Gonorrhoea is treated by a doctor, usually with an antibiotic injection. In most guidelines ceftriaxone is the first-choice drug. The treatment works well, but there is an important caveat: the gonorrhoea bacterium is becoming less sensitive to antibiotics. That is why the right dose of the right drug, given by a doctor, really matters.
This is the topic that keeps us up most. Not to scare you, but to explain why self-treating is a bad idea.
How is gonorrhoea treated?
The standard treatment is an injection of ceftriaxone, often in a single dose. If chlamydia is confirmed alongside, a doctor may prescribe an additional antibiotic. A doctor decides what fits your situation, partly based on the site of infection and any allergies.
The international treatment guideline advises ceftriaxone as first choice and has been tightened in recent years because of resistance (St Cyr et al., MMWR 2020, PMID 33332296). In the Netherlands the NHG guideline and RIVM follow a comparable line.
Why an injection and not just pills?
An injection delivers a reliable, high concentration of the antibiotic at the right moment. That is exactly what is needed to tackle the bacterium effectively in one go and give resistance as little chance as possible. Trying an old course of pills yourself misses that effect and can backfire.
A too-low or wrong dose lets the strongest bacteria survive, and those are precisely the ones that pass on resistance. So treatment belongs with a doctor, and you always discuss a positive result with your GP or the GGD.
What is antibiotic resistance in gonorrhoea?
Resistance means an antibiotic works less well or no longer against the bacterium. In gonorrhoea this has happened step by step over the decades: one drug after another lost its effect. Researchers therefore describe Neisseria gonorrhoeae as a bacterium heading toward superbug status (Unemo & Shafer, Clin Microbiol Rev 2014, PMID 24982323).
| Period | Development | Consequence |
|---|---|---|
| 20th century | Penicillin and later other drugs lose their effect | Switch to new antibiotics |
| Around 2000 | Resistance to ciprofloxacin rises | This drug is no longer advised |
| Now | Ceftriaxone is first choice, with global monitoring | Treat sparingly and targeted |
Worldwide, a surveillance network tracks which antibiotics still work, so guidelines can be adjusted in time (Wi et al., PLoS Med 2017, PMID 28686231). For you the message is simple: leave the choice of drug to a doctor.
Why a follow-up test after treatment can help
With gonorrhoea a doctor sometimes advises a follow-up test, also called a test-of-cure, to confirm the infection is truly gone. This is more relevant in gonorrhoea than in some other STIs, precisely because of resistance. Whether and when this is needed for you is up to the doctor.
Important for the timing: a NAAT can still pick up dead material from the bacterium, so a follow-up test is not done right after the course. Your doctor tells you when a retest is reliable.
What can you do yourself?
The most important thing is: get tested if there was a risk, and see a doctor if the result is positive. Hold off on sex until treatment is complete and your doctor gives the green light, so you do not infect anyone. It can also be worthwhile to inform recent partners.
Good to know: a follow-up test is not done with blood, but with the same kind of sample as the first test, so urine or a swab. The timing is precise, because right after the course a PCR test can still pick up remnants of the bacterium. Your doctor indicates when a retest is meaningful and becomes reliable.
If you want to map your situation first, you can do a targeted gonorrhoea test or a combined test for chlamydia, gonorrhoea and trichomonas. More about the bacterium and the symptoms is in the pillar gonorrhoea (the clap): recognising symptoms and testing. If you are unsure about the differences between men and women, see gonorrhoea in men and women. What to do after a positive result is in tested positive for an STI: what now.
Resistance sounds heavy, but the practice is level-headed: test in time, let a doctor treat, and a follow-up test if needed. That keeps the clap treatable.
Sources
- RIVM, Gonorrhoea (rivm.nl).
- Thuisarts.nl, I may have gonorrhoea (thuisarts.nl).
- St Cyr S et al. Update to CDC's treatment guidelines for gonococcal infection, 2020. MMWR Morb Mortal Wkly Rep. 2020 (PMID 33332296).
- Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014 (PMID 24982323).
- Wi T et al. Antimicrobial resistance in Neisseria gonorrhoeae: global surveillance and a call for international collaborative action. PLoS Med. 2017 (PMID 28686231).
Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP. This article is meant as explanation, not as medical advice.
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