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Health condition · Clinically reviewed

Gonorrhoea, rising in the UK and treatable, but the resistance picture matters.

Often silent, easy to test for and, in 2026, still treatable with a single injection. But antibiotic resistance is changing how UK clinics manage every case.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BASHH, UKHSA and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects the BASHH 2024 update on ceftriaxone dosing, test-of-cure and the UK resistance picture.

Key facts

Gonorrhoea at a glance.

The essentials, in plain English. What it is, how it presents, and how UK genitourinary medicine clinics manage it in 2026.

  • What it is

    A sexually transmitted infection caused by Neisseria gonorrhoeae, affecting the urethra, cervix, rectum, pharynx and, rarely, the eye.

  • How common

    One of the most common bacterial STIs in the UK and rising year on year, with the highest rates in young adults and men who have sex with men.

  • Presentation

    Discharge, dysuria and pelvic pain when symptomatic, but around half of infections in women and a minority in men cause no symptoms at all.

  • Why it matters

    Untreated it can cause pelvic inflammatory disease, epididymitis, infertility and, rarely, disseminated gonococcal infection.

  • Resistance

    Antimicrobial resistance is rising, with multidrug-resistant and extensively drug-resistant strains now a UK national concern.

  • First-line therapy

    Ceftriaxone 1 g intramuscularly as a single dose, given in a specialist genitourinary medicine clinic, per BASHH 2024.

Why this guide matters

A common infection, in an uncommon moment.

Cases are rising, resistance is rising, and the way UK clinics treat and follow up gonorrhoea has shifted. Three anchor points shape everything below.

  • Test at every exposed site

    Urine or vulvovaginal swab is not enough on its own. Rectal and pharyngeal swabs pick up infections that would otherwise be missed and drive onward transmission.

  • One injection, in a specialist clinic

    Ceftriaxone 1 g intramuscularly, in a genitourinary medicine clinic, remains the UK first-line. It is deliberately given somewhere culture, partner tracing and surveillance are joined up.

  • Return for test-of-cure

    A repeat test at around two weeks confirms clearance and feeds UKHSA resistance surveillance. It is not optional in 2026.

How the diagnosis is made

From first concern to a confirmed diagnosis.

The BASHH assessment used in UK genitourinary medicine clinics, in the order it usually happens. Nothing here should be a surprise on the day.

  1. 01

    Assessing

    Sexual history and risk

    A structured, non-judgemental history covering partners, sites of exposure, condom use and previous STIs guides which tests are needed.

  2. 02

    Assessing

    Symptom and site review

    Urethral, vaginal, rectal, pharyngeal and ocular symptoms are asked about explicitly, because gonorrhoea often sits at more than one site.

  3. 03

    Assessing

    Examination

    Genital, rectal and pharyngeal examination in a specialist GUM setting, looking for discharge, tenderness, proctitis or lymphadenopathy.

  4. 04

    Confirming

    NAAT testing

    Nucleic acid amplification testing on first-void urine, vulvovaginal swab and rectal or pharyngeal swabs where indicated.

  5. 05

    Confirming

    Culture and sensitivities

    Culture is taken before treatment for antimicrobial resistance monitoring, which is central to the UK response to rising resistance.

  6. 06

    Confirming

    Full STI screen

    HIV, syphilis, chlamydia, hepatitis B and C, and herpes are offered alongside, plus a pregnancy test where relevant.

  7. 07

    Onward

    Specialist GUM referral

    BASHH recommends assessment in a genitourinary medicine clinic for treatment, partner notification and follow-up.

Typical timeline: a single GUM appointment for testing and, in many cases, same-day treatment.

Symptoms

What gonorrhoea can look like.

Presentation depends on the site of infection, the sex of the patient and, often, luck. Silent infections are the norm, not the exception.

  • Male urethral infection

    Yellow or green urethral discharge and dysuria, usually within a week of exposure. Around one in ten men have no symptoms at all.

  • Female genital infection

    Often silent. Around half of women have no symptoms. When present, vaginal discharge, dysuria, intermenstrual bleeding and pelvic pain are typical.

  • Epididymitis

    Testicular pain and swelling from ascending infection. See our guide on /conditions/epididymitis/ for the full picture.

  • Proctitis

    Anal discharge, pain, tenesmus and bleeding, most often in men who have sex with men and anyone who has receptive anal sex.

  • Pharyngeal infection

    Usually asymptomatic and picked up on screening. Important because the pharynx is a common site for resistance to emerge.

  • Ophthalmia neonatorum

    Purulent conjunctivitis in a newborn from vertical transmission. A neonatal emergency requiring urgent specialist care.

  • Disseminated gonococcal infection

    A rare but serious complication with arthritis, tenosynovitis, skin lesions and, occasionally, endocarditis or meningitis.

  • PID and later infertility

    Untreated cervical infection can ascend to cause pelvic inflammatory disease, Fitz-Hugh-Curtis syndrome and infertility. See /conditions/pelvic-inflammatory-disease/ and /conditions/female-infertility/.

Treatment

How gonorrhoea is treated in the UK.

A single injection remains first-line, with reserve regimens, follow-up and partner work built around it. All care runs through specialist GUM.

  • Ceftriaxone 1 g IM

    The BASHH 2024 first-line option, given as a single intramuscular dose in a specialist GUM setting. The 1 g dose replaced 500 mg to keep pace with resistance.

  • Cefixime plus azithromycin

    A reserve oral option where ceftriaxone cannot be given and sensitivities allow. Efficacy is declining and it is only used with specialist input.

