregnancy — risk of neonatal eye infection · Antibiotic-resistant gonorrhoea — treatment failure requiring specialist review
Gonorrhoea with systemic symptoms — joint pain, skin pustules, and fever — indicates disseminated gonococcal infection, which requires hospital admission and IV antibiotics. Any gonorrhoea in pregnancy with abdominal pain or fever requires emergency obstetric assessment.
What Causes Gonorrhoea?
Gonorrhoea is caused by Neisseria gonorrhoeae — a Gram-negative diplococcus that infects mucosal surfaces and is developing dangerous levels of antibiotic resistance.
Neisseria gonorrhoeae infects the same mucosal sites as chlamydia. The organism has remarkable ability to develop antibiotic resistance — multidrug-resistant gonorrhoea is a major global public health threat.
Gonorrhoea during pregnancy carries significant risks: preterm birth, premature rupture of membranes, low birth weight, and neonatal ophthalmia (gonococcal eye infection in the newborn).
STIs are transmitted through unprotected vaginal, anal, or oral sex. Some (herpes, HPV, syphilis) can spread through skin-to-skin contact even without penetration or visible symptoms.
Many STIs, particularly chlamydia, gonorrhoea, and early HIV, cause no symptoms at all. Regular testing is the only way to detect them — waiting for symptoms means delayed treatment and onward transmission.
Condoms reduce STI transmission by 85–98% when used consistently and correctly. They are less effective for infections spread by skin contact (herpes, HPV, syphilis) where lesions extend beyond the condom-covered area.
STI co-infection is common. Gonorrhoea and chlamydia frequently co-exist (15–40% co-infection rate). HIV significantly increases susceptibility to all other STIs and their complications.
Key Risk Factors
How Is Gonorrhoea Diagnosed?
Gonorrhoea is diagnosed by NAAT from urethral, vaginal, rectal, and pharyngeal sites — all relevant exposure sites must be tested. Culture is required for antibiotic sensitivity testing. Symptomatic presentations may show Gram-negative diplococci on microscopy within minutes at a GUM clinic.
How Is Gonorrhoea Treated?
Gonorrhoea requires injectable ceftriaxone as first-line treatment. Oral antibiotics alone are no longer recommended due to resistance. Test of cure at 2 weeks is mandatory.
Supportive Measures
Abstain from sex until you and all treated partners have a test of cure confirming eradication. Gonorrhoea does not respond to oral over-the-counter antibiotics — intramuscular ceftriaxone 1g is required. Do not attempt self-treatment.
Gonorrhoea Reinfection & Resistance
Gonorrhoea does not confer immunity — reinfection from an untreated partner or new exposure is common. A test of cure must be performed 2 weeks after treatment. All partners from the past 60 days must be notified and treated. In MSM, 3-monthly STI screening is recommended.
When Should You Get Tested for Gonorrhoea?
Disseminated gonococcal infection (fever, joint pain, skin pustules) · PID with systemic sepsis · Gonorrhoea in pregnancy with preterm labour symptoms — attend A&E immediately.
Purulent discharge from the urethra or vagina · Known gonorrhoea exposure from a partner · Pharyngeal or rectal symptoms in MSM · Gonorrhoea in pregnancy · Treatment failure — symptoms persist after antibiotic course.
How to Prevent Gonorrhoea
Gonorrhoea prevention relies on the same principles as all STI prevention, with additional emphasis on test of cure and antibiotic stewardship.
All confirmed gonorrhoea should have a test of cure 2 weeks after treatment to confirm eradication, especially with multidrug-resistant strains. Antibiotic resistance is monitored nationally.
Annual STI testing is recommended for all sexually active people. Those with multiple partners should test every 3 months. Free NHS testing is available at sexual health clinics, online via SHGM/SH:24, and from GP surgeries.
Use condoms consistently for vaginal, anal, and oral sex with new or casual partners. Dental dams reduce transmission during oral-vulval contact. Lube reduces condom breakage and anal mucosal trauma.
Notify all recent sexual partners when diagnosed with an STI so they can be tested and treated. Partner notification can be done directly or anonymously through the sexual health clinic (contact tracing service).
HPV vaccination prevents 90% of cervical cancer and most genital warts. Hepatitis B vaccine is recommended for all MSM, PWID, and sexual health clinic attendees not previously vaccinated.
PrEP (Truvada or Descovy) is available free on the NHS at sexual health clinics for eligible high-risk individuals. It is over 99% effective when taken as prescribed. Regular HIV and kidney function testing is required during use.
