Overview

Sexually transmitted infections (STIs) may feel harmless when symptoms, such as genital ulcers, urethral discharge, and painful urination, have subsided. However, in reality, these infections can pose serious risks, especially if left untreated. Some of the common STIs, including gonorrhoea and chlamydia, often have few or no severe symptoms. Hence, some individuals overlook getting tested or seeking appropriate treatment. 

Gonorrhoea, caused by a bacterium called Neisseria gonorrhoeae, can damage the reproductive system if untreated and may cause infertility or other serious conditions. This article explains the potential complications of untreated gonorrhoea and why getting timely treatment is essential.

What is gonorrhoea?

Gonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae.¹ It infects the lining of the urinary and reproductive tracts, leading to symptoms like painful urination in a person assigned male at birth (AMAB) (urethritis) and vaginal discharge (cervicitis) in a person assigned female at birth (AFAB).²

It’s the second most common STI globally, with over 100 million new cases every year.^3,4 People AMAB tend to be diagnosed more often because they experience symptoms more clearly, while many people AFAB may not notice symptoms until complications arise.⁵

How is it spread? 

Gonorrhoea spreads through vaginal, anal, and oral sex with someone who’s infected. It’s caused when the bacterium in genital fluids comes into contact with another person’s genital, anal, or throat lining.⁶

You cannot contract gonorrhoea from hugging, kissing, or sharing surfaces with an infected person. Risk factors include: having multiple sexual partners, being 18-25 years old, and AMAB individuals who have sex with AMAB.⁶ Pregnant women with untreated infection can also pass it to their babies during childbirth, potentially causing serious illness in newborns.⁶

Why untreated gonorrhoea matters

Even if symptoms fade, the infection does not go away-the bacteria can silently spread deeper through the body. Some sites, like the throat or rectum, may hold bacteria that resist low-concentration antibiotics, allowing them to persist and evolve antibiotic resistance. Left untreated, gonorrhoea can cause serious health issues affecting your reproductive health, overall body, and well-being.⁷ 

Complications in individuals AFAB 

Pelvic inflammatory disease (PID)

In individuals AFAB, untreated gonorrhoea may lead to PID, where the infection spreads to the uterus, fallopian tubes, or ovaries.⁸ This can cause chronic pelvic pain, scarring of the fallopian tubes, infertility, and ectopic pregnancy (A dangerous pregnancy outside of the womb).⁸ One of the serious complications is Fitz-Hugh-Curtis Syndrome, where inflammation spreads to the liver area, causing sharp pain and possible complications.⁷

Risks during pregnancy and birth

Untreated gonorrhoea in pregnancy can lead to:^11,12

• Preterm birth
• Increased risk of miscarriage 
• Low birth weight 
• Ectopic pregnancy which is dangerous and requires emergency care

Risk to newborns

Babies born to infected mothers are at risk of eye infection known as ophthalmia neonatorum, which can lead to blindness, joint infection, or blood infection if not treated immediately. That’s why newborns are often given preventive eye drops at birth.⁷

Complications in AMAB

Inflammation of the epididymis 

In individuals AMAB, untreated gonorrhoea can travel to the epididymis, leading to epididymitis. If left untreated for too long, it may lead to infertility, including a condition called azoospermia, where sperm count is very low or absent.^{7, 9}

Complications in both individuals AMAB and AFAB 

Bloodstream Spread and Systemic Effects

When gonorrhoea spreads through the blood (known as disseminated infection), it is rare and can cause Disseminated Gonococcal Infection (DGI). This DGI can affect the joints, heart valves (endocarditis), skin (dermatitis), the brain/lining (meningitis), and tendon sheaths (tenosynovitis). 

These infections can be severe and life-threatening.¹⁰ Gonorrhoea infection also increases the risk of acquiring HIV, by making the genital mucosa more vulnerable.² 

How to prevent complications

Because many people don’t have symptoms, regular screening is vital—especially if you're aged 18–25, have multiple partners, take part in unprotected sex or your partner tested positive.

Use condoms consistently and correctly, and encourage partners to get tested together. Early diagnosis lets doctors prescribe antibiotics before complications set in.

Because gonorrhoea can gain antibiotic resistance over time, clinics are increasing resistance testing, ensuring treatment works. Always complete prescribed medications and return for follow-up if symptoms persist after 3–5 days.⁷

FAQs

How can gonorrhoea be prevented?

Abstinence, regular use of condoms during sexual intercourse, being in a monogamous relationship, avoiding sexual intercourse with someone tested positive of gonococcal infection and getting regular screening are the recommended ways to prevent gonorrhoea. 

How is gonorrhoea diagnosed? 

Gonorrhoea can be diagnosed in people assigned male at birth (AMAB) and people assigned female at birth (AFAB) by testing the urine or vaginal samples, respectively. This also involves the use of specialised diagnostic tests. Growth media can be used for gonorrhoea culture, which requires cervical or urethral swab specimens. If someone has had oral and/or anal sex, pharyngeal or rectal swab samples can be used for testing. 

What are the treatment options for the complications of untreated gonorrhoea?

Treatment of complications from untreated gonorrhoea depends on the area infected and the severity of infection. Single or dual antibiotic therapy is generally recommended with follow-up to ensure total clearance of N.gonorrhoeae. Patients are instructed to return to the hospital for evaluation for the possibility of treatment failure and antimicrobial resistance if they experience persistent or recurrent symptoms (eg, three to five days) after completing therapy for a gonorrhoea-associated complication. 

Will treating one partner prevent the spread?

Yes, partner treatment is important. Both partners need to be treated before having sex again to prevent re-infection.

What if gonorrhoea returns after treatment?

This may indicate either a new infection or antibiotic resistance. Return to your clinic for re-testing and further care.

Summary

Gonorrhoea is common but treatable. Left untreated, it can cause serious complications affecting fertility, overall health, and even newborns. Screening, early diagnosis, and proper treatment are key to preventing harm. If symptoms appear or don't it’s important to get tested and treated promptly, to protect yourself and others.