Quick answer
Gonorrhea is an infection caused by the bacterium Neisseria gonorrhoeae, passed on through vaginal, anal and oral sex.1 In men, it usually causes pus-like discharge and burning when urinating, 2 to 5 days after infection.1 In Brazil, it is treated with injectable ceftriaxone and oral azithromycin, as a single dose.1 Partners need treatment, and the throat and rectum can be infected without any symptoms.1
What it is and how it spreads
The bacterium infects mucous membranes: the urethra, cervix, rectum, throat and, more rarely, the lining of the eyes.1 The risk of transmission is, on average, 50% with each sexual contact with an infected person.1
Symptoms at each site
In the male urethra, fewer than 10% of infections cause no symptoms.1 At the other sites, silent infection is the rule, which is why testing depends on each person's type of sex.1
| Site | What usually happens |
|---|---|
| Male urethra | Discharge in more than 80% of cases with symptoms and pain when urinating in more than 50% |
| Female urethra | Often no symptoms |
| Throat | No symptoms in more than 90% of cases |
| Rectum | Usually no symptoms. It can cause proctitis in 12% and anal discomfort in 7% |
| Eyes | Pus-like discharge and swelling, through contact with hands or objects. Needs prompt treatment |
Source for the table: Brazilian protocol.1
How it is diagnosed
In men with discharge, a Gram stain is quick and performs well: the finding is pairs of bacteria inside immune cells.1 Molecular testing identifies gonorrhea and chlamydia at the same time, with high accuracy, and is the method of choice for people without symptoms.1 Culture shows which antibiotics the bacterium responds to.1
The sample follows the type of sex: urine, genital discharge, or swabs from the anus and throat, with tests validated for these sites.1
How it is treated
For uncomplicated infection of the urethra, cervix, rectum or throat, the Brazilian protocol uses injectable ceftriaxone and oral azithromycin, as a single dose.1 The dose is set in the consultation. The American guideline uses ceftriaxone and adds doxycycline for 7 days when chlamydia has not been ruled out.2
For people with a severe allergy to cephalosporins, the Brazilian protocol provides an alternative with azithromycin alone.1 When treatment fails, there is a specific retreatment regimen.1
Until everyone has finished treatment, the advice is no unprotected sex for 7 days after the single-dose medicine.1 The American guideline recommends a repeat test 3 months later, even if the partner was treated.2
Why antibiotic resistance matters
Gonorrhea is very good at developing resistance.3 In Brazil, Ministry of Health monitoring shows that resistance to ciprofloxacin persists and that resistance to azithromycin has risen considerably.3
In the countries that sent data to the WHO surveillance program, resistance to ceftriaxone rose from 0.8% to 5% between 2022 and 2024, and resistance to ciprofloxacin reached 95%.4 These figures are not from Brazil, but they show the direction of the problem.
Complications
In men, the infection can spread up the urethra and cause epididymo-orchitis, prostatitis and urethral stricture.1 Conjunctivitis can lead to a corneal ulcer and even blindness if untreated.1
The disseminated form is rare, 0.5% to 3% of cases. The bacterium reaches the bloodstream and causes fever, skin lesions, and joint pain and inflammation.1
When to see a urologist
- If there is discharge or pus from the urethra
- If you have burning when urinating after sex
- If your partner is diagnosed with gonorrhea or chlamydia
- If symptoms continue after treatment
- If you have pain or swelling in a testicle
Frequently asked questions
What are the symptoms of gonorrhea in men?+
Pus-like discharge and burning when urinating. Among men with symptoms, more than 80% have discharge and more than 50% have pain when urinating.1
How many days until symptoms appear?+
Usually 2 to 5 days after infection.1
What color is gonorrhea discharge?+
It is usually yellowish or greenish and pus-like. Color alone does not confirm the diagnosis, because other types of urethritis can look the same.1
Can gonorrhea spread through oral sex?+
Yes. The bacterium can infect the throat, and more than 90% of these infections cause no symptoms.1
How is gonorrhea treated in Brazil?+
With injectable ceftriaxone and oral azithromycin, as a single dose, according to the Brazilian Ministry of Health protocol.1 The dose is set in the consultation.
Can I be treated with tablets only?+
The Brazilian protocol uses the ceftriaxone injection as the basis of treatment. Tablets alone appear only as an alternative for people with a severe allergy to cephalosporins.1
Do I need a repeat test after treatment?+
The American guideline recommends a repeat test 3 months later. For throat infection, it also recommends a test of cure 7 to 14 days after treatment.2
Can I get gonorrhea again?+
Yes. Having had the infection does not prevent a new one, and an untreated partner is one of the reasons symptoms come back.1
References
- Brasil. Ministério da Saúde. Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis (IST). Brasília: Ministério da Saúde; 2022. Brazilian Ministry of Health
- Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. Gonococcal infections chapter. CDC
- Brasil. Ministério da Saúde. Por que o monitoramento da resistência da gonorreia é importante para o SUS? Brasília: Ministério da Saúde; 2023. Brazilian Ministry of Health
- World Health Organization. More countries report rising levels of drug-resistant gonorrhoea, warns WHO. Geneva: WHO; 19 Nov 2025. WHO
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