Understanding Neisseria gonorrhoeae
Gonorrhea, caused by the gram-negative bacterium Neisseria gonorrhoeae, is the second most commonly reported bacterial STI in the United States, with approximately 1.6 million new cases annually. It is transmitted through vaginal, anal, and oral sexual contact and can infect the urethra, cervix, rectum, pharynx, and — in newborns — the eyes (ophthalmia neonatorum).
A defining public health challenge with gonorrhea is its escalating antibiotic resistance. The Gonococcal Isolate Surveillance Project (GISP), maintained by the CDC, tracks resistance patterns nationally and has documented progressive resistance to fluoroquinolones, tetracyclines, and oral cephalosporins. This resistance evolution is why treatment protocols have changed substantially over the past decade and why the recommended regimen is now a single-dose intramuscular injection.
your board-certified provider, provides a thorough, non-judgmental evaluation and coordinates care in full alignment with the CDC 2021 STI Treatment Guidelines. Below, we are transparent about what telehealth can and cannot do for gonorrhea — and how we bridge that gap.
Symptoms of Gonorrhea
Gonorrhea may be asymptomatic — particularly in women with cervical infection. When symptoms occur, they typically appear 1–14 days after exposure.
Urogenital Symptoms
- • Purulent (pus-like) urethral or vaginal discharge — often described as yellow-green
- • Dysuria (burning with urination), often more pronounced in men
- • Increased vaginal discharge or intermenstrual bleeding
- • Testicular pain (epididymo-orchitis)
Extra-Genital Presentations
- • Rectal gonorrhea: discharge, pain, bleeding, or tenesmus (often asymptomatic)
- • Pharyngeal gonorrhea: sore throat or asymptomatic; requires throat NAAT
- • Disseminated gonococcal infection (DGI): joint pain, skin lesions, fever — requires urgent care
CDC 2021 Treatment Guidelines — & What Telehealth Can Do
Transparency About Telehealth's Role in Gonorrhea Treatment
The current CDC-recommended first-line treatment for gonorrhea is ceftriaxone 500 mg intramuscular (IM) injection (1 g if weight >150 kg). Because IM injection requires in-person administration, Innocre cannot directly administer this treatment via telehealth. However, we play an important role in your care — and we will never leave you without a clear path forward.
Ceftriaxone 500 mg IM
Single intramuscular injection
Increase to 1 g IM if weight exceeds 150 kg. If chlamydia co-infection not excluded, add doxycycline 100 mg BID x7 days.
Cefixime 800 mg oral
Single oral dose
Less preferred due to lower efficacy, particularly for pharyngeal infection. Test of cure required at 1–2 weeks if used.
How Innocre Navigates the IM Injection Limitation
Lab Order First
We order a gonorrhea NAAT to confirm diagnosis before treatment, unless clinical urgency dictates otherwise.
Referral for Ceftriaxone Injection
We provide a standing order and referral to a local urgent care, community health center, or pharmacy that administers IM injections (available at many Walgreens, CVS MinuteClinic, and urgent care facilities).
Oral Alternative When Injection Is Inaccessible
If a patient cannot access an IM injection facility and the infection is urogenital (not pharyngeal), we may prescribe cefixime 800 mg oral with test of cure scheduled at 1–2 weeks, per CDC guidance.
Co-treatment for Chlamydia
When chlamydia co-infection has not been excluded by testing, doxycycline 100 mg BID x7 days is added per CDC guidelines.
Antibiotic Resistance: Why This Matters
Gonorrhea's ability to develop antibiotic resistance is exceptional among bacteria. Over the past several decades, N. gonorrhoeae has sequentially developed resistance to penicillin, tetracyclines, fluoroquinolones (ciprofloxacin), and oral cephalosporins. The GISP data has tracked declining susceptibility even to cefixime, which is why injectable ceftriaxone is now strongly preferred.
This is why we strongly discourage treating gonorrhea with antibiotics not aligned with current CDC guidelines. Do not use ciprofloxacin, azithromycin alone, or older cephalosporins — these regimens have unacceptably high failure rates.
If you have had gonorrhea treatment in the past that did not include ceftriaxone IM, or if your symptoms persist after treatment, please contact us for reassessment and culture-based susceptibility testing.
Partner Treatment & Test of Cure
All sexual partners from the 60 days preceding symptom onset or diagnosis should be evaluated and treated. your provider can discuss expedited partner therapy (EPT) where applicable by state law.
Test of cure is recommended in the following situations (in contrast to chlamydia, where it is not routinely needed):
- All patients treated with cefixime (oral) — retest at 1–2 weeks
- Pharyngeal gonorrhea — retest at 1–2 weeks regardless of regimen
- Persistent symptoms after treatment
- Pregnancy
All patients should be retested for gonorrhea at 3 months after treatment due to high reinfection rates.
When to Seek Urgent or Emergency Care
Seek urgent or emergency evaluation immediately for:
- • Fever, joint pain, or skin pustules — may indicate disseminated gonococcal infection (DGI), which requires IV antibiotics and hospitalization
- • Pelvic pain with fever in women — possible PID requiring in-person evaluation
- • Acute scrotal pain and swelling — possible epididymo-orchitis
- • Eye pain or discharge in a newborn — ophthalmia neonatorum requires emergency ophthalmic care