How Gonorrhea Is Treated

There was a time when a shot of penicillin was easily used to treat gonorrhea. Sadly, those days are gone. Due to the ongoing high rates of infection (and reinfection), gonorrhea has become resistant to nearly every major antibiotic in the treatment arsenal—and we are down to only a handful of drugs able to treat this otherwise uncomplicated concern. 

How to treat gonorrhea.

Theresa Chiechi / Verywell

The U.S. Centers for Disease Control and Prevention (CDC) updated treatment guidelines for gonorrhea to recommend a single 500 mg intramuscular dose of ceftriaxone. The recommendation was updated to address increasing resistance to azithromycin, which used to be part of the recommended treatment regimen.

The speed at which gonorrhea drug resistance has developed has been nothing short of astonishing. The first major sign of this was in the 1970s when penicillin no longer proved effective in clearing the infection. Prior to 2012, the use of oral antibiotics in monotherapy was widespread, the practice of which contributed to the development of resistance as people failed to complete their treatment and passed the increasingly resistant bacteria to others.

Today, although monotherapy is still recommended, the goal of treatment is to hit the infection hard and fast—ideally with a single dose—so that the bacteria is fully eradicated and not given the opportunity to mutate.

Uncomplicated Gonorrhea

Uncomplicated gonorrhea of the cervix, rectum, urethra, throat, and eye (gonococcal conjunctivitis) can usually be treated with a single dose of ceftriaxone. An alternative treatment is gentamicin plus azithromycin. For these cases, ceftriaxone and gentamicin are always given intramuscularly (with an injection into a muscle), whereas azithromycin is delivered orally (in pill form).

Alternative antibiotics may be used, but only if a preferred drug is not available or there is a known drug allergy.

Condition Recommendation
Cervix, rectum, urethra, or throat Ceftriaxone 500 mg intramuscularly in a single dose
If ceftriaxone is not available Cefixime 800 mg orally in a single dose
OR
Gentamicin 240 mg intramuscularly in a single dose, PLUS azithromycin 2 g orally in a single dose
For people allergic to ceftriaxone Gentamicin 240 mg intramuscularly in a single dose, PLUS azithromycin 2 g orally in a single dose
Gonococcal conjunctivitis Ceftriaxone 1 g intramuscularly in a single dose

All individuals who are diagnosed with gonorrhea should be tested for other STI's such as chlamydia. If a chlamydial infection cannot be excluded, the CDC recommends additional treatment with doxycycline 100 mg orally two times per day for 7 days. Those who are pregnant should receive a single 1 g dose of azithromycin.

In addition to being treated, your sex partners also need to be contacted, tested, and provided treatment as well. In certain cases, its possible for your partner(s) to receive treatment without undergoing a medical evaluation. This is to protect not only their health, but others' (including, potentially, yours).

After treatment is completed, a test to confirm the clearing of the infection is not needed. The only exception is pharyngeal gonorrhea, which is far more difficult to treat.

With that being said, anyone treated for gonorrhea would be asked to have another test done in three months. This is because the rate of gonorrheal reinfection is high, oftentimes from the same source. Whether your sex partners have been treated or not, it is important to have follow-up testing performed.

Disseminated Gonorrhea

Disseminated gonococcal infection (DGI) is a serious complication caused by an untreated disease. It is often referred to as arthritis-dermatitis syndrome, as the spread of bacteria through the bloodstream can trigger the development 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 you are diagnosed with DGI, you would need to be hospitalized so that certain medications can be delivered intravenously (into a vein). The treatment duration would be determined by the type of infection involved.

Condition Recommendation Duration
Gonococcal arthritis-dermatitis (preferred) Ceftriaxone 1 g IM or IV every 24 hours No less than seven days
Gonococcal arthritis-dermatitis (alternative) Cefotaxime 1 g intravenously every eight hours OR ceftizoxime 1 g every 8 hours No less than seven days
Gonococcal meningitis Ceftriaxone 1–2 g intravenously every 24 hours 10 to 14 days
Gonococcal endocarditis Ceftriaxone 1–2 g intravenously every 24 hours No less than four weeks

In Pregnancy and 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 no different than that of non-pregnant women and of no harm to your baby.

Whether you have been treated for gonorrhea or not, an antibiotic ointment (erythromycin 0.5%) will be applied to the baby's eyes at birth to prevent ophthalmia neonatorum, a gonorrheal eye infection transmitted to the baby as it passes through the birth canal. The ointment is routinely given to all newborns as a precautionary measure.

On the other hand, if you have not been treated or were diagnosed late, your baby will be given additional antibiotics whether there are symptoms or not. Doing so may clear the infection and prevent such complication as vaginitis, urethritis, respiratory infections, and DGI.

The treatment will be directed by the disease complications and the weight of the newborn in kilograms.

Condition Recommendation
No symptoms Ceftriaxone 20–50 mg per kg body weight delivered either intramuscularly or intravenously in a single dose
Gonococcal conjunctivitis Ceftriaxone 25–50 mg per kg body weight delivered either intramuscularly or intravenously in a single dose
DGI without meningitis Ceftriaxone 25–50 mg per kg body weight delivered either intramuscularly or intravenously for seven days OR Cefotaxime 25 mg per kg delivered either intramuscularly or intravenously every 12 hours for seven days
DGI with meningitis Ceftriaxone 25–50 mg per kg body weight delivered either intramuscularly or intravenously for 10 to 14 days OR Cefotaxime 25 mg per kg delivered either intramuscularly or intravenously every 12 hours for 10 to 14 days

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 CDC estimates that about 1.6 million new cases occurred in 2018 in the U.S.

  • What happens if gonorrhea goes untreated?

    Untreated gonorrhea can cause pelvic inflammatory disease in women, which can lead to infertility. In men, it can cause epididymitis, which may also cause infertility, though this is rare. In both males and females, it can also cause disseminated gonococcal infection.

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9 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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