Sexual health

Gonorrhea, and How It Spreads

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The second most reported bacterial STI in the country is a moving target. Gonorrhea often causes no symptoms, spreads through more than genital contact, and has steadily outrun the drugs used against it. Here is what the infection is, how it moves between people, why a throat swab can matter, and what treatment looks like now that resistance has narrowed the options.

Last updated: July 2026

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What gonorrhea actually is

Gonorrhea is an infection caused by the bacterium Neisseria gonorrhoeae. It grows on the warm, moist surfaces of the body and can infect several sites at once — the urethra, the cervix, the rectum, the throat, and, less often, the eyes. It is one of the most common bacterial sexually transmitted infections in the United States, and although it remains curable, treating it has become notably harder over the past two decades 1.

Gonorrhea is a close relative of chlamydia, and the two are frequently found together and checked for on the same urine sample or swab. The infections can look almost identical, but they are different bacteria that need different antibiotics, which is why a test that tells them apart matters. Someone reading about the difference between gonorrhea and chlamydia is usually trying to sort out which one they have and what that means for treatment — and the honest answer is that only a test can say.

What makes gonorrhea distinct among common STIs is less about how it feels and more about how the bacteria behave. Neisseria gonorrhoeae has a long record of developing resistance to the drugs used against it, which turns a routine, curable infection into a public-health problem worth watching closely 1.

How you get gonorrhea

Gonorrhea spreads through the fluids exchanged during vaginal, anal, and oral sex, and it can infect whichever site those fluids reach — the genitals, the rectum, or the throat. Ejaculation is not required for transmission, and the infection can move in either direction between partners. It is not spread by toilet seats, towels, cups, or casual contact, because the bacteria do not survive well outside the body 1.

Because gonorrhea travels in genital fluids rather than on the skin, condoms used consistently and correctly substantially lower the risk of passing or acquiring it 2. That protection is strongest for genital and rectal infection; oral transmission is harder to block completely, which is part of why throat infections are so often missed.

A pregnant person can also pass gonorrhea to their baby during vaginal birth. In a newborn it most often shows up as a serious eye infection in the first days or weeks of life, which is why prenatal screening and newborn eye care exist. As with other common STIs, a single exposure to one infected partner is enough — it is a matter of contact, not of how many partners someone has had.

Why gonorrhea is so often silent

Many gonorrhea infections cause no symptoms at all, and the quieter sites are the throat and rectum, where infection is easy to miss entirely. Genital infection is more likely to produce symptoms than throat or rectal infection, but even there a large share of people notice nothing and pass the infection on without knowing they carry it 1.

When symptoms do appear, they usually start within a week or two of exposure. In people with a penis, that can mean a discharge and burning with urination. In people with a vagina, symptoms are often milder or absent, and may be mistaken for a bladder infection or ordinary discharge. Throat gonorrhea rarely causes more than a mild sore throat, if anything at all, and rectal infection may cause itching, discomfort, or discharge — or nothing.

In the throat and rectum, gonorrhea usually causes no symptoms, so those sites are missed unless they are specifically swabbed. That is the practical reason a full picture depends on where samples are taken, not just on how a person feels. Someone who wants to understand throat gonorrhea symptoms will find the same theme running through all of them: mild, easy to dismiss, and frequently not there at all.

How common is gonorrhea, and who gets it

Gonorrhea is the second most reported bacterial STI in the United States, with more than 600,000 cases reported in 2023 — and, as with chlamydia, the real number is higher because so many infections are silent and never tested. Reported gonorrhea has actually declined in the most recent data, a hopeful shift after years of increases 3.

As with STIs generally, the burden falls heavily on younger adults: nearly half of all reported STIs are in people aged 15 to 24 3. Rates are also higher among men who have sex with men, in part because throat and rectal infections are common in that group and are missed without site-specific testing.

The recent decline is encouraging, but it sits against a longer backdrop of rising resistance, which is the reason public-health attention stays high even as case counts dip. A curable infection that is getting harder to cure is a different kind of problem than one that is simply common — the concern is less about how many people are infected in a given year and more about keeping the treatments that still work, working. That is why the story of gonorrhea today is really the story of its antibiotics.

Drug-resistant gonorrhea, the reason it matters

Over the decades, Neisseria gonorrhoeae has developed resistance to nearly every class of antibiotic ever used to treat it — sulfa drugs, penicillins, tetracyclines, and fluoroquinolones have each, in turn, stopped working reliably. Today one class, the cephalosporins, remains the last recommended option, and the CDC classifies drug-resistant gonorrhea as an urgent public-health threat 4.

That pressure changed how gonorrhea is treated. Current CDC guidance is a single antibiotic injection given in a clinic; when a chlamydia co-infection has not been ruled out, an oral antibiotic is added as well 5. The move to a single, more effective injection — rather than pills a person takes home — was a deliberate response to resistance, chosen to hit the infection hard in one supervised dose and slow the emergence of strains the drug can no longer clear.

The cephalosporins are the last antibiotic class still recommended for gonorrhea 4. Understanding how gonorrhea is treated today, and why it is a shot rather than a pill, is really about protecting that last line. It is also why finishing treatment, confirming a cure when the throat is involved, and treating partners are not just personal steps but part of a shared effort to keep the infection treatable at all.

What happens if gonorrhea goes untreated

Left untreated, gonorrhea can spread from its first site into the surrounding organs and, occasionally, into the bloodstream. In women, it can climb into the upper reproductive tract and cause pelvic inflammatory disease, which can lead to chronic pelvic pain, ectopic pregnancy, and infertility from scarring. In men, it can cause a painful inflammation of the tube behind the testicle 1.

