How is gonorrhea treated?

The infection can be cured with antibiotics. However, any damage done prior to treatment may be permanent. As bacteria become increasingly drug-resistant, prevention is the best way to protect yourself.

How long can someone have gonorrhea and be unaware of it?

Someone with gonorrhea may not be aware of it until it causes complications such as a secondary infection. For people who do experience symptoms, it can take up to 30 days for them to appear.

Can gonorrhea heal without treatment?

Gonorrhea needs to be treated in order to prevent dangerous and/or permanent complications. Because it's unethical to let test subjects go untreated, not much is known about how long the infection will naturally persist. In subjects who don't respond to treatment, studies suggest that the infection can last for longer than three months.

Gonorrhea: Signs, Symptoms, and Complications

Gonorrhea, sometimes called "the clap," is one of the most common sexually transmitted infections (STIs) in the United States. There are around 1.5 million new cases each year.

Despite its prevalence, many people don't know they have gonorrhea. This is because gonorrhea doesn't always cause symptoms, especially in females. Males tend to experience more noticeable symptoms, but they usually do not seek care early enough to prevent spreading the infection.

When symptoms do appear, they typically include:

A discharge from the penis or vagina
Pain while urinating or having sex

Complications of untreated gonorrhea can range from inflammation of the reproductive organs to infertility. This is why it's so important to stay up to date on STI screening.

This article discusses the symptoms and complications of gonorrhea. It also lets you know when you should see a healthcare provider.

Initial Symptoms of Gonorrhea

Gonorrhea is transmitted during sexual activity. If there are any early symptoms, they will generally involve the area that was exposed, including:

The genitals
The rectum
The throat

Females with this infection can develop:

Vaginal discharge
Burning or pain when urinating (dysuria)
Vaginal itchiness
Bleeding between periods
Lower abdominal pain or discomfort
Pain during sex (dyspareunia)

Females and Asymptomatic Gonorrhea

Most females infected with gonorrhea will not have symptoms. When there are symptoms, they are sometimes mistaken for a bladder or vaginal infection.

Males with this infection can develop:

A greenish-yellow discharge from the penis
Dysuria
Pain and swelling in the testicles or scrotum

Rectal gonorrhea may cause:

Mild itchiness
Discomfort
Bleeding or pain during defecation

These symptoms can be mistaken for hemorrhoids.

Timing of Gonorrhea Symptoms

If signs and symptoms of gonorrhea develop, they usually appear 10 to 14 days after exposure.

Symptoms in Babies

Vertical transmission can also occur. This means a baby can get gonorrhea from its mother.

This usually doesn't happen while the baby is in the womb. The transmission can occur during delivery when the baby is exposed to the mother's genital secretions.

When this happens, the bacteria that causes gonorrhea may be transferred to the newborn's eyes. This causes ophthalmia neonatorum, a form of conjunctivitis (eye infection). It is characterized by eye redness, pain, and discharge. The routine administration of an antibacterial eye ointment at birth can prevent this condition.

When babies do get the condition, they usually develop symptoms within two to five days. Other problems associated with the infection can include:

Scalp infection
Vaginitis
Urethritis

Complications include scarring of the cornea, meningitis, sepsis, and blindness.

2:22

Click Play to Learn About the Symptoms of Gonorrhea

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Complications of Gonorrhea

Left untreated, gonorrhea can lead to serious complications. These complications can affect the reproductive tract and, less commonly, the joints, skin, heart, and central nervous system.

Complications in Females

In females with untreated gonorrhea, the most common complication is pelvic inflammatory disease (PID). This is a potentially serious infection of the female reproductive tract. Symptoms will often appear immediately after a menstrual period. In some cases, this is the first sign of infection.

PID is characterized by pain in the pelvis and lower abdomen. Other symptoms include:

Nausea
Vomiting
Fever
Chills
Cramping
Foul-smelling discharge

Infertility

An infection can sometimes cause scarring in the fallopian tubes. This can lead to complete tubal blockage and infertility. If a partial blockage occurs a fertilized egg may be unable to pass from the ovaries to the uterus. This would result in an ectopic (tubal) pregnancy. When this happens, a miscarriage is inevitable. If there is a rupture and hemorrhage, it can put the mother's life at risk.

Complications in Males

In males, an untreated infection can damage and block the epididymis. This is the narrow tube that stores sperm in the scrotum.

Gonorrheal epididymitis may be identified by:

Dysuria
Foul-smelling discharge
Painful ejaculation
Swollen lymph nodes in the groin

The blockage of one or both tubes can lead to infertility.

Gonococcal Conjunctivitis

You can get a condition known as gonococcal conjunctivitis if infected body fluids get into your eyes. This can cause:

Redness
Pain
Swelling
Profuse discharge of the eyes

Left untreated, the infection can cause scarring and perforation of the cornea. This can lead to vision loss or blindness. In rare cases, the infection can cause the cornea to "melt," binding the eyeball partially or completely to the eyelid.

Disseminated Gonococcal Infection (DGI)

In rare cases, a gonorrheal infection can spread through the bloodstream and affect distant organs. This is called disseminated gonococcal infection (DGI). This complication occurs in around 3% of people who have gonorrhea.

People with an impaired immune system are at the highest risk for disseminated gonococcal infection. This includes organ recipients and people with inadequately treated HIV.

