Gonorrhea is caused by bacteria, not a virus. The specific organism is called Neisseria gonorrhoeae, a type of bacteria that appears as tiny kidney bean-shaped pairs under a microscope, each one less than a micrometer across. This distinction matters because it determines how the infection is treated: bacterial infections can be cured with antibiotics, while viral infections cannot.
Why the Difference Matters for Treatment
Because gonorrhea is bacterial, it’s curable. A single injection of an antibiotic clears an uncomplicated infection in most cases. Viral STIs like herpes or HIV, by contrast, can be managed but not eliminated from the body. If gonorrhea were a virus, there would be no cure, only symptom control. This is one of the most practical reasons to understand the distinction.
That said, “curable” doesn’t mean “easy to cure forever.” Neisseria gonorrhoeae has a remarkable ability to develop resistance to antibiotics. Between 2022 and 2024, resistance to the two primary antibiotics used to treat gonorrhea rose sharply. Resistance to ceftriaxone, the current first-line treatment, jumped from 0.8% to 5% of tested strains worldwide, while resistance to cefixime climbed from 1.7% to 11%. Resistance to an older class of antibiotics, ciprofloxacin, has reached 95%, making it essentially useless against gonorrhea today. Health authorities are closely tracking these trends because losing effective antibiotics could make a curable infection far harder to treat.
Symptoms to Recognize
Gonorrhea infects mucous membranes, most commonly in the genitals, rectum, and throat. Symptoms differ somewhat between men and women, and many people, particularly women, have no noticeable symptoms at all.
In men, the most common signs are a burning sensation when urinating and a white, yellow, or green discharge from the penis. Less commonly, the testicles may become painful or swollen. In women, symptoms include painful or burning urination, increased vaginal discharge, and vaginal bleeding between periods. Because these symptoms overlap with other infections like urinary tract infections or yeast infections, testing is the only reliable way to confirm gonorrhea.
Infections in the throat or rectum often produce no symptoms, which is why routine screening matters for people at higher risk.
How Gonorrhea Is Diagnosed
The most accurate test for gonorrhea is a nucleic acid amplification test, commonly called a NAAT. It works by detecting the bacteria’s genetic material in a urine sample or a swab from the infected site. These tests have sensitivity above 90% and specificity above 99%, meaning they catch nearly all true infections while producing very few false positives.
Older culture-based testing, where a lab tries to grow the bacteria from a swab, is far less reliable. For throat infections, culture catches only about 41% of cases, while the best NAAT catches 84%. For rectal infections, the gap is similar: 43% for culture versus 93% for NAAT. In practical terms, using the more sensitive test more than doubles the number of infections detected. Culture still has a role in tracking antibiotic resistance, since it lets labs test which drugs actually kill a specific strain, but NAAT is the standard for diagnosis.
What Happens if It Goes Untreated
Left alone, gonorrhea doesn’t resolve on its own. In women, the bacteria can spread from the cervix into the uterus and fallopian tubes, causing pelvic inflammatory disease. This can lead to chronic pelvic pain, scarring of the reproductive tract, and infertility. Ectopic pregnancy, where a fertilized egg implants outside the uterus, becomes more likely after fallopian tube damage.
In men, untreated gonorrhea can cause a painful infection in the tubes attached to the testicles, which in rare cases leads to infertility. In both sexes, the bacteria can occasionally enter the bloodstream and spread to joints and other organs, a serious condition that requires hospitalization. Gonorrhea also makes it easier to transmit and acquire HIV, because the active infection creates inflammation that gives the virus more entry points.
A Vaccine on the Horizon
One unexpected development is that a vaccine originally designed to prevent meningitis appears to offer partial protection against gonorrhea. This makes biological sense: the meningitis B bacterium is a close relative of Neisseria gonorrhoeae. Real-world studies estimate the vaccine’s effectiveness against gonorrhea at roughly 33% to 42%, not enough to fully protect an individual, but significant enough to reduce cases across a population.
The UK became one of the first countries to act on this evidence, launching a targeted vaccination program in mid-2025 for people at greatest risk. The vaccine is being used off-label, since its licensed purpose is still meningitis prevention. If the program succeeds in reducing gonorrhea rates, it could reshape prevention strategies globally, particularly as antibiotic resistance narrows treatment options.