Gonorrhea Treatment in 2026 — What Actually Works

Gonorrhea is the second most-reported STI in the United States. It's also been the most pharmacologically frustrating: it has developed resistance to every class of antibiotic ever used to treat it, often within a decade or two of introduction. Today the CDC's first-line regimen is a single drug (ceftriaxone), and we don't have a strong backup yet.

Here's what the current 2026 treatment looks like, why it keeps changing, and what's coming.

The current first-line treatment (2026)

The CDC's current recommended regimen for uncomplicated gonococcal infection of the cervix, urethra, or rectum:

• Ceftriaxone 500 mg as a single intramuscular (IM) injection (1 g if body weight ≥150 kg)
• If chlamydia infection has not been excluded: add doxycycline 100 mg twice daily for 7 days

Ceftriaxone is the only routinely recommended first-line treatment. It's effective in over 99% of cases in the US — but the margin is narrower than it used to be.

What changed and why

Gonorrhea has been outsmarting antibiotics for over 80 years:

Cases of "super gonorrhea" — resistant to ceftriaxone — have been reported in the UK, Japan, Australia, and increasingly the US. So far they remain rare. Public health authorities are watching closely.

Treatment at specific anatomical sites

Cervical, urethral, rectal gonorrhea

Ceftriaxone 500 mg IM single dose. Works in the vast majority of cases.

Pharyngeal gonorrhea (throat)

Same regimen: ceftriaxone 500 mg IM. Throat infections are harder to clear because antibiotics penetrate the throat less effectively. Test-of-cure recommended at 7-14 days after treatment.

Disseminated gonococcal infection (DGI)

Spread of gonorrhea beyond the local area (joints, skin, blood). Requires hospitalization in many cases:

• Ceftriaxone 1 g IM or IV daily for 7+ days, depending on severity

Pelvic Inflammatory Disease (PID) involvement

Combination regimen, including ceftriaxone + doxycycline + metronidazole.

Eye infection (gonococcal conjunctivitis in adults)

Ceftriaxone 1 g IM single dose. Saline lavage of the eye.

Neonatal exposure

Newborns exposed during birth get prophylactic erythromycin or ceftriaxone.

What if the patient is allergic to cephalosporins?

This is increasingly tricky. The CDC's alternatives in 2026 include:

• Gentamicin 240 mg IM + azithromycin 2 g orally (in limited circumstances)
• Consultation with infectious disease specialist for severe penicillin/cephalosporin allergy

Always disclose true allergy status. Many people who think they're allergic to penicillins actually aren't.

Why a single dose works

Gonorrhea bacteria, when susceptible to ceftriaxone, are killed quickly. A high single dose achieves bactericidal levels rapidly and suppresses the organism long enough to clear the infection without giving it time to develop resistance.

Multi-day regimens are sometimes used for harder-to-treat sites (throat, joints) or disseminated infection.

After treatment — what to expect

Symptoms should improve within 24-72 hours

If discharge, burning, pain don't start improving in 3 days, follow up — this could be a resistant strain or co-infection.

Refrain from sex

For 7 days after treatment AND until all sexual partners have been treated.

Partner treatment

All partners from the past 60 days should be tested and treated (usually presumptively). See STI partner notification.

Re-testing

• Test of cure (TOC): Routinely recommended only for pharyngeal infection (at 7-14 days)
• Re-screening: Recommended at 3 months — gonorrhea reinfection is very common

Symptoms that might warrant treatment

In women (urogenital)

• Increased vaginal discharge
• Pelvic pain
• Bleeding between periods
• Painful urination
• Often asymptomatic (~50%)

In men (urogenital)

• Discharge from penis (often more purulent than chlamydia — thicker, more yellow/green)
• Painful urination
• Testicular pain (rarely)
• About 10% are asymptomatic

At other sites

• Rectal: Anal discharge, itching, soreness, bleeding (often asymptomatic)
• Pharyngeal: Usually completely asymptomatic — occasionally mild sore throat
• Joints (DGI): Painful, swollen joint(s); fever; rash

Testing for gonorrhea

NAAT (nucleic acid amplification test) is the gold standard, available as:

• Urine (men, urogenital)
• Vaginal swab (women)
• Rectal swab
• Pharyngeal swab

Self-collected swabs are now FDA-approved and widely available. Results in 1-7 days.

For symptomatic men with discharge, gram-stain microscopy can give a presumptive diagnosis on the same day.

The future: what's coming

Zoliflodacin

A new oral antibiotic specifically designed for gonorrhea, with a novel mechanism (topoisomerase inhibitor). Phase 3 trials completed; FDA review in progress. May provide a non-cephalosporin option.

Gepotidacin

Another novel-class antibiotic; FDA-approved in 2024 for UTI but being studied for gonorrhea.

Combination therapy debate

Some experts argue for routine dual therapy (ceftriaxone + azithromycin) to slow resistance. Others worry about driving resistance in other organisms. Currently the US recommends single-drug ceftriaxone except for specific scenarios.

A vaccine?

Several gonorrhea vaccine candidates are in development. Some Meningococcal B vaccines have shown partial cross-protection. A gonorrhea-specific vaccine is years away from clinical use.

What you should actually do

If you might have gonorrhea:

1. Get tested — urine + rectal + throat swabs depending on exposure
2. Get treated promptly if positive — ceftriaxone IM (likely + doxycycline for possible chlamydia)
3. Notify partners so they can be treated
4. Wait 7 days after treatment before sex
5. Re-test at 3 months to catch reinfection

If you're treated and symptoms persist:

• Could be a resistant strain — return to clinic immediately
• Could be co-infection with chlamydia/trichomonas/Mycoplasma
• Could be reinfection from an untreated partner
• Always re-evaluate, don't assume failure means "needs more antibiotic"

Bottom line

Gonorrhea treatment in 2026 is straightforward in the vast majority of cases: one ceftriaxone shot, possibly with a week of doxycycline for chlamydia coverage. The current regimen works well, but the long-term trend is concerning. Antibiotic stewardship — only treating real infections, completing courses, retesting — matters more than ever.

If you've had unprotected sex or are showing symptoms, don't wait. Gonorrhea is more common, more often asymptomatic, and more easily missed than people think.

For more on STI testing and treatment, see our chlamydia pillar guide, doxycycline vs azithromycin guide, and STI testing window periods.