Untreated gonorrhea can cause lasting damage to the reproductive system, joints, and other organs, even after the initial infection clears. The most significant long-term effects differ between women and men, but both face risks of infertility, chronic pain, and systemic complications. Because up to 80% of women and 10% to 20% of men with gonorrhea have no symptoms at all, many people don’t know they’re infected until damage has already started.
Pelvic Inflammatory Disease in Women
The most common serious consequence of untreated gonorrhea in women is pelvic inflammatory disease, or PID. Roughly 10% to 20% of untreated infections progress to PID, where the bacteria travel upward from the cervix into the uterus, fallopian tubes, and surrounding tissue. The infection triggers an inflammatory response that destroys the delicate hair-like cells lining the fallopian tubes. These cells are responsible for moving an egg from the ovary to the uterus, and once they’re damaged, the body replaces them with scar tissue rather than functional cells.
That scarring process is what causes the long-term problems. Scar tissue can partially or fully block the fallopian tubes, create adhesions between pelvic organs, and permanently impair the tubes’ ability to transport eggs. The result is a significantly higher risk of infertility, ectopic pregnancy (where a fertilized egg implants outside the uterus), and chronic pelvic pain. A large study of veterans found that people who tested positive for gonorrhea or chlamydia had roughly double the risk of developing PID compared to those who tested negative. Repeat infections compounded the damage: those with more than one positive test had a 37% higher risk of PID and a 20% higher risk of infertility compared to those with a single infection.
Fertility and Pregnancy Risks
Gonorrhea’s impact on fertility extends beyond PID itself. Even after the infection is treated, the scarring left behind can make it harder to conceive. Women with a history of gonorrhea face an 11% increased risk of infertility and a 14% increased risk of ectopic pregnancy compared to those without the infection. These numbers may sound modest, but they represent a meaningful shift in odds, particularly for women who’ve been infected more than once.
For women who are pregnant, untreated gonorrhea creates serious risks for the baby. A systematic review of 30 studies found that pregnant women with gonorrhea were 55% more likely to deliver preterm, 66% more likely to have a low-birth-weight baby, and more than twice as likely to experience perinatal death. Premature rupture of membranes, where the water breaks too early, was 41% more likely. Babies born to infected mothers also face a fourfold increased risk of ophthalmia neonatorum, a severe eye infection that can cause blindness if untreated. This link is well-established enough that hospitals routinely apply antibiotic eye drops to newborns as a preventive measure.
Long-Term Effects in Men
In men, untreated gonorrhea most commonly spreads to the epididymis, the coiled tube behind each testicle that stores and carries sperm. This condition, epididymitis, causes pain and swelling and often results in poor semen quality with reduced sperm count and motility. If the infection continues unchecked, the inflammatory response can scar the reproductive tract and obstruct the passage of sperm entirely, a condition called obstructive azoospermia. At that point, the testes may still produce sperm, but it has no way to reach the ejaculate.
Gonorrhea in men can also cause prostatitis (infection of the prostate gland), orchitis (infection of the testicle itself), and penile swelling. While men are more likely than women to notice symptoms like discharge or painful urination, the 10% to 20% who remain asymptomatic face the same risk of complications from delayed treatment.
Disseminated Gonococcal Infection
In a small percentage of cases, roughly 0.5% to 3%, the bacteria enter the bloodstream and spread throughout the body. This is called disseminated gonococcal infection, or DGI, and it affects both men and women. It typically shows up in one of two ways.
The first is arthritis-dermatitis syndrome: a combination of joint pain, tendon inflammation, and skin lesions. The joint pain tends to be asymmetric, affecting different joints on each side of the body, and can involve both large joints like knees and ankles and smaller ones in the fingers and toes. Tendon inflammation along the fingers, wrists, toes, and ankles is a hallmark sign that distinguishes gonococcal arthritis from other types of joint infection. Skin lesions appear in up to 75% of these cases, typically as small pustules or blisters on the trunk and limbs. About 60% of patients develop a fever.
The second presentation is localized septic arthritis, where one or a few joints become painfully swollen and infected. The knees, ankles, wrists, and elbows are most commonly affected. This form is less likely to cause fever or systemic symptoms but can cause joint damage if not treated promptly.
Increased HIV Risk
An active gonorrhea infection significantly raises the risk of acquiring HIV. The inflammation and tissue damage caused by gonorrhea create an easier entry point for HIV, and the immune cells that gather at the site of a gonorrhea infection are the same cells HIV targets. A meta-analysis found that men who have sex with men who had rectal gonorrhea were 3.25 times more likely to be newly diagnosed with HIV compared to those without rectal gonorrhea. This effect works in both directions: gonorrhea also increases the likelihood of transmitting HIV to a partner.
Why Asymptomatic Infection Is So Dangerous
The single biggest reason gonorrhea causes long-term damage is that so many cases go unnoticed. Up to 80% of women with gonorrhea have no symptoms. Among men, the asymptomatic rate is lower but still substantial at 10% to 20%. Rectal and throat infections are especially likely to be silent in both sexes. Without symptoms, there’s no prompt to seek testing, and the bacteria can quietly cause weeks or months of inflammatory damage before being discovered, if they’re discovered at all.
Young women face a compounded risk. They’re more biologically susceptible to infection, more likely to have hidden infections, and more likely to experience the diagnostic delays that allow complications to develop. This is the primary reason health guidelines recommend routine gonorrhea screening for sexually active women under 25, regardless of symptoms.
The Role of Reinfection
Having gonorrhea once does not provide any lasting immunity. You can be reinfected immediately after successful treatment, and each new infection restarts the inflammatory process and adds to cumulative tissue damage. Research shows that people with more than one positive test have significantly worse outcomes: a 37% higher risk of PID, 20% higher risk of infertility, and 16% higher risk of chronic pelvic pain compared to those with a single infection. The CDC recommends retesting three months after treatment to catch reinfections early, since reinfection rates are high.
Growing Antibiotic Resistance
Gonorrhea has progressively developed resistance to nearly every antibiotic used against it over the past several decades. The current recommended treatment, an injectable antibiotic called ceftriaxone, still works in the vast majority of cases. CDC surveillance data show that fewer than 0.1% of tested samples have shown elevated resistance to ceftriaxone between 2019 and 2024. However, resistance to azithromycin, previously used alongside ceftriaxone as a combination treatment, peaked at 5.8% in 2020, which is why it was dropped from the standard regimen.
The practical concern for patients is that if standard treatment fails and the infection persists, damage continues to accumulate while alternative antibiotics are identified. This makes follow-up testing after treatment more important than ever, particularly for throat infections, which are harder to cure.