Gonorrhea infection

Last reviewed: 22 Aug 2023
Last updated: 20 Jun 2023



History and exam

Key diagnostic factors

  • urethral discharge in men
  • tenderness and/or swelling of the epididymis
  • mucopurulent or purulent exudate at the endocervix
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations 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
More 1st investigations to order

Investigations to consider

  • transvaginal ultrasound
  • pelvic CT/MRI
More investigations to consider

Treatment algorithm


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


child ≤45 kg


recurrent/resistant: urogenital/anorectal infection or pharyngitis



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



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


Division of Urogynecology

Associate Residency Program Director

Temple University Hospital




VD declares that he has no competing interests.

Eva Jungmann, FRCP MSc

Consultant in Genitourinary and HIV Medicine

Archway Centre & Mortimer Market Centre




EJ declares that she has no competing interests.

  • 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 leaflets


    More Patient leaflets
  • Videos

    Intramuscular injection animated demonstration

    More videos
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