DGI is often called arthritis-dermatitis syndrome. This is because it can cause inflammation of the joints (septic arthritis) and pus-filled lesions on the skin.

Very rarely, the infection can settle in the heart and cause endocarditis (inflammation of the heart valve). When this happens, symptoms include:

Malaise
Fever
Heart murmur
Progressive heart failure

DGI can also cause meningitis, which is an inflammation of the membranes surrounding the brain and spinal cord. This can trigger headaches, fever, fatigue, a stiff neck, and mental confusion.

When to See a Healthcare Provider

Most signs of gonorrhea are relatively non-specific and can be easily missed. Because of this, the best rule of thumb is to request an STI screen from a healthcare provider if you have had condomless sex. This is especially true if your sex partner is someone you don't know well, or who you think may have an STI. It is also important to get tested if you have any signs of infection, however mild.

If you are sexually active, you should get tested annually for gonorrhea and other STIs. This is important even if you have no symptoms and have not had sex without physical protection. If you're hesitant, remember that health professionals are not there to judge you. Their role is to provide treatment if needed and guidance to reduce your future risk.

Summary

Gonorrhea often has no symptoms, especially in females. In males, symptoms may not be noticed in time to prevent passing the disease on to others.

When symptoms do appear, they can include discharge, pain, and itchiness. Symptoms appear in areas that were exposed to the bacteria, such as the genitals, the rectum, and the throat.

Complications of untreated gonorrhea can range from infertility to pelvic inflammatory disease (in females) or disseminated gonococcal infection, which happens when the infection enters the bloodstream.

Since symptoms can be easy to miss, it is important to get screened for gonorrhea and other STIs regularly if you are sexually active.

Gonorrhea Doctor Discussion Guide

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

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CDC Guidance on Screening and Treatment

In 2021, the CDC released updated guidance on screening and treatment for STIs, including gonorrhea. Annual screening is recommended for:

All sexually active women aged less than 25 years
Older women with increased risk
All men who have sex with men

Gonorrhea is typically treated with antibiotics, namely Rocephin (ceftriaxone).

Frequently Asked Questions

How is gonorrhea treated?

The infection can be cured with antibiotics. However, any damage done prior to treatment may be permanent. As bacteria become increasingly drug-resistant, prevention is the best way to protect yourself.
How long can someone have gonorrhea and be unaware of it?

Someone with gonorrhea may not be aware of it until it causes complications such as a secondary infection. For people who do experience symptoms, it can take up to 30 days for them to appear.
Can gonorrhea heal without treatment?

Gonorrhea needs to be treated in order to prevent dangerous and/or permanent complications. Because it's unethical to let test subjects go untreated, not much is known about how long the infection will naturally persist. In subjects who don't respond to treatment, studies suggest that the infection can last for longer than three months.

13 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.

Kreisel KM, Weston EJ, Cyr SB, Spicknall IH. Estimates of the prevalence and incidence of chlamydia and gonorrhea among US men and women, 2018. Sex Transm Dis. 2021;48(4):222-31. doi:10.1097/OLQ.0000000000001382
Centers for Disease Control and Prevention. Detailed STI facts—gonorrhea.
Centers for Disease Control and Prevention. Gonorrhea – CDC fact sheet.
Matejcek A, Goldman RD. Treatment and prevention of ophthalmia neonatorum. Can Fam Physician. 2013;59(11):1187-90.
Fyle-Thorpe O. Chlamydia and gonorrhea: an update. J Nurse Pract. 2019;15(6):424-8. doi:10.1016/j.nurpra.2018.12.027
Office on Women’s Health, U.S. Department of Health and Human Services. Pelvic inflammatory disease fact sheet.
McAnena L, Knowles SJ, Curry A, Cassidy L. Prevalence of gonococcal conjunctivitis in adults and neonates. Eye (Lond). 2015;29(7):875–880. doi:10.1038/eye.2015.57
Hook EW III, Handsfield HH. Gonococcal infections in the adult. In: Holmes KK, Sparling PF, Stamm WE, et al., eds. Sexually Transmitted Diseases. 4th ed. McGraw-Hill.
de Campos FP, Kawabata VS, Bittencourt MS, Lovisolo SM, Felipe-Silva A, de Lemos AP. Gonococcal endocarditis: an ever-present threat. Autopsy Case Rep. 2016;6(2):19. doi:10.4322%2Facr.2016.037
Centers for Disease Control and Prevention. Which STI tests should I get?
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1
Michigan Medicine. Gonorrhea.
Lovett A, Duncan JA. Human immune responses and the natural history of Neisseria gonorrhoeae infection. Front Immunol. 2019:3187. doi:10.3389/fimmu.2018.03187

Additional Reading

Lee K, Ngo-Metzger Q, Wolff T, Chowdhury J, LeFevre M, Meyers DS. Sexually transmitted infections: recommendations from the U.S. Preventive Services Task Force. Am Fam Physician. 2016;94(11):907-915.
McAnena L, Knowles S, Curry A, Cassidy L. Prevalence of gonococcal conjunctivitis in adults and neonates.Eye. 2015;29(7):875-880. doi:10.1038/eye.2015.57
St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s treatment guidelines for gonococcal infection, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(50):1911-1916. doi:10.15585/mmwr.mm6950a6

By Jerry Kennard
Jerry Kennard, PhD, is a psychologist and associate fellow of the British Psychological Society.

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