Gonorrhea

Symptoms

In women:

• Abnormal vaginal discharge
• Burning when urinating
• Bleeding after sex or between periods
• Lower abdominal or groin pain
• Most women have no or only mild symptoms

In men:

• White, yellow or green discharge from the urethra
• Burning when urinating
• Pain or swelling in the testicles (less common)

Rectal infection may cause discharge, itching, pain or bleeding. Throat infection is usually symptom-free. In men with symptoms, discharge and burning are typical; in women the picture often stays silent.

Diagnosis

The most reliable diagnostic method is the nucleic acid amplification test (NAAT / PCR). In women a vaginal or endocervical swab is used; in men urine or a urethral swab. If there is a history of anal or oral contact, a sample is also taken from that site. A urine sample is practical; at some sites a swab is more sensitive.

Culture may be needed if antibiotic resistance is suspected or treatment fails. Gonorrhea and chlamydia are often found together; both should be tested. Testing for syphilis and HIV is also recommended. If pregnancy is suspected, a pregnancy test is done first.

Treatment

Gonorrhea is treated with antibiotics. According to the CDC 2021 guideline, the first choice for uncomplicated urogenital, rectal and pharyngeal infection is ceftriaxone 500 mg intramuscularly as a single dose (1 g for body weight 150 kg and over). Routine dual therapy with azithromycin is no longer recommended.

If chlamydia has not been ruled out, doxycycline 100 mg twice daily for 7 days is added. In pregnancy, azithromycin is preferred instead of doxycycline. In cephalosporin allergy, alternative regimens (for example gentamicin + azithromycin) are discussed; because of resistance, fluoroquinolones are not used empirically.

After treatment, symptoms should improve within a few days. If they do not, reassessment is needed. In pharyngeal infection, a test of cure after treatment is recommended. Partners from the last 60 days should be tested and treated if needed. Avoid sex during treatment and until it is completed. Retesting after 3 months is recommended.

Antibiotic resistance is a global problem. If there is no response to treatment, culture and susceptibility testing are planned. In Türkiye, gonorrhea is a notifiable disease.

Complications

Untreated gonorrhea can increase these risks in women:

• Pelvic inflammatory disease
• Tubal damage and infertility
• Increased risk of ectopic pregnancy
• Chronic pelvic pain

In men, epididymitis and, rarely, urethral stricture may occur. Rarely, the infection spreads through the blood (disseminated gonococcal infection); it can affect the joints, tendons and skin. If untreated in pregnancy, the newborn may develop severe conjunctivitis.

Antibiotics cannot reverse complications. Early diagnosis and treatment protect reproductive health.

Who should be screened

Annual gonorrhea screening is recommended for sexually active women under 25. At 25 and over, screening is considered if there is a new partner, more than one partner, an STI history in the partner or a previous STI. If there are symptoms or the partner is positive, testing is done at any age. A risk assessment is done in pregnancy.

Prevention

• Using a condom every time you have sex
• Number of partners and risk assessment
• Regular screening (especially under 25)
• Partner treatment and avoiding sex during treatment
• Assessment before planning a pregnancy

Having had gonorrhea once does not give immunity. Reinfection is possible. Because of resistant strains, follow-up after treatment is important.

Our approach at SoftCare

At SoftCare Clinic, gonorrhea assessment begins with a gynaecological history and examination. If there are symptoms or screening is needed, a vaginal swab or urine sample is taken; NAAT (PCR) is run at a partner laboratory. Tests for chlamydia and other STIs can be planned at the same time.

If the result is positive, ceftriaxone treatment is started, and doxycycline is added if chlamydia has not been ruled out. Informing the partner is discussed. In pharyngeal infection or lack of response to treatment, a follow-up test and, if needed, culture are planned. If there is pelvic pain, fever or heavy discharge, PID is assessed. If disseminated infection is suspected, an urgent referral is made. HIV treatment is not provided at the clinic; a referral is arranged if needed. Notification obligations are fulfilled.

Appointments: +90 212 241 30 10 · softcareclinic.com

References

• 1. Centers for Disease Control and Prevention (CDC). Gonorrhea – CDC Fact Sheet. https://www.cdc.gov/gonorrhea/about/
• 2. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1–187.
• 3. Centers for Disease Control and Prevention (CDC). Gonococcal Infections Among Adolescents and Adults. STI Treatment Guidelines. https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm
• 4. T.C. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü (Ministry of Health of Türkiye, General Directorate of Public Health). Gonore. https://hsgm.saglik.gov.tr/tr/hastaliklar/gonore.html
• 5. World Health Organization (WHO). Guidelines for the Treatment of Neisseria gonorrheae.
• 6. U.S. Preventive Services Task Force (USPSTF). Screening for Chlamydia and Gonorrhea. Recommendation statement.
• 7. Merck Manual Professional Edition. Gonorrhea.
• 8. British Association for Sexual Health and HIV (BASHH). National Guideline for the Management of Gonorrhoea (2025 update).
• Note: Treatment doses, resistance status and screening intervals are updated by the physician according to current national and international guidelines. This reference list is for information only.

Listing a source does not mean SoftCare wrote that text.

Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: 2 October 2026