Gonorrhea, a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae, is usually treated with a single injection of the antibiotic drug ceftriaxone. Other antibiotics may be used if you are allergic to ceftriaxone or the drug is unavailable. In some cases, the injection may be accompanied by a single dose of the oral antibiotic azithromycin.

In the past, a penicillin shot was all that was needed to cure gonorrhea. But, high rates of infection coupled with the overuse of penicillin led to widespread antibiotic resistance. Oral antibiotics once used on their own to treat gonorrhea were also met with high levels of resistance, in part because many people failed to complete the course of treatment.

Today, the goal of gonorrhea treatment is to hit the infection hard and fast—ideally with a single dose—so that the bacteria are completely eradicated and don’t have the chance to mutate and become resistant.

This article outlines the current guidelines for the treatment of gonorrhea, including the treatment of sexual partners. It also explains how uncomplicated gonorrhea, disseminated (widespread) gonorrhea, and gonorrhea in newborns are each treated.

Prescriptions

There are six antibiotic drugs recommended for the treatment of gonorrhea by the Centers for Disease Control and Prevention (CDC):

There are no home remedies, over-the-counter medications, or complementary or alternative therapies able to treat a gonorrhea infection.

  • Ceftriaxone (preferred): Delivered either by intramuscular injection (into a large muscle) or intravenously (into a vein)
  • Cefixime (alternative): Delivered by intramuscular injection
  • Gentamicin (alternative): Delivered by intramuscular injection
  • Cefotaxime (alternative): Delivered by intramuscular injection
  • Azithromycin (alternative): Taken by mouth as an oral tablet
  • Erythromycin (for newborns): Applied to the eye as an ointment

Ceftriaxone is the antibiotic most capable of treating gonorrhea on its own. Others may be used either on their own or along with a single oral dose of azithromycin.

Uncomplicated Gonorrhea

Uncomplicated gonorrhea—meaning gonorrhea that is localized to the site of the initial infection—is usually easily treated with a single dose of ceftriaxone. This includes gonorrhea infections of the genitals, throat, and rectum. Gonococcal conjunctivitis, an infection caused by touching your eyes with contaminated fingers, is also treated with a single dose of ceftriaxone.

Other antibiotics, used either alone or in combination, may be prescribed if you are allergic to ceftriaxone or the drug is unavailable.

The dosages are described in milligrams (mg) or grams (g).

Disseminated Gonorrhea

Disseminated gonococcal infection (DGI) is a serious complication caused by untreated gonorrhea. It is often referred to as “arthritis-dermatitis syndrome” because the dissemination (spread) of N. gonorrhoeae throughout the body triggers symptoms of arthritis and skin lesions.

In rare cases, meningitis (inflammation of the membrane surrounding the brain and spinal cord) and endocarditis (inflammation of the heart valves) can develop if gonorrhea is left untreated.

If diagnosed with DGI, you will need to be hospitalized for treatment. The duration of treatment depends on the type of complication you have.

Treatment of Sexual Partners

People diagnosed with gonorrhea should be tested for a related STI called chlamydia. If chlamydia is diagnosed (or cannot be excluded), the CDC recommends additional treatment with azithromycin or the oral antibiotic drug doxycycline.

Sex partners also need to be contacted, tested, and provided treatment. In certain cases, a partner may be treated without undergoing testing. This is a precautionary measure that not only protects their health but may also prevent the spread of infection.

After treatment is completed, you do not need to undergo further testing to see if the infection has cleared. The only exception is gonorrhea of the throat, which is far more difficult to treat.

Treatment of Newborns

If you are diagnosed with gonorrhea during pregnancy, it is important to seek treatment as soon as possible to prevent passing the infection to your unborn baby. The treatment is the same whether you are pregnant or not and poses no harm to the baby.

CDC Recommendations

Your healthcare provider may ask you to return in three to 12 months for repeat testing, a practice endorsed by the CDC. This is because up to one of every eight people previously treated for gonorrhea will be reinfected, and often by the same source.