Speak to a Clinician About Gonorrhoea Testing
Through The GP Service, a clinician can assess your symptoms, arrange gonorrhoea testing, prescribe treatment, and advise on partner notification and test of cure — all online.
Expert clinical advice, when you need it.
Gonorrhoea FAQs
Gonorrhoea is increasingly difficult to treat due to rising antibiotic resistance. The current UK first-line treatment is a single intramuscular injection of ceftriaxone 1g. A test of cure is required 2 weeks later to confirm eradication. Azithromycin is no longer recommended routinely due to resistance. Multidrug-resistant gonorrhoea has been identified in multiple countries, including the UK. If you have been treated for gonorrhoea and symptoms persist, return to the clinic immediately — do not take additional antibiotics without guidance. Treatment of all recent sexual partners is essential to prevent reinfection.
STI testing is recommended annually for all sexually active people. Those with new or multiple partners should test every 3 months. Testing is free at NHS sexual health clinics and from online services (SH:24, SHGM). You do not need symptoms to be tested — most STIs cause no symptoms. A full STI screen covers chlamydia, gonorrhoea, syphilis, HIV, hepatitis B, and hepatitis C. Specific sites tested (urine, swabs, blood) depend on your sexual practices. Results are usually available within 1–2 weeks. Positive results trigger automatic partner notification advice.
Not all STIs are curable, but all are treatable. Bacterial STIs — chlamydia, gonorrhoea, and syphilis — are fully curable with antibiotics when diagnosed promptly. Viral STIs — HIV, herpes, HPV, and hepatitis B — cannot be cured but can be effectively managed. HIV is controlled with ART to the point of undetectability. Herpes is managed with antivirals that suppress outbreaks. HPV often clears naturally within 1–2 years in people with healthy immune systems. Genital warts can be treated and removed, though the underlying HPV virus may persist. The key message: all STIs are manageable with prompt diagnosis and treatment.
Yes. HIV is now a manageable chronic condition, not a death sentence. With antiretroviral therapy (ART), people with HIV can live long, healthy lives with a normal life expectancy. ART suppresses the virus to undetectable levels in the blood, meaning it cannot be transmitted sexually (Undetectable = Untransmittable, or U=U). Most people on modern ART take a single tablet daily and experience minimal side effects. HIV does not prevent you from having children, working, or having a fulfilling life. In the UK, HIV care is excellent and free on the NHS. The biggest barrier to good outcomes is late diagnosis — testing early is life-saving.
PEP (post-exposure prophylaxis) is a 28-day course of antiretroviral drugs that prevents HIV infection after a potential exposure. It must be started within 72 hours — the sooner the better. PEP is available from A&E departments, sexual health clinics, and some GUM clinics 24/7. It is free on the NHS for NHS patients. PEP is not a substitute for PrEP or condoms and should be used only in genuine emergencies (unprotected sex with a known HIV-positive person not on suppressive ART, condom failure, sexual assault, or needlestick). After completing PEP, an HIV test at 45 days and 3 months confirms whether infection was prevented.
Yes, but safely. With modern antiviral suppression, the risk of transmitting herpes to a partner is substantially reduced. Daily suppressive valaciclovir reduces transmission risk by approximately 50%, combined with condom use. Disclosing herpes to a new partner is an important conversation — most people with herpes have had it from a previous partner without knowing. Your sexual health clinician can help with disclosure conversations and partner testing. Most people with herpes continue to have satisfying, loving relationships. Herpes is extremely common — HSV-2 affects around 1 in 6 adults — and carries significant social stigma disproportionate to its medical impact.
Without treatment, chlamydia can persist silently for months or years, causing progressive damage to the reproductive tract. In women, untreated chlamydia causes pelvic inflammatory disease (PID) in 10–15% of cases, leading to tubal factor infertility, chronic pelvic pain, and ectopic pregnancy risk increased 6–10-fold. In men, chlamydia causes epididymo-orchitis, which can impair sperm production and quality. Reactive arthritis (formerly Reiter's syndrome) — involving joint inflammation, eye inflammation, and urethritis — is a rare but recognised complication. These complications are entirely preventable with prompt diagnosis and a simple 7-day course of doxycycline.
PE affects approximately 20–30% of men at some point — making it the most common male sexual dysfunction. Many men suffer in silence due to embarrassment, assuming it is shameful or untreatable. In reality, PE is a well-recognised medical condition with highly effective treatments. Dapoxetine (a short-acting SSRI licensed specifically for PE) can more than triple ejaculatory latency time in clinical trials. Behavioural techniques (stop-start, squeeze) are effective for lifelong PE. Combining medication with psychological or couples therapy produces the best outcomes. Most men with PE who seek treatment experience significant improvement.