Gonorrhea is treated with a single antibiotic injection, typically given during one clinic visit. The standard treatment is a 500 mg shot of ceftriaxone, a powerful antibiotic delivered into the muscle. Most people start feeling better within a few days, and the infection clears completely with this single dose.
What the Standard Treatment Looks Like
For uncomplicated gonorrhea affecting the genitals, rectum, or throat, the CDC recommends a single intramuscular injection of ceftriaxone at 500 mg. That means one shot, usually in the upper arm or buttock, and you’re done. There’s no course of pills to remember over several days. For people weighing 300 pounds (150 kg) or more, the dose is doubled to 1,000 mg.
The injection itself takes just a few seconds, though the site can feel sore for a day or two afterward. You’ll typically receive the shot the same day you’re diagnosed, sometimes right in the exam room. Many sexual health clinics keep the medication on hand specifically so treatment isn’t delayed.
Why You Might Get a Second Antibiotic
Gonorrhea and chlamydia frequently travel together. Because co-infection is so common, your provider will often test for chlamydia at the same visit. If chlamydia hasn’t been ruled out, you may also receive an oral antibiotic (typically doxycycline, taken as pills for seven days) to cover that second infection. Even if your chlamydia test comes back negative later, treating both upfront prevents a missed infection from causing complications.
The Antibiotic Resistance Problem
Gonorrhea has developed resistance to nearly every antibiotic ever used against it, including penicillin, tetracycline, and fluoroquinolones. Ceftriaxone is one of the last reliable options, which is why the current guidelines are so specific about using it. The bacteria hasn’t widely developed resistance to ceftriaxone yet, but isolated cases of reduced susceptibility have appeared globally.
If you have a severe allergy to ceftriaxone or similar antibiotics (cephalosporins), your provider will need to use an alternative regimen. These backup options are less straightforward and typically involve a combination of two different antibiotics, along with a follow-up test to confirm the infection actually cleared. This is one reason allergies are important to mention before treatment.
What Happens After Treatment
Symptoms like discharge, burning during urination, or pelvic discomfort generally start improving within one to three days after the injection. Full resolution usually takes about a week. If your symptoms haven’t improved after a few days, contact your provider, as this could signal a resistant strain or a different infection altogether.
You should avoid all sexual contact for at least seven days after treatment and until your symptoms have completely resolved. If your partner is also being treated, wait until they’ve finished their treatment and are symptom-free as well. Having sex too soon risks passing the infection right back.
The CDC recommends retesting three months after treatment to check for reinfection. This isn’t because the first treatment failed. It’s because reinfection rates are high, especially if a partner wasn’t treated or if you have new sexual partners. Getting retested at that three-month mark catches repeat infections early, before they cause damage or spread further.
Getting Your Partners Treated
Anyone you’ve had sex with in the 60 days before your diagnosis needs to be treated too, even if they have no symptoms. Gonorrhea is frequently asymptomatic, particularly in women, so a partner who feels fine can still be carrying and transmitting the bacteria.
If your partner can’t or won’t visit a clinic, a practice called Expedited Partner Therapy (EPT) allows your provider to write a prescription or provide medication that you can give directly to your partner, without them needing their own exam first. EPT is legal in most U.S. states and is a practical option when a partner faces barriers to getting their own appointment. The preferred approach is still for partners to be evaluated in person, but EPT is far better than leaving them untreated.
Complications of Untreated Gonorrhea
Treatment is simple, but the consequences of skipping it are not. In women, untreated gonorrhea can spread to the uterus and fallopian tubes, causing pelvic inflammatory disease. This can lead to chronic pelvic pain, scarring that blocks the fallopian tubes, and infertility. In men, the infection can spread to the epididymis (the tube behind the testicle), causing painful swelling and, in rare cases, affecting fertility.
In uncommon cases, gonorrhea can enter the bloodstream and become a systemic infection, called disseminated gonococcal infection. This can cause joint pain and swelling, skin lesions, and in rare cases, infections of the heart or brain lining. Disseminated infections require longer courses of intravenous antibiotics and hospitalization, a much more serious situation than the single shot needed for an uncomplicated case.
Treatment During Pregnancy
Gonorrhea during pregnancy is treated with the same ceftriaxone injection used for everyone else. The medication is considered safe during pregnancy. What changes is the urgency: untreated gonorrhea in a pregnant person raises the risk of premature birth, low birth weight, and can pass to the baby during delivery, potentially causing a serious eye infection. Pregnant individuals diagnosed with gonorrhea are typically retested after treatment to confirm the infection has cleared, rather than waiting the standard three months.