Gonorrhea is the second most commonly reported notifiable disease in the United States, caused by the gram-negative diplococcus Neisseria gonorrhoeae. The CDC recorded 648,056 US cases in 2022 — a 25% increase over five years — with rectal and pharyngeal infections rising fastest.
Gonorrhea (ICD-10: A54) is a sexually transmitted bacterial infection caused by Neisseria gonorrhoeae, a fastidious gram-negative diplococcus that selectively infects columnar and transitional epithelium of the urogenital tract, rectum, pharynx, and conjunctiva. The organism attaches via pili and Opa proteins, then invades mucosal cells, triggering neutrophilic inflammation that produces the classic purulent discharge. Asymptomatic carriage is common — up to 80% of cervical infections and 40-50% of male urethral infections produce no symptoms — which is the main reason for ongoing transmission. Clinically, gonorrhea presents as urethritis, cervicitis, proctitis, pharyngitis, conjunctivitis, or disseminated infection (gonococcal arthritis-dermatitis syndrome).
The key symptoms of Gonorrhea are: Thick, yellow or green purulent urethral discharge in men, typically appearing 2-7 days after exposure and persisting until treated., Painful or burning urination (dysuria) due to acute urethritis — sharper and earlier in onset than the discomfort of a urinary tract infection., Increased or abnormal vaginal discharge in women, often watery to yellow, sometimes accompanied by intermenstrual bleeding or post-coital bleeding., Lower abdominal or pelvic pain in women, which signals possible ascension to pelvic inflammatory disease and warrants urgent evaluation., Painful intercourse (dyspareunia) and cervical motion tenderness on bimanual exam — features of cervicitis or early PID., Anal itching, mucopurulent discharge, tenesmus, or bleeding in rectal gonorrhea, though up to 85% of rectal infections cause no symptoms., Sore throat or pharyngitis in oropharyngeal gonorrhea — present in fewer than 10% of pharyngeal infections; most are asymptomatic..
Diagnosis relies on nucleic acid amplification testing (NAAT), which has displaced culture as the routine method due to high sensitivity (>95%) and specificity (>99%) across all anatomic sites. Specimen choice depends on the patient and the suspected site: first-catch urine in symptomatic men, vaginal or endocervical swab in women, and self- or clinician-collected pharyngeal and rectal swabs as indicated. CDC recommends extragenital (pharyngeal and rectal) testing in MSM, in patients with relevant exposures regardless of orientation, and in any patient with persistent symptoms despite genital-only negative NAAT. Culture remains essential for two purposes: antimicrobial susceptibility testing whenever treatment failure is suspected, and confirmation of disseminated, joint, or ophthalmic disease where treatment intensification depends on sensitivity. Gram stain of urethral discharge in symptomatic men shows intracellular gram-negative diplococci with 95% sensitivity and is a reasonable rapid test in clinics with microscopy. In women, microscopy is too insensitive to use alone. Every gonorrhea diagnosis should trigger bundled testing for chlamydia, syphilis, HIV, and hepatitis B and C at the same visit, since co-infection rates are 10-30% for chlamydia and substantial for other STIs. Partner notification (within the prior 60 days) is mandatory in most US states. Test-of-cure (repeat NAAT 7-14 days after treatment) is recommended for pharyngeal gonorrhea, treatment failure, pregnancy, or alternative-regimen use, but not for routine urogenital cases. All patients should be retested for reinfection 3 months after treatment because incident reinfection rates approach 10-20% in the year following the initial diagnosis.
With single-dose intramuscular ceftriaxone, the prognosis for uncomplicated urogenital and rectal gonorrhea is excellent — microbiologic cure in 98-99% of cases with no long-term sequelae. Pharyngeal infection has slightly lower cure rates (95-98%) and warrants test of cure. Pelvic inflammatory disease, when promptly treated, resolves clinically in over 90% of cases, but tubal scarring still occurs in roughly 12% of women after a single episode and 50% after three episodes, with corresponding rises in ectopic pregnancy and infertility risk. Disseminated infection responds well to intravenous ceftriaxone, with full recovery in over 90% of patients without permanent joint damage if treated within the first week. The dominant prognostic concerns at the population level are reinfection (10-20% within 12 months in high-risk groups) and antimicrobial resistance — extensively drug-resistant strains have been documented in Japan, the United Kingdom, France, and Australia, and ceftriaxone-resistant cases are accumulating, though they remain rare in the US (under 0.1% in 2022 CDC surveillance).
Infectious disease or sexual health specialist input is warranted in suspected treatment failure, disseminated gonococcal infection, complicated pelvic inflammatory disease, pregnancy with cephalosporin allergy, recurrent infection despite appropriate therapy, and gonococcal endocarditis or meningitis. Primary care and sexual health clinics manage most uncomplicated cases according to CDC algorithms.
Find specialists →Urethral and vaginal symptoms typically resolve within 3-5 days of ceftriaxone administration. Sexual activity should be avoided for 7 days after treatment and until partners are treated. Pelvic inflammatory disease pain and fever resolve over 3-7 days with appropriate antibiotics. Joint involvement in disseminated infection resolves over 2-4 weeks of treatment. Retest at 3 months for reinfection; test of cure at 7-14 days only for pharyngeal sites, pregnancy, or treatment failure concerns.
No specific restrictions for uncomplicated gonorrhea once treatment is administered. With pelvic inflammatory disease, rest until pain and fever resolve, then gradually return to normal activity. Disseminated infection with septic arthritis requires joint rest until inflammation settles, typically 1-2 weeks.
Look for a clinician who follows the CDC 2021 STI Treatment Guidelines, has access to NAAT testing at all relevant sites (urine, vaginal, pharyngeal, rectal), can prescribe expedited partner therapy where legal, and integrates bundled STI screening at every visit. Sexual health clinics typically provide rapid testing, partner notification support, and discreet care.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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