  • Gentamicin

    An injectable alternative for confirmed cephalosporin allergy or resistant strains, used on specialist advice with confirmed sensitivities.

  • Gemifloxacin or spectinomycin

    Reserve options for resistant or allergic cases. Availability varies and use is directed by microbiology and specialist GUM.

  • Test-of-cure at two weeks

    A repeat NAAT, and culture where possible, at around 14 days is now standard in the UK because it underpins resistance surveillance.

  • Partner notification

    All recent sexual partners are traced, tested and treated through the GUM clinic. Empirical treatment is offered to high-risk contacts.

  • UKHSA notification

    Gonorrhoea is under formal UK surveillance. Cases feed into the national resistance monitoring programme, which shapes future guidance.

  • Prevention and DoxyPEP

    Condom counselling, HIV PrEP review and, for selected MSM, doxycycline post-exposure prophylaxis are discussed in specialist GUM.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

A specialist genitourinary medicine clinician can tell you which parts apply to you. If you are worried, book a GUM appointment or speak to your GP.

  • BASHH. UK national guideline for the management of gonorrhoea in adults, 2024 update.

  • UKHSA. Sexually transmitted infections and antimicrobial resistance surveillance reports.

  • NICE CKS. Gonorrhoea.

  • World Health Organization. Guidelines for the treatment of Neisseria gonorrhoeae.

Red flags

When gonorrhoea needs urgent attention.

Most cases are managed comfortably in a routine GUM clinic. These are the situations that need a faster or more specialist response.

  • Ophthalmia neonatorum

    Purulent conjunctivitis in a baby under 28 days needs same-day neonatal and ophthalmology review. Untreated infection threatens sight.

  • Disseminated gonococcal infection

    Fever, joint pain, tenosynovitis and pustular skin lesions in a sexually active adult warrants urgent admission and blood cultures.

  • Suspected PID

    Lower abdominal pain, deep dyspareunia and adnexal tenderness need same-day assessment to prevent tubal damage and infertility.

  • Epididymo-orchitis

    Sudden testicular pain in a young man should be treated as testicular torsion until proven otherwise, then reviewed for gonorrhoea and chlamydia.

  • Multidrug-resistant strain

    A treatment failure or a positive test-of-cure after ceftriaxone triggers UKHSA-led investigation and specialist commissioned care.

  • Pregnancy

    Any suspected gonorrhoea in pregnancy needs urgent GUM assessment to protect the pregnancy and prevent neonatal infection.

  • HIV co-infection

    A new STI in someone living with HIV, or diagnosed alongside HIV, needs joint management by GUM and HIV specialists.

  • Sexual assault or safeguarding

    Any concern about assault, coercion or a child under 16 triggers safeguarding pathways alongside clinical testing and treatment.

  • Suspected reinfection

    A repeat positive test within three months usually reflects reinfection from an untreated partner and warrants partner notification review.

Living with it

A treatable infection, with a clear plan.

Four things that make the biggest difference around a diagnosis. Complete treatment, tell partners, screen for the rest and reduce future risk.

A quiet reminder

A diagnosis is not a verdict. It is a plan.

GUM clinics see this every day. The care is confidential, non-judgemental and, in most cases, wraps up in a fortnight.

  1. 01 Treat

    Complete the specialist plan

    A single injection of ceftriaxone in a GUM clinic treats most infections. Attend the appointment, avoid sex for seven days and return for test-of-cure.

  2. 02 Partners

    Tell recent partners

    Partner notification is confidential and can be done by you or by the clinic on your behalf. It protects them and prevents you being reinfected.

  3. 03 Screen

    Test for the rest

    Gonorrhoea travels with other STIs. A full screen for HIV, syphilis, chlamydia and hepatitis is offered alongside and repeated where relevant.

  4. 04 Prevent

    Reduce future risk

    Condoms, regular testing every three to six months if you are at higher risk, HIV PrEP where appropriate and open conversations with partners.

Frequently asked

Everything we get asked about gonorrhoea.

Quick answers on symptoms, testing, ceftriaxone, resistance and test-of-cure.

  • What is gonorrhoea?

    Gonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It can infect the urethra, cervix, rectum, throat and, rarely, the eye, and is passed on through unprotected vaginal, anal or oral sex.

  • How would I know if I had it?

    You often would not. Around half of women and about one in ten men have no symptoms. When symptoms occur they include discharge, dysuria, pelvic pain, intermenstrual bleeding, testicular pain or rectal discomfort. Regular testing is the only reliable way to know.

  • How is gonorrhoea diagnosed?

    Through nucleic acid amplification testing on urine or a swab from the affected site, alongside culture for antimicrobial sensitivities. BASHH recommends testing at every site of exposure, which usually means urine or vulvovaginal swab plus rectal and pharyngeal swabs where relevant.

  • How is it treated in 2026?

    The BASHH 2024 first-line treatment is ceftriaxone 1 g given as a single intramuscular injection in a genitourinary medicine clinic. Alternatives such as cefixime, gentamicin or spectinomycin are only used with confirmed sensitivities or in allergy, always under specialist guidance.

  • Why is antimicrobial resistance such a concern?

    Neisseria gonorrhoeae has developed resistance to nearly every antibiotic used against it, including penicillins, tetracyclines, macrolides and fluoroquinolones. Multidrug-resistant and extensively drug-resistant strains have appeared in the UK, which is why culture, test-of-cure and UKHSA surveillance now sit at the heart of care.

  • What is test-of-cure and why does it matter?

    Test-of-cure is a repeat test around two weeks after treatment to make sure the infection has cleared. It is now standard in the UK because it catches treatment failure early, protects partners and feeds the national resistance monitoring system.

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