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Gonorrhea - CDC Fact Sheet (Detailed Version)

Basic Fact Sheet | Detailed Version

Detailed fact sheets are intended for physicians and individuals with specific questions about sexually transmitted diseases. Detailed fact sheets include specific testing and treatment recommendations as well as citations so the reader can research the topic more in depth.

What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) caused by infection with the Neisseria gonorrhoeae bacterium. N. gonorrhoeae infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. N. gonorrhoeae can also infect the mucous membranes of the mouth, throat, eyes, and anus.

How common is gonorrhea?

Gonorrhea is a very common infectious disease. CDC estimates that, annually, 820,000 people in the United States get new gonorrheal infections, and less than half of these infections are detected and reported to CDC. CDC estimates that 570,000 of them were among young people 15-24 years of age. In 2012, 334,826 cases of gonorrhea were reported to CDC 2.

How do people get gonorrhea?

Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread perinatally from mother to baby during childbirth.

People who have had gonorrhea and received treatment may be reinfected if they have sexual contact with a person infected with gonorrhea.

Who is at risk for gonorrhea?

Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans 2.

What are the signs and symptoms of gonorrhea?

Many men with gonorrhea are asymptomatic 3, 4. When present, signs and symptoms of urethral infection in males include dysuria or a white, yellow, or green urethral discharge that usually appears one to fourteen days after infection 5. In cases where urethral infection is complicated by epididymitis, men with gonorrhea may also complain of testicular or scrotal pain.

Most women with gonorrhea are asymptomatic 6, 7. Even when a woman has symptoms, they are often so mild and nonspecific that they are mistaken for a bladder or vaginal infection 8, 9. The initial symptoms and signs in women include dysuria, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements 10. Rectal infection also may be asymptomatic. Pharyngeal infection may cause a sore throat, but usually is asymptomatic 11, 12.

What are the complications of gonorrhea?

Untreated gonorrhea can cause serious and permanent health problems in both women and men.

In women, gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID).  The symptoms may be quite mild or can be very severe and can include abdominal pain and fever 13. PID can lead to internal abscesses and chronic pelvic pain. PID can also damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy.

In men, gonorrhea may be complicated by epididymitis.  In rare cases, this may lead to infertility 14.

If left untreated, gonorrhea can also spread to the blood and cause disseminated gonococcal infection (DGI). DGI is usually characterized by arthritis, tenosynovitis, and/or dermatitis 15. This condition can be life threatening.

What about Gonorrhea and HIV?

Untreated gonorrhea can increase a person’s risk of acquiring or transmitting HIV, the virus that causes AIDS 16.

How does gonorrhea affect a pregnant woman and her baby?

If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby 17. Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult a health care provider for appropriate examination, testing, and treatment, as necessary.

Who should be tested for gonorrhea?

Any sexually active person can be infected with gonorrhea.  Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should stop having sex and see a health care provider immediately.

Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with an STD should see a health care provider for evaluation.

Some people should be tested (screened) for gonorrhea even if they do not have symptoms or know of a sex partner who has gonorrhea 18.  Anyone who is sexually active should discuss his or her risk factors with a health care provider and ask whether he or she should be tested for gonorrhea or other STDs.

People who have gonorrhea should also be tested for other STDs.

How is gonorrhea diagnosed?

Urogenital gonorrhea can be diagnosed by testing urine, urethral (for men), or endocervical or vaginal (for women) specimens using nucleic acid amplification testing (NAAT) 19.  It can also be diagnosed using gonorrhea culture, which requires endocervical or urethral swab specimens.

If a person has had oral and/or anal sex, pharyngeal and/or rectal swab specimens should be collected either for culture or for NAAT (if the local laboratory has validated the use of NAAT for extra-genital specimens) 20.

What is the treatment for gonorrhea?

Gonorrhea can be cured with the right treatment. CDC now recommends dual therapy (i.e. using two drugs) for the treatment of gonorrhea. It is important to take all of the medication prescribed to cure gonorrhea. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not repair any permanent damage done by the disease. Antimicrobial resistance in gonorrhea  is of increasing concern, and successful treatment of gonorrhea is becoming more difficult 21. If a person’s symptoms continue for more than a few days after receiving treatment, he or she should return to a health care provider to be reevaluated.

