Gonorrhoea !
Gonorrhoea is a sexually transmitted bacterial infection of the urethra, cervix, rectum or throat; untreated, it can spread to the uterus and tubes.
Updated 2026-10-29
Structures involved
Tap one to see what it is and open it in 3D.
Microorganisms that cause it
Why it happens
- Patterns of acute inflammation: serous, fibrinous, purulent, abscess, ulcer
- Cervix and vagina: the transformation zone
What it is
A sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae that affects men and women. It infects the urethra, cervix, rectum, throat and eyes, and can spread to the upper genital tract or the bloodstream.
Who gets it
One of the most common bacterial sexually transmitted infections worldwide, mainly in young adults; under-diagnosed because many infections, especially in women and at the rectum and throat, cause no symptoms. Rising antimicrobial resistance is a global concern. This page shows the female model; male genital parts are in the male pelvis region.
Causes
- Neisseria gonorrhoeae, a gram-negative intracellular diplococcus
- Spread by vaginal, anal or oral sex
- Transmission from mother to baby during birth (neonatal conjunctivitis)
Risk factors
- Age under 25
- New or multiple sexual partners, or a partner with a sexually transmitted infection
- Inconsistent condom use
- Previous sexually transmitted infection
- Sex work, men who have sex with men
- Substance use
Pathophysiology
The bacterium attaches to columnar epithelium with pili, invades it and triggers an intense neutrophil response, producing purulent discharge. It changes its surface antigens, so infection does not give lasting immunity. In women it can ascend from the cervix to the endometrium and tubes; in men to the epididymis. Bloodstream spread causes disseminated gonococcal infection.
Classification
- Uncomplicated: urethritis, cervicitis, proctitis, pharyngitis, conjunctivitis
- Complicated, ascending: pelvic inflammatory disease, Bartholin abscess in women; epididymitis and prostatitis in men
- Disseminated gonococcal infection: arthritis–dermatitis syndrome, septic arthritis, rarely endocarditis or meningitis
- Neonatal ophthalmia
Symptoms and signs
- Men: purulent urethral discharge and dysuria, usually within a few days of exposure
- Women: often no symptoms; otherwise increased vaginal discharge, dysuria, bleeding between periods or after sex
- Cervicitis with mucopurulent discharge and friable cervix on examination
- Rectal infection: anal discharge, pain or bleeding, or no symptoms
- Throat infection: usually no symptoms, sometimes sore throat
- Disseminated infection: fever, migratory joint pain, tenosynovitis and few pustular skin lesions
Diagnosis
- Clinical
- Suspected from urethral or cervical discharge, sexual history and exposure to a partner with an STI; testing is offered to people at risk even without symptoms.
- Tests
- Nucleic acid amplification tests (NAAT) on first-void urine in men, vaginal or cervical swabs in women, and rectal and pharyngeal swabs by exposure; Gram stain of urethral discharge in symptomatic men; culture with susceptibility testing when treatment fails or resistance is a concern. Testing for chlamydia, HIV, syphilis and hepatitis B.
- Imaging
- Not routinely needed; pelvic ultrasound if a tubo-ovarian abscess is suspected; joint imaging in disseminated infection.
Differential diagnosis
- Chlamydia infection
- Trichomoniasis and Mycoplasma genitalium infection
- Urinary tract infection
- Bacterial vaginosis or candidiasis
- Reactive arthritis (when joints are involved)
Goal of treatment
Cure the infection with an effective antibiotic, prevent complications and onward transmission, and treat sexual partners.
Treatment
- Medical
- A single dose of an injectable third-generation cephalosporin is the current first-line treatment in most guidelines; alternatives depend on local resistance and allergies.
- Medical
- Treatment for chlamydia (usually a tetracycline) is added when chlamydia has not been excluded.
- Acute
- Hospital treatment with intravenous antibiotics for disseminated infection, severe pelvic inflammatory disease or neonatal infection.
- Follow-up
- Partner notification and treatment, no sex until treatment ends and symptoms resolve, retesting after a few months, and test of cure for throat infection or treatment failure.
Drugs for this condition
Complications
- Pelvic inflammatory disease, tubal infertility, ectopic pregnancy and chronic pelvic pain
- Bartholin abscess
- Epididymitis and, rarely, male infertility or urethral stricture
- Disseminated gonococcal infection and septic arthritis
- Increased risk of acquiring and transmitting HIV
- Neonatal conjunctivitis that can damage the eye
Prognosis
Cure is expected with correct treatment, but reinfection is common and resistance is increasing; untreated infection can leave lasting reproductive damage.
Prevention
- Consistent condom use
- Screening of people at risk, including young sexually active women
- Partner notification and treatment
- Neonatal eye prophylaxis
- Sexual health education
Test yourself
Think of the answer, then tap the question to see it.
What does a Gram stain of urethral discharge show in gonorrhoea?
Gram-negative intracellular diplococci inside neutrophils.
Why are women with gonorrhoea often diagnosed late?
Cervical infection is frequently asymptomatic, so it is found by screening or only after complications such as PID.
What is the preferred diagnostic test for gonorrhoea?
Nucleic acid amplification testing (NAAT) of urine or genital, rectal and pharyngeal swabs; culture when resistance is a concern.
What is the classic presentation of disseminated gonococcal infection?
Arthritis–dermatitis syndrome: fever, migratory polyarthralgia, tenosynovitis and a few pustular skin lesions.
Which antibiotic class is first-line for gonorrhoea in most current guidelines?
An injectable third-generation cephalosporin, because resistance to other classes is widespread.
Related conditions
- Chlamydia infection
- Pelvic inflammatory disease
- Bartholin gland cyst and abscess
- Syphilis
- HIV infection and AIDS
- Ectopic pregnancy
- Trichomoniasis
- Bacterial vaginosis
- Urinary tract infection (acute cystitis)
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Gonorrhea (StatPearls (NCBI Bookshelf), 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.
