Gonorrhea

What Gonorrhea Is

Gonorrhea is a sexually transmitted bacterial infection caused by Neisseria gonorrhoeae. It spreads through contact with mucous membranes during oral sex, anal sex and vaginal sex. The bacteria can live in the throat, rectum and genitals and can occasionally infect the eyes. Many people still think of gonorrhea as a genital-only problem, but modern data show that this assumption is dangerously outdated. A substantial number of infections exist in the throat and rectum where symptoms are uncommon and most people never think to test.

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Incubation Period

Most gonorrhea infections become detectable within two to seven days after exposure and nearly all do so within fourteen days. Testing too early can miss an active infection. Shameless Care’s multi-site STI testing panels include guidance on proper timing so your results are accurate and meaningful.

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Symptoms When They Occur

Although gonorrhea can cause symptoms, many infections remain silent, especially in the throat and rectum.

• Genital infections can produce discharge, burning with urination, pelvic discomfort or testicular swelling.
• Rectal infections may cause itching, pain or discharge but often cause nothing noticeable.
• Throat infections almost never cause symptoms and are found only through testing.

Because oral and rectal infections rarely produce symptoms, the only reliable detection method is routine multi-site screening. Shameless Care includes oral, anal and genital testing so that hidden infections are not missed.

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Complications if Untreated

Untreated gonorrhea can cause pelvic inflammatory disease, infertility, chronic pelvic pain, epididymitis in men, increased risk of HIV acquisition, joint and skin infections through disseminated gonococcal infection and pregnancy complications that can impact both the pregnant person and the baby. Prompt detection and treatment prevent these complications.

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Antibiotic Resistance

Gonorrhea has developed resistance to nearly every antibiotic that has been used against it. Penicillin, tetracyclines and fluoroquinolones have all failed. Resistance to azithromycin has risen dramatically. The current recommended treatment is ceftriaxone, though public health agencies monitor resistance closely.

For the most definitive explanation of this check out the Shameless Care Podcast Episode 22 titled “Super Gonorrhea: Are STIs outsmarting Antibiotics” wherever you listen to podcasts! 

This resistance pattern is also why DoxyPEP provides partial protection against gonorrhea but far better protection against chlamydia and syphilis. Even partial protection still helps reduce infections and reduce community transmission. Shameless Care offers DoxyPEP to patients seeking modern, science-based prevention strategies.

Get DoxyPEP delivered to your home here. 

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Reportable Infection Requirements

Gonorrhea is reportable in all fifty states. When someone tests positive, both the laboratory and the diagnosing clinician must report the case to the local county health department. This report includes name, address and race. Reporting is required by law for every clinic, hospital and telemedicine service. Shameless Care complies precisely with reporting laws and never sends anything beyond what is required.

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Site Specific Testing Requirements

Gonorrhea is site specific. A genital test detects genital infection only. A throat swab detects throat infection only. A rectal swab detects rectal infection only. Any test that checks the genitals but ignores the throat and rectum is incomplete and can miss the majority of infections.

Shameless Care’s STI panels include oral, anal and genital samples so that every exposed site is evaluated.

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Reinfection and Partner Treatment

Most repeat infections occur because a partner was never treated or because the original infection was in the throat or rectum and was never tested. Treating partners at the same time and testing all sites dramatically reduces reinfection. Where permitted by law, expedited partner therapy helps break the cycle of transmission.

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Pregnancy Considerations

Gonorrhea can cause pregnancy complications including preterm birth, infection of the amniotic sac and transmission during delivery. Appropriate treatment is essential.

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How Common Gonorrhea Really Is

The CDC receives more than seven hundred thousand reported gonorrhea cases each year, but this number does not reflect reality. Gonorrhea is often asymptomatic, frequently extragenital and commonly missed in healthcare settings that test only with urine samples.

There is no large national survey equivalent to NHANES for gonorrhea prevalence, but studies that include throat and rectal swabs show a large reservoir of unrecognized infections.

A major study of heterosexual young adults in Ireland found that sixty three percent of gonorrhea infections were located in the throat only. Genital-only infections accounted for only eight percent of positive cases. These are infections that would be completely invisible using genital-only testing.

Another study analyzing forty five million gonorrhea and chlamydia tests in the United States found that only 1.5 percent of tests in women were throat swabs and only 0.4 percent were rectal swabs. Yet among those few throat tests performed, the positivity rate for gonorrhea was twice as high as the genital positivity rate. In other words, the area almost no one tests is the area more likely to be positive.

This is critical. Genital-only testing is missing most gonorrhea infections, and these missed infections serve as an ongoing reservoir for community spread.

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The Problem with Telemedicine and Standard Clinics

Many telemedicine services and even traditional clinics still offer “gonorrhea and chlamydia testing” that includes only a urine specimen. They do not test the throat. They do not test the rectum. Patients walk away with a false sense of security while still carrying a fully infectious organism in another site.

This oversight is not minor. It is one of the main drivers of ongoing transmission. If a throat or rectal infection is never tested, it is never treated. If it is never treated, it is never reported, never included in public health data and continues to spread silently.

Shameless Care avoids this entirely by testing every exposed site. This is the only way to catch the majority of gonorrhea infections that exist in sexually active adults.

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Contagiousness and Testing Timelines

People are considered infectious until they complete treatment and any symptoms improve. Most guidelines recommend abstaining from sexual contact for seven days after treatment and ensuring all partners are treated as well. Reinfection is common, so retesting at three months is recommended.

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The Bottom Line

Gonorrhea is common, frequently silent and far more widespread than the official numbers suggest. It lives in the throat and rectum more often than people realize. It is reportable in all fifty states. It has a long history of antibiotic resistance. And it is consistently missed by any test that checks only the genitals.

If you want true protection, you need two things.

You need comprehensive multi-site STI testing and you need modern prevention tools like DoxyPEP.

Shameless Care provides the most complete at-home STI panels available, with oral, anal and genital testing included by design. We also offer DoxyPEP, which significantly reduces the risk of acquiring chlamydia, syphilis and some strains of gonorrhea when used correctly after sex.

If you want testing and prevention options that match how people actually have sex today, Shameless Care is here to help.