What about partners?

If a person has been diagnosed and treated for gonorrhea, he or she should tell all recent anal, vaginal, or oral sex partners (all sex partners within 60 days before the onset of symptoms or diagnosis) so they can see a health provider and be treated 20. This will reduce the risk that the sex partners will develop serious complications from gonorrhea and will also reduce the person’s risk of becoming reinfected. A person with gonorrhea and all of his or her sex partners must avoid having sex until they have completed their treatment for gonorrhea and until they no longer have symptoms. For tips on talking to partners about sex and STD testing, visit http://www.gytnow.org/talking-to-your-partner.

How can gonorrhea be prevented?

Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea 22. The surest way to avoid transmission of gonorrhea or other STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

Sources

  1. Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health, 36(1), 6–10 (2004).
  2. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2012 (U.S. Department of Health and Human Services, Atlanta, 2014).
  3. Handsfield HH, Lipman TO, Harnisch JP, Tronca E, Holmes KK. Asymptomatic gonorrhea in men. N Engl J Med, 290(3), 117–123 (1974).
  4. Peterman T, Tian L, Metcalf C et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med, 145(8), 564–572 (2006).
  5. Harrison WO, Hooper MR, Wiesner PJ et al. A trial of minocycline given after exposure to prevent gonorrhea. N Engl J Med, 300(19), 1074–1078 (1979).
  6. Wallin J. Gonorrhea in 1972: a 1-year study of patients attending the VD unit in Uppsala. Brit J Vener Dis, 51, 41–47 (1974).
  7. Platt R, Rice PA, McCormack WM. Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea. JAMA, 250(23), 3205–3209 (1983).
  8. McCormack WM, Johnson K, Stumacher RJ, Donner A, Rychwalski R. Clinical spectrum of gonococcal infection in women. Lancet, 1(8023), 1182–1185 (1977).
  9. Curran J, Rendtorff R, Chandler R, Wiser W, Robinson H. Female gonorrhea: its relation to abnormal uterine bleeding, urinary tract symptoms, and cervicitis. Obstet Gynecol, 45(2), 195–198 (1975).
  10. Klein EJ, Fisher LS, Chow AW, Guze LB. Anorectal gonococcal infection. Ann Intern Med, 86, 340–346 (1977).
  11. Wiesner PJ, Tronca E, Bonin P, Pedersen AHB, Holmes KK. Clinical spectrum of pharyngeal gonococcal infection. N Engl J Med, 288(4), 181–185 (1973).
  12. Bro-Jorgensen A, Jensen T. Gonococcal pharyngeal infections: report of 110 cases. Brit J Vener Dis, 49, 491–499 (1973).
  13. Svensson L, Westrom L, Ripa K, Mardh P. Differences in some clinical and laboratory parameters in acute salpingitis related to culture and serologic findings. Am J Obstet Gynecol, 138(7), 1017–1021 (1980).
  14. Berger R, Alexander E, Harnisch J et al. Etiology, manifestations and therapy of acute epididymitis: prospective study of 50 cases. J Urol, 121(6), 750–754 (1979).
  15. Holmes KK, Counts GW, Beaty HN. Disseminated gonococcal infection. Ann Intern Med, 74, 979–993 (1971).
  16. Fleming D, Wasserheit J. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm DIs, 75(1), 3–17 (1999).
  17. Thadepalli H, Rambhatla K, Maidman J, Arce JJ, Davidson EC Jr. Gonococcal sepsis secondary to fetal monitoring. Am J Obstet Gynecol, 126(4), 510–512 (1976).
  18. U.S. Preventive Services Task Force. Screening for gonorrhea: recommendation statement. Ann Fam Med, 3, 263–267 (2005).
  19. Van Der Pol B, Ferrero DV, Buck-Barrington L et al. Multicenter evaluation of the BDProbeTec ET system for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male uerthral swabs. J Clin Microbiol, 39(3), 1008–1016 (2001).
  20. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR, 59(RR-12) (2010).
  21. Centers for Disease Control and Prevention. Cephalosporin susceptibility among Neisseria gonorrhoeae isolates - United States, 2000–2010. MMWR, 60(26), 873–877 (2011).
  22. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ, 82(6), 454–461 (2004).
 

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