What is gonorrhea?

Gonorrhea is a sexually transmitted infection (STI) caused by the Neisseria gonorrhoeae bacterium. The infection is passed from person to person through unprotected vaginal, anal, or oral sex. It can affect the penis, vagina, or throat, among other areas of the body.

According to the Centers for Disease Control and Prevention (CDC), 555,608 new cases were reported in the United States in 2017.

Gonorrhea can lead to serious complications when left untreated, so it’s important to receive treatment as soon as possible. Most gonorrhea cases can be cured with the correct medications and prompt treatment.

How is gonorrhea treated?

Antibiotics can relieve symptoms and may cure gonorrhea infections, as long as they’re taken as prescribed. Treatment will begin as soon as a diagnosis is made.

Genital gonorrhea

For non-pregnant women with gonorrhea infections affecting the cervix, urethra, or rectum, the CDC recommends the simultaneous use of these drugs:

If ceftriaxone isn’t available include, the recommended alternative treatment is:

  • cefixime (Suprax), 400 mg, a single dose taken orally
  • azithromycin (Zithromax), 1 g, a single dose taken orally

Ceftriaxone and cefixime both belong to a class of antibiotics known as cephalosporins.

Oral gonorrhea

Gonorrhea infections that affect the throat are more difficult to treat than those that affect the genital area. Although the same medications are recommended for treating oral gonorrhea infections, they tend to be less effective.

A doctor may perform a throat culture five to seven days after treatment begins. This can help them determine whether the infection is gone. Prolonged treatment is necessary if the infection doesn’t go away within a few days.

Did you know? Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) and ofloxacin (Floxin), are no longer recommended for gonorrhea treatment. Spectinomycin, another antibiotic sometimes recommended for the treatment of gonorrhea, is no longer available in the United States.

How is disseminated gonorrhea treated?

Disseminated gonorrhea is a rare complication that occurs when N. gonorrhoeae infects the bloodstream. People with disseminated gonorrhea need to be hospitalized during the first phase of treatment. They should also see an infectious disease specialist.

Gonococcal arthritis

For people affected by gonococcal arthritis, the CDC recommends an initial treatment of:

  • ceftriaxone, 1 g, injected into the muscle or given intravenously every 24 hours
  • azithromycin (Zithromax), 1 g, a single dose taken orally

If a person can’t use ceftriaxone, perhaps because of a drug allergy, they may be given:

  • cefotaxime, 1 g, given intravenously every 8 hours
  • ceftizoxime, 1 g, given intravenously every 8 hours

The first phase continues until the condition has shown signs of improvement for at least 24 to 48 hours. During the second phase, if the condition shows improvement, the person with gonorrhea will be switched to an oral antibiotic. Total treatment time should last at least 1 week.

Gonococcal meningitis and endocarditis

For people affected by gonococcal meningitis and gonococcal endocarditis, the CDC recommends an initial treatment of:

  • ceftriaxone, 1-2 g given intravenously every 12-24 hours
  • azithromycin (Zithromax), 1 g, a single dose taken orally

Parenteral therapy, otherwise known as intravenous feeding, is also recommended. Total treatment time for meningitis should last at least 10 days, while total treatment time for endocarditis should last at least 4 weeks.

Is treatment different for pregnant women with gonorrhea?

The medications used for pregnant women with gonorrhea are essentially the same as the medications used for non-pregnant women.

Treatment is necessary to prevent disease transmission to, or complications for, the baby.

Gonorrhea in babies often manifests as conjunctivitis, or pink eye. Some states require that all newborns are given antibiotic eye drops, such as erythromycin, as a preventive measure against the disease.

Pregnant women who are diagnosed with gonorrhea should be tested for other STIs as well.

What are the possible side effects of gonorrhea treatment?

Side effects are one concern when it comes to antibiotic therapy. All of the recommended antibiotics can cause changes in the bacteria that normally inhabit the bowel or vagina.

This may make women more susceptible to diarrhea or vaginal yeast infections. Gastrointestinal upset is another common side effect of antibiotics.

Other possible side effects vary depending on the type of antibiotic being used.

Cephalosporins may cause symptoms such as:

Azithromycin may cause symptoms such as:

  • upset stomach
  • nausea
  • diarrhea
  • vomiting

How can gonorrhea be prevented?

Taking certain precautions will help prevent the spread of gonorrhea. There are also preventive measures that can keep the infection from occurring in the first place.

The most reliable ways to prevent gonorrhea are to:

  • abstain from sexual intercourse
  • always use a condom during vaginal, oral, or anal sexual intercourse
  • have a sexually monogamous partner who doesn’t have the infection

Since gonorrhea doesn’t usually cause symptoms, it’s important for people who are sexually active to get tested regularly. This is especially important if their partner has been diagnosed with gonorrhea.

Consider speaking with a doctor about how often to get tested for gonorrhea and other STIs.

Preventing the spread of gonorrhea

To minimize the risk of transmitting gonorrhea to others, avoid having sexual intercourse for at least seven days after completion of treatment. Also encourage any sexual partners from within the past 60 days to see their own doctors for evaluation.

If a person diagnosed with gonorrhea is in a romantic relationship, their partner should also get tested for gonorrhea. It’s still possible to contract gonorrhea while being treated for gonorrhea.

If both partners are diagnosed with gonorrhea, their treatment will be the same. Both will need to abstain from sexual intercourse until they’ve completed treatment and are cured.

What’s the takeaway?

In recent years, the N. gonorrhea bacterium has become resistant to some of the drugs used to treat gonorrhea, including penicillin and the tetracyclines. This means that these medications are less effective at treating and curing the infection.

As a result, nearly all people treated in the United States will receive a combination of the same two antibiotics: ceftriaxone and azithromycin.

Research published in the Journal of Antimicrobial Chemotherapy believe the bacterium may eventually build a resistance to even more of the drugs used to treat gonorrhea.

If left untreated — or treated improperly — gonorrhea can result in pelvic inflammatory disease (PID) in women or scarring of the urethra in men.

People who’ve been recently diagnosed with gonorrhea should also get tested for other STIs, including: