Gonorrhea: common, treatable, and increasingly resistant

Gonorrhea shares a lot with chlamydia — it's a common bacterial STI, frequently causes no symptoms, and can lead to serious complications if left untreated. The two are often tested for together and sometimes occur together. But gonorrhea has one feature that makes it a distinct and growing concern: it's becoming increasingly resistant to the antibiotics used to treat it, to the point that public health bodies now track it as one of the more urgent antibiotic-resistance threats. That doesn't mean it's untreatable — it is treatable — but it makes proper treatment and follow-up more important than ever.

What it is and how it spreads

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It's transmitted through vaginal, anal, and oral sex, and can infect the genitals, rectum, throat, and eyes. As with chlamydia, it spreads through infected fluids and contact with infected mucous membranes — not through casual contact, toilets, or shared objects. It can also pass from a pregnant person to their baby during birth, which can cause a serious eye infection in the newborn, so it's screened for in pregnancy.

Symptoms — present more often than chlamydia, but still often absent

Gonorrhea causes symptoms somewhat more often than chlamydia, particularly in people with penises, but a large share of infections — especially in the vagina, rectum, and throat — still cause none. When symptoms appear, they usually show up within about 1–2 weeks and can include:

• Thick or unusual discharge from the penis, vagina, or rectum (sometimes green or yellow)
• Pain or burning when urinating
• Testicular pain or swelling (in people with testicles)
• Bleeding between periods or heavier periods (in people with a uterus)
• Rectal pain, discharge, or discomfort (with rectal infection)
• A sore throat (with throat infection, though usually symptomless)

Throat and rectal infections are particularly likely to be symptomless, which is why testing the relevant sites — based on the kind of sex you've had — matters. Relying on symptoms means missing most infections.

Testing

Testing is simple and similar to chlamydia: a urine sample for genital infection, or a swab (often self-taken) of the vagina, rectum, or throat. Gonorrhea and chlamydia are frequently tested for together from the same sample. Gonorrhea is generally detectable from about 1–2 weeks after exposure, so testing after a specific worry is usually advised at around that point. At-home kits can test for gonorrhea, and clinics test for it as standard. The when-to-get-tested guide covers timing.

Treatment — and the resistance problem

Gonorrhea is treated with antibiotics, and current guidance in most places is a single antibiotic injection (commonly ceftriaxone), sometimes with additional tablets depending on local guidance and whether chlamydia is also being treated. When treated with an effective antibiotic, it's cured.

The complication is antibiotic resistance. Over the decades, gonorrhea has developed resistance to nearly every antibiotic once used against it, one after another. Treatment guidelines have changed repeatedly as older drugs stopped working, and there is genuine concern in the medical community about strains resistant to the current front-line treatments. This is why:

• Treatment should follow current medical guidance — self-treating with leftover or online antibiotics is both ineffective and contributes to resistance.
• A follow-up "test of cure" is often recommended a few weeks after treatment, to confirm the infection has actually cleared — more routinely than for chlamydia, precisely because of resistance.
• Completing treatment exactly as prescribed matters, both for your cure and for slowing resistance.

As with chlamydia, recent partners should be tested and treated, and sex should be avoided until treatment is complete and confirmed effective, to prevent reinfection and spread.

Why untreated gonorrhea matters

Left untreated, gonorrhea can cause the same kinds of serious complications as chlamydia. In people with a uterus, it can cause pelvic inflammatory disease (PID), leading to chronic pain, ectopic pregnancy, and infertility. In people with testicles, it can cause epididymitis and, rarely, fertility problems. In rare cases, gonorrhea can spread through the bloodstream to cause disseminated gonococcal infection, affecting the joints and skin, which is a more serious illness. Untreated gonorrhea also increases susceptibility to HIV.

These outcomes are preventable by finding and treating the infection early — which, given how often it's symptomless, means testing.

Prevention

Condoms substantially reduce gonorrhea transmission and are the primary prevention method. Regular testing — especially with new or multiple partners, and including the relevant sites (throat and rectum, not just genitals, based on the sex you have) — catches infections early. Open conversations about testing status between partners reduce spread. The condoms guide covers the protection side.

The bottom line on gonorrhea: common, frequently silent, still treatable — but the resistance picture makes it a genuine "test, treat properly, and confirm the cure" infection rather than something to take casually. Early detection and correct treatment are what keep it manageable, both for you and for everyone.