When most people think about sexually transmitted infections, they picture symptoms involving the genitals. Burning during urination, unusual discharge, sores and pelvic discomfort may immediately come to mind. However, one common STI can quietly settle somewhere many people never think to test: the throat.
Throat gonorrhea—also called pharyngeal gonorrhea—is a gonorrhea infection involving the pharynx, or the back of the throat. It can be passed through oral sex and frequently causes no noticeable symptoms. That means someone can feel perfectly healthy while unknowingly carrying and transmitting the infection.
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It can infect the genitals, rectum and throat.
A throat infection can develop when someone performs oral sex on a partner who has gonorrhea involving the penis, vagina or rectum. A person with gonorrhea in the throat may also transmit the infection to a partner’s genitals through oral sex.
According to the Centers for Disease Control and Prevention, oral sex can transmit several other infections, including chlamydia, syphilis, herpes and human papillomavirus, or HPV. It is also possible to have an STI in more than one location simultaneously—for example, in both the throat and genitals.
Oral sex carries little to no risk of HIV transmission, but that does not mean it is risk-free. Gonorrhea and other STIs can spread even when no ejaculation occurs and even when neither partner has symptoms.
Most cases of pharyngeal gonorrhea are asymptomatic. When symptoms do occur, they may be mild and easily mistaken for a cold, allergies, strep throat or another routine infection.
Possible symptoms include:
These symptoms cannot confirm gonorrhea because many other conditions can cause them. Conversely, having no throat discomfort does not rule out an infection.
A routine throat culture for strep does not automatically test for gonorrhea. You must tell your healthcare provider about your possible exposure so the appropriate test can be ordered.
One of the biggest misconceptions about STI screening is that a urine test checks every part of the body. It does not.
A urine sample may detect a genital or urethral infection, but it generally will not identify gonorrhea living only in the throat. If you have had oral sex, ask whether you need a throat swab.
During this test, a clinician uses a small swab to collect a sample from the back of the throat. The sample is usually tested using a nucleic acid amplification test, commonly called a NAAT. Testing may also involve a bacterial culture, particularly when treatment failure or antibiotic resistance is suspected.
Be direct with your provider about the types of sex you have. This information helps determine which locations need to be tested. Depending on your sexual activity, that may include the throat, genitals and rectum. It is a medical conversation—not a moral judgment.
Throat gonorrhea may rarely cause serious complications at the site itself, but an untreated infection can continue spreading between partners. The throat can function as a hidden reservoir because people who feel healthy are unlikely to seek testing.
Pharyngeal gonorrhea is also more difficult to eliminate than gonorrhea affecting the genitals or rectum. Health officials are particularly concerned about the throat’s possible role in the development and spread of antibiotic-resistant gonorrhea. The CDC notes that relatively few antibiotic regimens reliably cure more than 90 percent of throat infections.
In rare cases, untreated gonorrhea can spread into the bloodstream or joints, creating a potentially life-threatening condition called disseminated gonococcal infection. Gonorrhea can also increase a person’s chances of acquiring or transmitting HIV.
Consider speaking with a healthcare professional about pharyngeal testing if:
The CDC recommends annual gonorrhea screening for sexually active gay and bisexual men. It also recommends annual screening for sexually active women younger than 25 and women 25 or older who have risk factors such as new or multiple partners or a partner with an STI. Individual needs may call for more frequent testing. CDC
Yes. Gonorrhea can be cured with the correct antibiotic treatment. The CDC’s recommended treatment for uncomplicated pharyngeal gonorrhea is a ceftriaxone injection, with the dose determined partly by the patient’s weight. A clinician may provide additional treatment if chlamydia has not been ruled out.
Do not try to treat the infection with leftover antibiotics or someone else’s medication. Incorrect treatment may fail to clear the infection and contribute to antibiotic resistance.
Because throat gonorrhea can be especially difficult to eradicate, the CDC advises returning seven to 14 days after treatment for a test of cure. People treated for gonorrhea should also be retested approximately three months later because reinfection is common.
Avoid sexual activity for seven days after treatment and until all recent partners have been evaluated and treated. Otherwise, partners may continue passing the infection back and forth.
Condoms and dental dams can reduce STI transmission during oral sex. Limiting your number of partners, discussing recent test results and maintaining a mutually monogamous relationship with a tested partner can also reduce risk.
Most importantly, make sure your STI testing matches the sexual activity you actually have. A negative urine test does not necessarily mean your throat is clear.
You do not need symptoms to have an STI—and you do not need to feel embarrassed about asking for the right test. A quick, honest conversation and a throat swab could protect both you and your partners.
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