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Health condition · Clinically reviewed

Gonorrhoea, testing, resistance and the treatment that actually works.

A common bacterial STI with a growing resistance problem - a single injection of ceftriaxone is now the reliable first-line cure, and confidential care is widely available.

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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 and NICE CKS gonorrhoea guidance, current at the time of last review.

  • 03

    Current for 2026

    Reflects rising antibiotic resistance - single-dose IM ceftriaxone first-line, with test of cure recommended.

Key facts

Gonorrhoea at a glance.

The essentials in plain English - what it is, why resistance matters, and how it is diagnosed and treated in UK sexual health services.

  • What it is

    A bacterial sexually transmitted infection caused by Neisseria gonorrhoeae, spread through unprotected genital, anal or oral contact.

  • Resistance concern

    Increasing antibiotic resistance is a significant public health concern - oral antibiotics are no longer reliable first-line therapy.

  • In men

    Usually symptomatic - urethral discharge and dysuria are the classic presentation.

  • In women

    Often asymptomatic, or vaginal discharge and pelvic pain - untreated infection carries a real risk of pelvic inflammatory disease.

  • Other sites

    Can also infect the rectum, throat (pharynx) or eyes (conjunctiva), depending on the site of sexual exposure.

  • First-line therapy

    A single intramuscular dose of ceftriaxone, given rising resistance to oral agents - with test of cure and partner treatment.

Why this guide matters

Common, resistant, and still curable.

Gonorrhoea is not the infection it was a decade ago. The three points below shape how UK sexual health services now find it and treat it.

  • Resistance has changed the treatment

    Oral antibiotics can no longer be relied on - a single injection of ceftriaxone is now the standard first-line cure.

  • Culture matters as much as the swab

    A culture sample lets the lab check sensitivity, so treatment can be adjusted quickly if resistance is found.

  • Partner treatment prevents ping-pong

    Testing and treating recent partners stops reinfection and slows the spread of resistant strains.

How the diagnosis is made

From first swab to a confirmed cure.

The steps a UK GUM clinic or sexual health service will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Sexual history and exposure sites

    A confidential discussion of symptoms, partners and the type of sex you have had, to decide which sites need testing.

  2. 02

    Assessing

    Site-specific NAAT testing

    Nucleic acid amplification test, first-line - urine or urethral swab in men, vulvovaginal swab in women, plus rectal or pharyngeal swabs based on exposure.

  3. 03

    Assessing

    Culture for sensitivity

    A culture sample is taken alongside NAAT so the lab can test antibiotic sensitivity - essential given rising resistance patterns.

  4. 04

    Confirming

    Full STI screen

    Chlamydia, HIV and syphilis testing are offered alongside gonorrhoea, since co-infection is common.

  5. 05

    Confirming

    Examination for complications

    Assessment for pelvic inflammatory disease, epididymo-orchitis or disseminated infection where symptoms suggest it.

  6. 06

    Preparing

    Contact tracing and partner notification

    Recent partners are traced and offered testing and treatment - essential to stop reinfection and onward spread.

  7. 07

    Preparing

    Specialist sexual health clinic care

    Management is led by a GUM or sexual health clinic, given the need for culture-guided therapy and resistance monitoring.

Typical timeline: swab to injection in a single clinic visit.

Symptoms

What gonorrhoea can look like.

Men are usually symptomatic, women often are not. The pattern also depends on the site of exposure - genital, rectal, pharyngeal or ocular.

  • Urethral discharge in men

    Cloudy or purulent discharge from the urethra - usually the first thing men notice, and often within a week of exposure.

  • Dysuria in men

    Burning or stinging on passing urine, frequently alongside discharge - prompts most men to seek testing quickly.

  • Often asymptomatic in women

    Many women have no symptoms at all - infection is picked up through screening or partner notification rather than complaints.

  • Vaginal discharge and pelvic pain

    When symptomatic, women may notice discharge, intermenstrual bleeding or pelvic pain - see our pelvic inflammatory disease guide for the complication this can lead to.

  • Rectal infection

    Usually silent, but can cause anal discharge, discomfort or itching depending on the extent of inflammation.

  • Pharyngeal infection

    Throat infection from oral sex is typically asymptomatic and only found on targeted swabbing.

  • Conjunctival infection

    Eye infection can occur from genital-to-eye transfer, or in newborns during birth - usually causes marked redness and discharge.

  • Red flag - disseminated infection

    Fever, joint pain and a pustular rash can signal disseminated gonococcal infection - a medical emergency needing urgent care.

Treatment

How gonorrhoea is treated in the UK.

A single injection of ceftriaxone first-line, culture-guided alternatives where needed, and test of cure to confirm the infection has actually gone.

  • Single-dose IM ceftriaxone

    First-line therapy given rising resistance to oral antibiotics - one intramuscular injection clears the great majority of infections.

  • Culture-guided alternative therapy

    Where ceftriaxone cannot be used, an alternative is chosen based on culture and sensitivity results rather than guesswork.

  • Test of cure

    Recommended for everyone given current resistance patterns - a repeat NAAT or culture confirms the infection has actually cleared.

