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Gonorrhea infection

Last reviewed: 15 Apr 2025
Last updated: 02 May 2025

Summary

Definition

History and exam

Key diagnostic factors

  • urethral discharge in men
  • tenderness and/or swelling of the epididymis
  • mucopurulent or purulent exudate at the endocervix
Full details

Other diagnostic factors

  • pelvic pain in women
  • urethral irritation in men
  • dysuria in men
  • tenderness and/or swelling of testis
  • tenderness and/or swelling of prostate
  • anal pruritus
  • mucopurulent discharge from the rectum
  • rectal pain
  • tenesmus
  • rectal bleeding
  • vaginal discharge
  • cervical friability
  • uterine, adnexal, or cervical motion tenderness
  • uterine mass
  • anterior cervical lymphadenopathy
  • conjunctivitis
  • fever
  • skin lesions (papules, bullae, petechiae, or necrotic) at extremities
  • polyarthritis
  • purpuric rash
  • positive Brudzinski and Kernig sign
  • seizures
  • focal cerebral signs
  • murmur
  • ophthalmia neonatorum
  • rhinitis
  • urethritis (infantile)
  • vaginitis
Full details

Risk factors

  • age 20 to 24 years
  • men who have sex with men (MSM)
  • black ancestry
  • current or prior history of STI
  • multiple recent sex partners
  • inconsistent condom use
  • risk factors of partner
  • history of sexual or physical abuse
  • substance use
  • past incarceration
  • high-morbidity community
Full details

Diagnostic tests

1st tests to order

  • nucleic acid amplification test (NAAT)
  • culture
  • urinalysis in men
  • Gram stain of urine sediment
  • Gram stain of urethral discharge
  • HIV test
  • syphilis test
Full details

Tests to consider

  • transvaginal ultrasound
  • pelvic CT/MRI
Full details

Treatment algorithm

ACUTE

nonpregnant >45 kg: urogenital/anorectal or pharyngeal infection (excluding complicated genitourinary infection)

nonpregnant >45 kg: complicated genitourinary infection

nonpregnant >45 kg: disseminated gonococcal infection

pregnant: uncomplicated urogenital/anorectal or pharyngeal infection (excluding complicated genitourinary infection)

pregnant: complicated infection

neonate

child ≤45 kg

ONGOING

recurrent/resistant: urogenital/anorectal infection or pharyngitis

Contributors

Authors

Sheldon Morris, MD, MPH

Assistant Professor

Division of Infectious Diseases

Department of Medicine

UCSD Antiviral Research Center

Division of Family Medicine

Department of Family and Preventive Medicine

UCSD La Jolla Family and Sports Medicine

San Diego

CA

Disclosures

SM has received research funding via his institution from Merck, Gilead Sciences, National Institutes of Health, California HIV/AIDS Research Program, and California Institute for Regenerative Medicine. He has completed a National Institutes of Health contract for research study on the Visby Medical Sexual Health Test. He holds stock in Bristol Myers Squibb and Pfizer. He is a co-founder of Aspera Biomedicines and a consultant for Primmune Therapeutics. SM is an author of a number of references cited in this topic.

Peer reviewers

Vani Dandolu, MD, MPH

Associate Professor

Ob/Gyn and Urology

Director

Division of Urogynecology

Associate Residency Program Director

Temple University Hospital

Philadelphia

PA

Disclosures

VD declares that he has no competing interests.

Eva Jungmann, FRCP MSc

Consultant in Genitourinary and HIV Medicine

Archway Centre & Mortimer Market Centre

London

UK

Disclosures

EJ declares that she has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Centers for Disease Control and Prevention. Gonococcal isolate surveillance project (GISP). 30 August 2021 [internet publication].Full text

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Full text  Abstract

Miller WC, Ford CA, Morris M, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. 2004 May 12;291(18):2229-36.Full text  Abstract

Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. MMWR Recomm Rep. 2014;63(RR-02):1-19.Full text  Abstract

Fifer H, Saunders J, Soni S, et al. 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae. Int J STD AIDS. 2020 Jan;31(1):4-15.Full text  Abstract

US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et al. Screening for chlamydia and gonorrhea: US Preventive Services Task Force recommendation statement. JAMA. 2021 Sep 14;326(10):949-56.Full text  Abstract

World Health Organization. WHO guidelines for the treatment of Neisseria gonorrhoeae. 2016 [internet publication].Full text

Centers for Disease Control and Prevention. Guidance on the use of expedited partner therapy in the treatment of gonorrhea. 18 August 2021 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Gonorrhea infection images
  • Differentials

    • Chlamydia infection
    • Trichomonas
    • Other infectious causes of urethritis, cervicitis, pelvic inflammatory disease (PID), and epididymitis
    More Differentials
  • Guidelines

    • Reducing sexually transmitted infections
    • Guidance on the use of expedited partner therapy in the treatment of gonorrhea
    More Guidelines
  • Patient information

    Gonorrhea

    More Patient information
  • Videos

    Intramuscular injection animated demonstration

    More videos
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