How Gonorrhea Is Diagnosed

If you suspect that you have been infected with gonorrhea, it's important that you see a doctor. This sexually transmitted infection often doesn't cause symptoms, so you should be tested even if you feel well. The diagnosis is based on a urine sample or a swab of the potentially infected area (vagina, urethra, or throat, for example) that is sent to a laboratory for bacterial culture, gram stain, or a genetic test. If you're unable to see a physician, or you prefer to handle this privately, there are also kits you can use to self-test from home. 

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Labs and Tests

There are three tests used to diagnose gonorrhea, each of which has their benefits and limitations. In addition to gram-staining and bacterial cultures, a newer technology, called the nucleic acid amplification test (NAAT), can provide genetic evidence of infection.

Nucleic Amplification Test (NAAT)

Due to its speed and accuracy, the Centers for Disease Control and Prevention (CDC) recommends that the NAAT be used to diagnose gonorrheal infections of the rectum and throat. This test can deliver highly accurate results within a few hours. You can expect to receive your tests results within two to three days.

The NAAT identifies the genes unique to N. gonorrhoeae in a urine sample or a swab of the vagina, cervix, or urethra (in males). Through a process called thermocycling, the DNA strands in the sample are duplicated over and over again until there are roughly a billion copies.

Bacterial Culture

A bacterial culture can be highly effective in diagnosing gonorrhea of the genitals, rectum, eyes, or throat. A gonorrheal swab requires both mucosal cells and infectious discharge.

Cells collected with a swab of the affected area are sent to a lab, where they are added to a substance designed to promote the growth of N. gonorrhoeae. If there is growth, the test is positive. If there is no growth, the test is negative. Generally speaking, it can take from five to seven days to receive the results of a bacterial culture.

A culture can also be used to determine whether a bacterium is resistant to any of the antibiotic drugs that are used to treat this infection. This is especially important if treatment doesn't clear an infection or if disseminated gonococcal infection (DGI) develops. DGI is a severe complication in which the bacteria spreads through the bloodstream to organs in the body.

While culture results can provide definitive proof of an infection, the test can be marred if the swab is not taken properly. A bacterial culture is temperature-sensitive and it may be less accurate if there are any mistakes in the handling, storage, incubation, or processing of a sample.

Gram Staining

Gram staining is a technique in which special dyes are used to stain the walls of bacteria so that they can be isolated and identified with a microscope. You should expect to receive your gram stain test results in two to three days.

Gram staining is often used for diagnosing a gonorrheal infection in males. It is typically performed by obtaining a swab from the urethra, as well as a first catch urine sample. The first catch is a method by which urination is withheld for at least an hour before collection and only the first 20 to 30 milliliters of urine are collected from the flow.

A gram stain has a low sensitivity, so a negative result would not be considered definitive, and other forms of testing would be necessary.

Differential Diagnoses

Several medical conditions can cause symptoms similar to the symptoms of gonorrhea.

Common conditions your doctor may consider during your diagnostic evaluation:

  • Urinary tract infections
  • Herpes simplex urethritis
  • Vaginitis
  • Bacterial vaginosis
  • Internal hemorrhoids
  • Epididymitis
  • Mucopurulent cervicitis
  • Bacterial conjunctivitis
  • Orchitis

Our Doctor Discussion Guide below can help you start a conversation with your doctor about what different results may mean.

Gonorrhea Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Man

Self-Checks/At-Home Testing

If you think you may have been exposed to gonorrhea, you might look for signs and symptoms before seeking out a test. Remember, though, symptoms don't occur often and you should be tested to confirm a diagnosis or put your mind at ease—officially.

Stigma, embarrassment, and fear of disclosure are among the reasons why some people avoid getting tested for STDs. In fact, according to a report from the CDC, undiagnosed STDs cause infertility in more than 20,000 American women each year.

To this end, an increasing number of public health advocates have endorsed the use of at-home STD tests, which provide consumers the autonomy and confidentiality they desire.

The most popularly marketed home kits for gonorrhea require you to collect the swab and/or urine samples at home and mail them to the lab for analysis. You then log onto a secure website to get your results in three to five business days.

Drawback of At-Home Tests

Despite the appeal of at-home testing, there are many drawbacks. Collecting samples tends to be more difficult than manufacturers suggest, and user error is rife. Most companies are neither clear on the type of tests they provide nor their accuracy (as measured by sensitivity/specificity). Moreover, the cost of the kits can be prohibitive, starting at $90 for a single STD and over $300 for a comprehensive STD screen.

One test to actively avoid is the rapid gonorrhea test strip. While the urine and fluid-based tests can deliver results in as little as 15 minutes, they offer a sensitivity of as low as 60—meaning that as many as two of every five tests will return a false-negative result.

If You Test Positive

If you receive a positive result for gonorrhea, you should have a comprehensive STD screening, including for chlamydia, syphilis, trichomoniasis, and HIV. Co-infection is common among these STDs, and some co-infections, like HIV, are more likely to progress if you also have another STD. If you used an at-home test, you should get this additional screening through a physician.

It is highly suggested that you contact current and recent sex partners, and that they get tested (and treated, if needed). While the CDC recommends that you or your provider notify all partners you had sex within the 90 days prior to the onset of symptoms or the confirmation of your diagnosis, you may want to go further back than that.

Once treatment is completed, a follow-up test is not required to confirm the infection has cleared as long as the recommended antibiotics are used. However, given the high rates of reinfection, your doctor may request that you be retested in three months irrespective of whether your partners have been treated or not.

Screening Recommendations

Gonorrhea is the second most common STD in the United States, accounting for over 500,000 infections in recent years. To this end, the U.S. Preventive Services Task Force recommends that screening for gonorrhea and other common STDs be performed in people who are at an increased risk of exposure and/or disease complications.

Who Should Be Screened?

  • Gonorrhea and chlamydia should be screened in all sexually active females who are at increased risk of exposure.
  • Gonorrhea and chlamydia should be screened in pregnant females who are at increased risk.
  • Syphilis, hepatitis B, and HIV should be screened in all pregnant females.
  • Syphilis, hepatitis B, and HIV should be screened in males or females who are at increased risk.
  • HIV testing should be conducted as part of a routine doctor's visit for all people ages 15 to 65.

You are considered at risk if you've ever had multiple sex partners or have engaged in unprotected sex (including oral sex). This is true even if the potential exposure happened years ago. If you are infected, you will continue to be contagious until you receive treatment, and there's a risk of bringing the infection into a new relationship without even knowing. Your partner's sexual history and behaviors can affect your risk of STDs as well.

See your doctor for screening. Or, to find a testing site near you, visit the CDC's online locator. Many of the listed clinics offer low-cost or no-cost confidential testing for qualified residents.

Frequently Asked Questions

  • How long after exposure does it take for a gonorrhea test to come up positive?

    It may take between five days to two weeks to have a positive gonorrhea test result after exposure.

  • Is gonorrhea curable?

    Yes, gonorrhea can be cured with antibiotics, but any damage done prior to receiving treatment may be permanent.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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