  • Partner notification and treatment

    Essential to prevent reinfection - recent partners are traced, tested and treated even if they have no symptoms.

  • Abstinence until confirmed clear

    Sex should be avoided until treatment is complete and test of cure is negative, to avoid passing the infection on.

  • Screening for other STIs

    Chlamydia, HIV and syphilis testing are offered alongside treatment, since co-infection with gonorrhoea is common.

  • Specialist clinic management

    Care is led by a sexual health clinic (GUM), which can access up-to-date resistance data and culture facilities.

  • PID treatment where present

    If pelvic inflammatory disease has developed, combination antibiotic therapy is needed - see our pelvic inflammatory disease guide.

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.

Your GP or a GUM clinician knows your history and can tell you which parts apply to you. If in doubt, get tested.

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

  • NICE CKS. Gonorrhoea.

  • UK Health Security Agency. Surveillance of antimicrobial resistance in Neisseria gonorrhoeae.

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

Red flags

When gonorrhoea needs urgent attention.

Most infections clear with a single injection. These are the situations where a specialist opinion, an urgent GUM slot or hospital care is needed.

  • Disseminated gonococcal infection

    Fever, migratory joint pain, tenosynovitis and a pustular rash suggest the infection has spread through the bloodstream - needs urgent hospital care.

  • Suspected PID

    Lower abdominal pain, deep dyspareunia, abnormal bleeding or fever needs same-day assessment - untreated PID can scar the fallopian tubes.

  • Epididymo-orchitis

    Acute testicular pain and swelling in a sexually active man needs prompt review and must be distinguished from testicular torsion.

  • Neonatal conjunctivitis

    A newborn with eye discharge or swelling born to a mother with untreated gonorrhoea needs immediate ophthalmology and paediatric review - it can threaten sight.

  • Treatment failure after ceftriaxone

    Persistent symptoms or a positive test of cure after treatment should prompt urgent specialist review for resistant infection.

  • Pregnancy

    Untreated gonorrhoea in pregnancy raises the risk of preterm birth and neonatal infection - prompt specialist treatment is needed.

  • Suspected sexual assault

    Any concern about non-consensual exposure should be routed through a Sexual Assault Referral Centre (SARC) for holistic support.

  • Under-16 disclosure

    A positive test in a young person triggers a safeguarding conversation using Fraser and Gillick principles.

  • Repeated reinfection

    Frequent reinfection points to unresolved partner treatment or ongoing risk - worth a fuller sexual health review.

Living with it

A curable infection, with a clear plan.

Four things that make the biggest difference - attending for the injection, waiting until you are confirmed clear, telling recent partners and taking the test of cure seriously.

A quiet reminder

Resistance makes follow-up matter more, not less.

A single injection cures most infections quickly - but with resistant strains circulating, the test of cure is what actually confirms it worked.

  1. 01 Treatment

    Attend for the injection

    Ceftriaxone is given as a single intramuscular dose in clinic - there is no oral equivalent that reliably clears resistant strains.

  2. 02 Abstinence

    Wait until you are confirmed clear

    Avoid sex, including oral, until treatment is complete and your test of cure comes back negative.

  3. 03 Partners

    Tell recent partners

    Contact tracing feels awkward but prevents reinfection and stops the infection moving through resistant strains further.

  4. 04 Re-test

    Take the test of cure seriously

    Because resistance is rising, a confirmed cure matters more than it used to - do not skip the follow-up appointment.

Frequently asked

Everything we get asked about gonorrhoea.

Quick, confidential answers on testing, resistance, treatment and partners.

  • What is gonorrhoea?

    Gonorrhoea is a bacterial sexually transmitted infection caused by Neisseria gonorrhoeae. It can infect the genitals, rectum, throat and eyes, and increasing antibiotic resistance makes it a significant and growing public health concern.

  • What are the symptoms of gonorrhoea?

    Men usually get urethral discharge and dysuria. Women are often asymptomatic, or notice vaginal discharge and pelvic pain. Rectal, pharyngeal or conjunctival infection can occur depending on the site of sexual exposure, and these are often silent.

  • How is gonorrhoea tested?

    A nucleic acid amplification test (NAAT) is first-line, taken from urine, a vulvovaginal swab, or a rectal or pharyngeal swab depending on your sexual history. A culture sample is also taken to check antibiotic sensitivity, given rising resistance.

  • What is the current treatment for gonorrhoea?

    BASHH first-line treatment is a single intramuscular dose of ceftriaxone, reflecting rising resistance to oral antibiotics. Test of cure is recommended given current resistance patterns, and any alternative regimen is guided by culture results.

  • Do my partners need to be treated too?

    Yes - all recent sexual partners should be tested and treated, even if they have no symptoms. Partner notification and treatment is essential to stop reinfection and to slow the spread of resistant strains.

  • Can gonorrhoea cause complications if untreated?

    Yes. In women, untreated infection can lead to pelvic inflammatory disease and long-term fertility problems. In men, it can cause epididymo-orchitis. Rarely, it can spread through the bloodstream to cause disseminated gonococcal infection, which needs urgent hospital care.

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