What is gonorrhoea and how is it spread
Gonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It spreads through unprotected vaginal, anal or oral sex with someone who already has the infection, and it can affect the genitals, rectum, throat and, less commonly, the eyes. It is one of the more common bacterial STIs diagnosed in UK sexual health clinics, and anyone who is sexually active without consistent condom use can be at risk, regardless of age or relationship status.
The bacteria can be passed on even when the infected partner has no symptoms, which is one of the main reasons gonorrhoea continues to circulate. Unlike some infections that cause obvious, early warning signs, gonorrhoea is often silent, so people can unknowingly pass it on to others or go some time before realising they need treatment.
It is also possible to have gonorrhoea at more than one site at once, for example in the throat as well as the genitals, particularly after oral sex. This matters for testing, since a single genital swab will not pick up an infection confined to the throat or rectum.
Signs and symptoms of gonorrhoea
Around 1 in 10 infected men and almost half of infected women have no symptoms at all, so the absence of symptoms does not rule out infection. When symptoms do appear, they usually start within about two weeks of exposure, although in some cases it can take considerably longer.
In women, typical symptoms include an unusual vaginal discharge (often described as thin, watery, yellow or green), pain or a burning sensation when urinating, and bleeding between periods or after sex. In men, symptoms more often include a white, yellow or green discharge from the penis and pain or a burning feeling when urinating. A throat infection may cause no symptoms, or occasionally a mild sore throat, while a rectal infection can cause discomfort, discharge or no symptoms at all.
Left untreated, gonorrhoea can lead to more serious complications, including pelvic inflammatory disease in women, which can affect fertility, and, less commonly, infection spreading to other parts of the body. This is one of the reasons testing and prompt treatment matter, even when symptoms feel mild or are absent.
Getting tested for gonorrhoea in the UK
Testing for gonorrhoea is straightforward and widely available. NHS sexual health clinics offer free testing using a nucleic acid amplification test (NAAT), carried out on a urine sample or a swab from the site of possible exposure, such as the genitals, throat or rectum. Many areas also allow self-taken swabs, so you do not always need an internal examination.
At-home STI testing kits are another option, letting you collect a sample in private and post it to a laboratory, with results usually available within a few days. Whichever route you use, testing all relevant sites is important if you have had oral or anal sex, since a genital-only test can miss an infection elsewhere.
It is sensible to get tested if you have symptoms, if a partner has been diagnosed with an STI, or simply as part of routine sexual health checks if you have had a new or casual partner, even without symptoms, given how often gonorrhoea goes unnoticed.
Important safety information
How gonorrhoea is treated
UK national guidance from the British Association for Sexual Health and HIV (BASHH), updated in 2025, recommends a single 1g injection of the antibiotic ceftriaxone into a muscle, usually in the buttock or thigh, as the first-line treatment for an uncomplicated anogenital or pharyngeal infection in adults. The injection is normally given during the same clinic visit as diagnosis, or as soon as test results confirm the infection, and most people notice their symptoms starting to improve within a few days.
Oral antibiotic tablets, such as cefixime, are sometimes used instead, for example if an injection is not suitable or available, but current guidance now gives cefixime as two separate doses taken six to twelve hours apart rather than a single dose, reflecting growing resistance. Ciprofloxacin, an older tablet option, is no longer recommended as a first-line choice because of safety concerns and widespread resistance, though a clinician may occasionally still use it if the specific bacteria strain is known to be sensitive to it.
Which antibiotic and route are used depends on where the infection is, any known antibiotic sensitivities from your test results, allergies, pregnancy status, and other medicines you take, so this decision is always made individually by the treating clinician rather than following a single fixed rule for everyone.
Antibiotic resistance and why follow-up testing matters
Neisseria gonorrhoeae has become resistant to several antibiotics that used to be reliable first-line treatments, including penicillin-type drugs and, increasingly, some oral options. This is a well-recognised and closely monitored issue in UK sexual health services, and it is the main reason treatment guidance has shifted toward a single, higher-dose injection rather than tablets for most people.
Because of this, routine test of cure is not usually necessary after ceftriaxone treatment of an anogenital infection known to be susceptible to it. However, a clinician may still recommend a follow-up test, typically one to two weeks after treatment, in certain situations: a pharyngeal (throat) infection, symptoms that have not fully resolved, pregnancy, or where there is uncertainty about antibiotic susceptibility. Attending any follow-up appointment you are offered is a simple way to confirm the infection has genuinely cleared.
If a follow-up test does show the infection has not cleared, this does not necessarily mean reinfection from a new exposure; it can also reflect resistant bacteria, incomplete treatment, or a missed site of infection, and your clinician will discuss the most appropriate next step with you.
Preventing reinfection and protecting partners
Partner notification is a core part of gonorrhoea treatment. Anyone you have had sex with in the relevant period before your diagnosis, often the last few weeks to a couple of months depending on your symptoms and how long you may have been infected, should be told so they can be tested and treated themselves, even if they have no symptoms. Sexual health clinics can often help with this discreetly, including contacting partners on your behalf if you prefer not to do it yourself.
It is best to avoid any sexual contact until your treatment is complete and, where one has been advised, a follow-up test confirms the infection has cleared. Having sex again too soon risks passing the infection to a partner or, in some cases, reinfection if your partner has not yet been treated.
Looking ahead, using condoms consistently remains the most effective way to reduce the risk of catching or passing on gonorrhoea and other STIs. Regular STI testing, particularly after a new or casual partner, also helps catch infections early, before symptoms appear or complications develop, and is a sensible habit alongside, not instead of, condom use.