Gonorrhoea is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It spreads primarily through vaginal, oral, or anal sex and can also be transmitted from a pregnant mother to her baby during childbirth. While preventable and curable, it remains one of the world’s most persistent public health challenges. According to the World Health Organization (WHO), there were an estimated 82.4 million new infections among adults aged 15 to 49 in 2020.
The infection often goes unnoticed in women, who may not show symptoms. When they do occur, symptoms can include vaginal discharge, painful urination, or bleeding between periods. Men are more likely to develop noticeable symptoms such as a white, yellow, or green discharge from the penis, painful urination, and occasionally swollen testicles. Gonorrhoea can also infect the throat or anus, often without symptoms, though soreness, discharge, or pain can occur.
If untreated, the disease can cause severe reproductive complications such as infertility in both sexes, pelvic inflammatory disease, and ectopic pregnancy. In infants, transmission during birth can lead to serious eye infections and blindness.
How the Disease is Diagnosed and Treated
Diagnosis usually involves molecular tests that detect the bacteria in urine samples or swabs from affected areas. Because many infections are symptomless, WHO recommends regular screening for people at higher risk, such as men who have sex with men, sex workers, and young adults in high-prevalence regions.
Gonorrhoea is typically treated with antibiotics from the cephalosporin family, most often ceftriaxone given as an injection. If this is not possible, cefixime or azithromycin may be used. Patients are advised to avoid sexual activity for seven days after treatment and to ensure all recent partners are tested and treated to prevent reinfection. Follow-up testing three months later helps confirm that the infection has cleared.
The Growing Challenge of Drug Resistance
One of the gravest concerns surrounding gonorrhoea today is antimicrobial resistance (AMR). N. gonorrhoeae has developed resistance to nearly every class of antibiotics ever used against it, including penicillins, tetracyclines, macrolides such as azithromycin, and fluoroquinolones like ciprofloxacin. Resistance to ceftriaxone, the current “last line” treatment, has also been reported in several countries including Japan, the UK, Australia, France, and Sweden.
These super-resistant strains, sometimes called “super gonorrhoea,” pose a serious global health threat. According to WHO surveillance, most cases of resistance occur in the African and Western Pacific regions, though resistant strains have now spread worldwide. The organization warns that treatment failure reports in developed nations may represent only the visible portion of a much larger problem, as resistance in low-resource countries is likely underreported.
New Tools in the Fight: Vaccines and Novel Treatments
Until recently, there was no vaccine for gonorrhoea. That changed in 2025 when England launched the world’s first vaccination program using GSK’s 4CMenB vaccine, originally designed for meningococcal B disease. Although not licensed specifically for gonorrhoea, studies have shown that it offers cross-protection against the infection. The vaccine is being given to high-risk groups such as gay and bisexual men with multiple recent partners or a history of bacterial STIs. The UK Health Security Agency estimates that this rollout could prevent up to 100,000 cases and save millions in healthcare costs. Epidemiologist Dr. Sema Mandal described the program as “hugely welcome” given the “very concerning numbers of gonorrhoea, including antibiotic-resistant strains.”
On the treatment front, researchers have hailed the antibiotic gepotidacin as a major breakthrough. Developed by GSK under the brand name Blujepa, it became the first new treatment for gonorrhoea in over 30 years. Clinical trials published in The Lancet found that gepotidacin, taken orally, was as effective as the standard injectable ceftriaxone plus azithromycin combination. It also showed strong performance against resistant strains, with no severe side effects. As a pill-based treatment, it could simplify care, reduce the need for injections, and limit the burden on healthcare systems.
The Global Response
WHO has launched several initiatives to contain the spread of gonorrhoea and its resistant forms. Its Enhanced Gonorrhoea Antimicrobial Surveillance Program (EGASP) tracks resistance patterns globally, while the Global Health Sector Strategy on HIV, Hepatitis, and STIs aims to cut new gonorrhoea infections by 90% by 2030. The agency is also supporting vaccine research, promoting rational antibiotic use, and strengthening laboratory networks to identify resistant strains earlier.
Experts warn that success will depend not only on science but also on reducing stigma and improving sexual health education. Gonorrhoea disproportionately affects marginalized populations, where barriers to healthcare, limited awareness, and fear of discrimination often delay diagnosis and treatment. As researchers Sophie Ross and Collins Iwuji noted in The BMJ, “Control will not be achieved without dismantling systemic barriers to good sexual health.”