Once your baby is born, an ointment containing 5% erythromycin will be applied to the baby’s eyes whether you have been treated or not. This prevents ophthalmia neonatorum, an infection that can occur if gonorrhea gets into the baby’s eyes as it passes through the birth canal.

If you have not been treated (or were diagnosed late in the pregnancy), your baby will be given antibiotics as a precautionary measure. If there are symptoms, more aggressive measures will be taken. In such cases, the dose is prescribed based on the weight of the baby in kilograms (kg).

Summary

Gonorrhea is typically treated with a single intramuscular injection of the antibiotic drug ceftriaxone. Other antibiotics may be used alone or in combination if you are allergic to ceftriaxone or the drug is unavailable. Sexual partners should also be treated.

People with complications of gonorrhea, including newborns, may require intravenous ceftriaxone (or a related antibiotic called cefotaxime) delivered in a hospital.

A Word From Verywell

It is important to note that not everyone with gonorrhea has symptoms. This is especially true of females and people who engage in anal sex.

It is for this reason that the CDC recommends annual gonorrhea and chlamydia testing for all sexually active females under 25. Those 25 and older with risk factors such as new or multiple sex partners or a sex partner with an STI should also be tested annually.

The CDC also recommends annual gonorrhea, chlamydia, syphilis, and HIV testing for sexually active men who have sex with men (MSM). Those with multiple or anonymous sex partners should be tested every three to six months.

Frequently Asked Questions

  • What does gonorrhea look like?
  • In many cases, gonorrhea does not cause any visible symptoms. However, when it does cause symptoms, they may include discharge from the penis or vagina and pain while urinating.
  • How common is gonorrhea?
  • Gonorrhea is very common. The Centers for Disease Control and Prevention (CDC) estimates that about 1.6 million new cases occurred in 2018 in the United States.
  • What happens if gonorrhea goes untreated?
  • Untreated gonorrhea can cause pelvic inflammatory disease (PID) in females, which can lead to infertility. In males, it can cause epididymitis, which may also cause infertility. It can also cause disseminated gonococcal infection (DGI), in which the infection spreads throughout the body affecting multiple organs.

In many cases, gonorrhea does not cause any visible symptoms. However, when it does cause symptoms, they may include discharge from the penis or vagina and pain while urinating.

Gonorrhea is very common. The Centers for Disease Control and Prevention (CDC) estimates that about 1.6 million new cases occurred in 2018 in the United States.

Untreated gonorrhea can cause pelvic inflammatory disease (PID) in females, which can lead to infertility. In males, it can cause epididymitis, which may also cause infertility. It can also cause disseminated gonococcal infection (DGI), in which the infection spreads throughout the body affecting multiple organs.

  • Centers for Disease Control and Prevention. Gonorrhea - CDC fact sheet (detailed version).

  • Tshokey T, Tshering T, Pradhan AR, et al. Antibiotic resistance in Neisseria gonorrhoea and treatment outcomes of gonococcal urethritis suspected patients in two large hospitals in Bhutan. PLoS One. 2018;13(8):e0201721. doi:10.1371/journal.pone.0201721

  • Centers for Disease Control and Prevention. Update to CDC’s treatment guidelines for gonococcal infection. MMWR Morbidity Mortality Weekly Rep. 2020 Dec;69(50);1911–6.

  • Yoshino Y, Abe M, Seo K, Koga I, Kitazawa T, Ota Y. Multifocal cellulitis due to disseminated Neisseria gonorrhoeae in a male patient. J Clin Med Res. 2014;6(3):215–217. doi:10.14740/jocmr1732w

  • Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1

  • Centers for Disease Control and Prevention. Gonorrhea treatment and care.

  • Moore DL, MacDonald NE; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Preventing ophthalmia neonatorum. Can J Infect Dis Med Microbiol. 2015;26(3):122–125. doi:10.1155/2015/720726

  • Centers for Disease Control and Prevention. Which STD tests should I get?

  • Centers for Disease Control and Prevention. Gonorrhea statistics.

  • Centers for Disease Control and Prevention. Latest data on antibiotic-resistant gonorrhea.

By Elizabeth Boskey, PhD

Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.

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