More rarely, the bacteria enter the bloodstream and cause disseminated gonorrhea — a body-wide infection that can bring on fever, painful or swollen joints, and skin sores. When gonorrhea spreads beyond the genitals this way it becomes a more serious illness that needs urgent medical care rather than a routine clinic visit. In newborns, an untreated maternal infection can cause a gonorrhea eye infection that threatens sight if it is not treated quickly.

As with chlamydia, most of this harm builds quietly, without the warning of clear symptoms, which is why the infection is treated whenever it is found rather than watched. The complications, not the original infection, are what cause lasting damage — so the entire aim is to catch and cure gonorrhea before it has the chance to move.

Testing, treatment, and telling partners

Gonorrhea is diagnosed with a nucleic acid amplification test on a urine sample or a swab, and the site matters: a urine test checks the genitals only, so finding a throat or rectal infection requires swabbing those sites specifically. Depending on how a person has sex, more than one sample may be needed to get a complete picture 1.

Treatment is a single antibiotic injection, with an oral antibiotic added when chlamydia has not been excluded 5. Because throat infections are harder to clear than genital ones, a follow-up test to confirm the cure is often recommended when the throat is involved. Retesting a few months after treatment is also common, since reinfection from an untreated partner is one of the most frequent reasons the infection reappears.

Treating partners is part of curing the infection, not an extra. CDC guidance is to notify partners from roughly the previous 60 days so they can be tested and treated, and where a partner is unlikely to see a clinician soon, many states allow expedited partner therapy — a way for the provider to treat that partner without a separate visit, unless the law prohibits it 6. Finishing treatment, waiting until partners are treated before having sex again, and testing regularly are what keep a curable but increasingly stubborn infection from cycling back.

Common questions

Yes. Gonorrhea can infect the throat during oral sex, and it usually causes no symptoms there, so it is easy to pass on unknowingly. A throat infection will not appear on a urine test; only a throat swab will find it. Throat infections are also harder to cure than genital ones, which is why a follow-up test is often recommended when the throat is involved.

It should not be counted on to. An untreated infection can persist, spread to other sites, and cause complications like pelvic inflammatory disease or, rarely, a bloodstream infection. Because gonorrhea is curable with a single injection and the risk sits in its complications, it is treated whenever it is found rather than waited out. Waiting also leaves partners exposed in the meantime.

It is an informal name for gonorrhea strains that resist most or all of the antibiotics normally used to treat it. The bacteria have a long history of developing resistance, and the cephalosporins are now the last recommended class, which is why the CDC calls drug-resistant gonorrhea an urgent threat. Truly untreatable cases remain rare, but the trend is the reason treatment guidance keeps tightening.

The single injection clears most uncomplicated infections quickly, but clinicians generally advise waiting about a week after treatment, and until any partners are treated, before having sex again. When the throat is infected, a follow-up test to confirm the cure is often recommended, because throat infections are harder to clear. Symptoms that persist after treatment are a reason to be re-evaluated.

Yes, gonorrhea is still curable, most often with a single antibiotic injection given in a clinic. The concern is not that it cannot be cured today, but that the bacteria keep developing resistance, leaving fewer drugs that work. That is why finishing treatment, confirming a throat cure when needed, and treating partners matter — they help keep the remaining treatments effective for everyone.

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When gonorrhea needs urgent care

  • —Fever with lower-abdominal or pelvic pain, or pain during sex, which can signal pelvic inflammatory disease
  • —Painful swelling of one testicle
  • —Painful or swollen joints with fever and skin sores, which can mean the infection has reached the bloodstream
  • —A newborn with red, swollen eyes and discharge in the first weeks of life

Severe pelvic or abdominal pain with a high fever, or hot, swollen joints with fever, needs same-day care — an emergency room if it is severe — because a spreading gonococcal infection is a medical emergency.

This article is health education, not medical advice, and does not replace a diagnosis or treatment plan from a clinician who knows your history. Testing and treatment decisions should be made with a licensed provider.

References

  1. 1.Centers for Disease Control and Prevention (2024). About Gonorrhea. CDC (cdc.gov/gonorrhea). linkGonorrhea is a bacterial STI that can infect the genitals, rectum, and throat, is often symptomless, and can cause pelvic inflammatory disease, ectopic pregnancy, and infertility if untreated.
  2. 2.Centers for Disease Control and Prevention (2024). Condom Use: An Overview. CDC (cdc.gov/condom-use). linkGonorrhea spreads in genital fluids, and consistent, correct condom use is highly effective at reducing transmission.
  3. 3.Centers for Disease Control and Prevention (2025). National Overview of STIs in 2023. CDC STI Statistics (Sexually Transmitted Infections Surveillance, 2023). linkMore than 600,000 gonorrhea cases were reported in the U.S. in 2023, gonorrhea declined in the most recent data, and nearly half of reported STIs occur in people aged 15 to 24.
  4. 4.Centers for Disease Control and Prevention (2024). Drug-Resistant Gonorrhea. CDC (cdc.gov/gonorrhea). linkNeisseria gonorrhoeae has developed resistance to nearly every antibiotic used against it, the cephalosporins are the last recommended class, and drug-resistant gonorrhea is designated an urgent public-health threat.
  5. 5.St. Cyr S, Barbee L, Workowski KA, et al. (Centers for Disease Control and Prevention) (2020). Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morbidity and Mortality Weekly Report, Vol. 69, No. 50. doi:10.15585/mmwr.mm6950a6 ✓Uncomplicated gonorrhea is treated with a single antibiotic injection, with an oral antibiotic added when a chlamydia co-infection has not been excluded.
  6. 6.Centers for Disease Control and Prevention (2021). Expedited Partner Therapy. CDC STI Treatment Guidelines, 2021. linkSex partners from the previous 60 days should be treated, and expedited partner therapy can treat a partner without an in-person visit when they are unlikely to seek timely care, unless prohibited by law.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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