Gonorrhea spreads through vaginal, anal, or oral sex without a condom with someone who has the infection. It can also pass from a pregnant person to their baby during childbirth. Those are the only routes: you cannot get gonorrhea from toilet seats, swimming pools, sharing towels, or casual contact like hugging.
Sexual Contact Is the Primary Route
The bacterium that causes gonorrhea lives on moist mucous membranes, the soft tissue lining the genitals, rectum, and throat. During unprotected sex, the bacteria transfer from one person’s infected tissue to another’s. This means any genital, anal, or oral contact can transmit it, not just penetrative intercourse. Oral sex is often overlooked as a risk, but giving oral sex to an infected partner can lead to a throat infection, and receiving it can lead to genital infection.
The infection establishes itself quickly. The bacteria use tiny hair-like structures called pili to latch onto the surface of your cells, then pull themselves in close and trigger the cells to essentially absorb them. Once inside, the bacteria manipulate your cell’s own signaling systems to survive and multiply, even suppressing the cell’s normal self-destruct response to infection. This is why gonorrhea can take hold after a single encounter.
Where on the Body You Can Get Infected
Gonorrhea doesn’t just infect the genitals. The three most common sites are the urethra (the tube you urinate through), the rectum, and the throat. You can be infected at more than one site at the same time, and the site depends on the type of sexual contact involved.
- Genital infection comes from vaginal or penile contact with an infected partner. In women and people with a cervix, the bacteria typically infect the cervix first.
- Rectal infection results from receptive anal sex with an infected partner.
- Throat infection typically results from performing oral sex on an infected partner.
The eyes can also become infected if you touch them after handling infected genital fluids, though this is uncommon in adults.
Most People With Gonorrhea Have No Symptoms
This is the single most important thing to understand about how gonorrhea spreads. Roughly 90% of women with a urogenital infection have no symptoms at all. Among men, somewhere between 56% and 87% are also asymptomatic. Rectal and throat infections are even more likely to be silent.
That means the person passing the infection to you may genuinely not know they have it. They won’t look sick. They may have been tested months ago and picked it up since. This is why gonorrhea continues to spread so effectively: the majority of carriers feel perfectly fine and have no reason to suspect anything is wrong without routine testing.
Transmission During Childbirth
A pregnant person with an untreated gonorrhea infection of the cervix can pass the bacteria to their baby during vaginal delivery. The most serious risk is an eye infection called ophthalmia neonatorum, which can damage the eye severely enough to cause blindness if untreated. Less common but possible complications include joint infections and meningitis. Newborns can also develop infections of the nose, vagina, urethra, or scalp (particularly at sites where fetal monitoring electrodes were attached).
This is why screening during pregnancy is standard. All pregnant people under 25, and those 25 and older with risk factors, are recommended for testing. Those who test positive are retested during the third trimester and again three months after treatment.
Reinfection Is Common
Having gonorrhea once does not protect you from getting it again. Your body does not build meaningful immunity to the bacteria. Reinfection rates are high, and the CDC notes that most repeat cases happen for one of two reasons: a sex partner wasn’t treated, or the person began having sex with a new infected partner.
After treatment, you should avoid sexual activity for seven days and until all partners have also completed treatment. The CDC recommends retesting three months after treatment regardless of whether you believe your partners were treated, because reinfection is so common during that window.
Who Should Get Tested
Because most infections cause no symptoms, testing is the only reliable way to know your status. CDC screening guidelines recommend annual testing for:
- Sexually active women under 25 and those 25 and older with risk factors (new partner, multiple partners, inconsistent condom use, a partner with an STI, or a previous STI)
- Men who have sex with men at all sites of contact (urethra, rectum, throat) at least once a year, and every three to six months if at higher risk
- People living with HIV at their first evaluation and at least annually after
- Transgender and gender diverse individuals based on their anatomy and sexual practices
For heterosexual men at low risk, there isn’t enough evidence to recommend routine screening. But any man with symptoms, a known exposure, or a partner who tested positive should be tested promptly.
What Does Not Spread Gonorrhea
The bacteria die quickly outside the human body. You cannot contract gonorrhea from doorknobs, toilet seats, shared clothing, swimming pools, hot tubs, or sharing food and drinks. Casual skin-to-skin contact like handshakes or hugs poses no risk. The bacteria require direct contact with infected mucous membranes or genital fluids to survive and establish an infection.