Gonorrhea is a bacterial sexually transmitted infection that, in men, most commonly infects the urethra, causing painful urination and a visible discharge from the penis. It can also infect the throat and rectum. About 95% of men with urethral gonorrhea develop noticeable symptoms, typically within a few days of exposure, making it one of the more obvious STIs. Still, that leaves a small percentage of men who carry the infection without knowing it, and infections in the throat or rectum are far more likely to be silent.
How Gonorrhea Infects the Body
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which spreads through vaginal, anal, or oral sex. When the bacterium reaches the lining of the urethra, it uses tiny hair-like structures on its surface to latch onto cells. These structures pull the bacterium into tight contact with the tissue, triggering changes in the cell’s signaling that allow the bacterium to slip inside. Once inside, it can survive, replicate, and avoid being shed as the body naturally turns over its surface cells.
This invasion is what triggers the immune response you experience as symptoms. Your body floods the area with white blood cells to fight the infection, producing the characteristic pus-like discharge and inflammation that make urination painful.
What Symptoms Look Like
Most men notice symptoms within two to five days of exposure, though it can take up to two weeks. The hallmark signs of urethral gonorrhea are a thick, yellowish or greenish discharge from the penis and a burning sensation during urination. Some men also experience swollen or tender testicles, though this is less common in early infection.
Rectal gonorrhea, which results from receptive anal sex, produces a different set of symptoms: anal discharge, itching, soreness, bleeding, and painful bowel movements. Many rectal infections, however, cause no symptoms at all. Throat infections from oral sex are similarly quiet. Most people with gonorrhea in the throat have no sore throat or other signs, which means these infections often go undetected unless specifically tested for.
How It’s Diagnosed
The standard test for gonorrhea in men is a urine sample analyzed using a nucleic acid amplification test, or NAAT. This is the most accurate available method, detecting significantly more infections than older culture-based tests. For men, a first-catch urine sample (the initial stream, not midstream) performs as well as or better than a urethral swab, which makes testing straightforward and painless.
If you’ve had oral or anal sex, a urine test alone won’t catch infections in the throat or rectum. Those sites require separate swab tests. NAATs are especially important for these locations: culture tests miss more than half of throat infections and over half of rectal infections that NAATs can detect. If your provider doesn’t ask about sexual practices to determine which sites to test, it’s worth bringing it up yourself.
What Happens Without Treatment
Untreated gonorrhea doesn’t just linger. It can spread deeper into the reproductive tract and cause a condition called epididymitis, an inflammation of the coiled tube behind each testicle that stores and carries sperm. Epididymitis causes fever, scrotal pain, and swelling, and if it goes on long enough, it can lead to scarring that affects fertility. Gonorrhea can also cause urethral stricture, a narrowing of the urethra from scar tissue that makes urination difficult.
In rare cases, the bacteria enter the bloodstream and cause disseminated gonococcal infection, which affects the whole body. This can show up as joint pain (especially in the hands and wrists), fever, tendon inflammation, and a distinctive skin rash with slightly raised pink or red sores that may later turn purple or fill with pus. Joint symptoms typically develop over one to four days and can become severe enough to require hospitalization.
How Gonorrhea Is Treated
Gonorrhea is treated with a single injection of an antibiotic, currently the CDC-recommended first-line option for uncomplicated infections. Because gonorrhea and chlamydia frequently occur together, you’ll also be treated for chlamydia with a week-long course of oral antibiotics unless testing has already ruled it out. The injection itself takes seconds, and most men feel symptom relief within a day or two.
You should avoid sexual contact for seven days after treatment and until any partners have been treated as well. Reinfection is common, and getting gonorrhea once does not protect you from getting it again.
Why Antibiotic Resistance Matters
Gonorrhea has a long history of developing resistance to every class of antibiotic used against it. The situation is getting worse. Between 2022 and 2024, resistance to the 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 globally. Resistance to a related oral antibiotic climbed from 1.7% to 11%. Older antibiotics are even less reliable: 95% of gonorrhea strains are now resistant to ciprofloxacin, an antibiotic that was once a standard treatment.
For you as a patient, this means treatment failure is possible, though still uncommon. If your symptoms don’t clear up after treatment, follow up with your provider. A bacterial culture (the older, less sensitive test) becomes important in these cases because it can identify exactly which antibiotics the specific strain responds to.
Reducing Your Risk
Condoms significantly reduce the risk of gonorrhea transmission when used consistently during vaginal, anal, and oral sex. Because gonorrhea can infect the throat and rectum without symptoms, regular screening matters if you have new or multiple partners. Men who have sex with men are recommended to screen at all exposed sites at least annually, and more frequently with higher-risk sexual activity.
If you’ve been treated for gonorrhea, retesting about three months later is important even if symptoms resolved completely. Reinfection rates are high, and catching a new infection early prevents complications and further transmission.