Corey Whelan is a patient advocate with a decades-long background in reproductive health. She is also a freelance writer, specializing in health and medical content

Renita White, MD, FACOG, is a board-certified obstetrician/gynecologist who practices at Georgia Obstetrics and Gynecology.

Gonorrhea is a curable sexually transmitted infection (STI). It is spread from having vaginal, anal, or oral sex without a condom. Anyone who is sexually active and has condomless sex may get gonorrhea from an infected partner.

You can have gonorrhea and not know it. This condition does not always cause symptoms, especially in people with a uterus. Gonorrhea symptoms in people of any sex may include:

Around 5 out of 10 infected females are asymptomatic (have no symptoms). You may also have mild symptoms that you mistake for another condition, such as a vaginal infection or bladder infection.

When gonorrhea does cause symptoms, they may occur days, weeks, or months after the initial infection. Late symptoms can result in a delayed diagnosis and lag in treatment. When gonorrhea goes untreated, complications can occur. These include pelvic inflammatory disease (PID) which can cause infertility.

This article will discuss how gonorrhea can cause infertility, plus symptoms you may have and treatments to expect.

Gonorrhea is caused by an infection from Neisseria gonorrhoeae bacteria. When caught early, most cases of gonorrhea are easily treated with injected antibiotics. Lack of treatment can eventually cause infertility in females (people with a uterus) and, less often, in males (people with testes).

When left untreated, the bacteria that cause gonorrhea travel up through the vagina and cervix into the reproductive organs, causing pelvic inflammatory disease (PID) in people with a uterus. PID can start days or weeks after the initial gonorrheal infection has occurred.

PID causes inflammation and the formation of abscesses (pockets of infected fluid) in the fallopian tubes and ovaries. If not treated early, scar tissue can form.

When scar tissue forms in the delicate lining of a fallopian tube, it narrows or closes the tube. Fertilization usually occurs within a fallopian tube. The scar tissue caused by PID makes it hard or impossible for an egg to become fertilized by sperm during sexual intercourse. Pregnancy won't occur naturally if an egg and sperm can't meet.

PID also increases the risk of ectopic pregnancy (the fertilized egg implants outside of the uterus, most often in the fallopian tube).

In people with testes, infertility is less likely to be caused by gonorrhea. However, untreated gonorrhea can infect the testes or prostate gland, reducing fertility.

Untreated gonorrhea in males can cause epididymitis , an inflammatory condition. Epididymitis causes inflammation of a coiled tube located at the back of the testicles. This tube stores and transports sperm.

Epididymitis can also cause inflammation to occur in a testicle. This is referred to as epididymo-orchitis. Epididymitis is treated with antibiotics. Untreated or severe cases can result in infertility.

PID symptoms can range from very mild and unnoticeable to severe. Like gonorrhea, it's possible to have PID and not know it at first.

Symptoms of PID can include:

Diagnosis of gonorrhea may be done with a urine test or swab test. Swab testing may also be done in the vagina, rectum, throat, or urethra.

If you or your healthcare provider suspects PID, they will ask about your medical symptoms and sexual history. Since there's no specific diagnostic test for PID, this condition can be challenging to diagnose.

If you have pelvic pain or lower abdominal pain that does not have any other cause, your healthcare provider may diagnose PID, provided you have at least one of these additional symptoms:

If advanced disease is suspected, further testing may be done, to gauge the extent of damage done to your reproductive organs. These tests may include:

Around 1 in 10 people with PID become infertile from PID. Early treatment is key for preventing infertility and other potential complications.

Antibiotics are the first-line treatment for PID. You may be prescribed oral antibiotics, or you may be given medication via injection or intravenously (IV, within a vein). Your sexual partner or partners will also require antibiotics, even if they are asymptomatic.

If you are severely ill, have an abscess, or are pregnant, you may require hospitalization during treatment. Abscesses that have ruptured or that might rupture may require surgical drainage to remove the infected fluid.

If you have scarring caused by PID, antibiotics will not reverse it. Blocked or damaged fallopian tubes may be treated surgically, restoring fertility, in some instances. You and your healthcare provider can discuss the viability of surgical repair for your condition.

PID damage is not repaired by assisted reproductive technology. However, procedures like in vitro fertilization (IVF) can override tubal scarring, making pregnancy possible for some people. If you have infertility caused by PID, a specialist such as a reproductive endocrinologist can discuss options for pregnancy with you.

Neither surgical scar removal or IVF are guaranteed to work. In some instances, you may wish to consider other options for pregnancy and parenthood. These include gestational surrogacy (when another person carries the fertilized egg to term), adoption, and foster care adoption.

Gonorrhea is a sexually transmitted bacterial infection. Left untreated, gonorrhea can cause infertility. Early treatment is necessary for preventing complications, such as pelvic inflammatory disease (PID) in females and epididymitis in males.

Untreated PID can cause fallopian tube scarring, making conception challenging or impossible in people with a uterus. When caught early, gonorrhea, PID, and epididymitis can be successfully treated with antibiotics. If you have scarring from advanced PID, treatments may help you achieve pregnancy or parenthood.

Anyone who is sexually active and doesn't use a condom, even once, can get gonorrhea. This very common sexually transmitted infection can occur in people of any age.

Getting gonorrhea isn't a sign of poor character or of making poor choices. It can happen to anyone. The only way to avoid getting gonorrhea and complications like PID is to always use condoms during sexual activity.

If you are sexually active or consider yourself at high risk, seeing a healthcare provider regularly for screening may make sense. You can also use at-home tests for gonorrhea and other STIs. Positive test results should always be followed up with a visit to a healthcare provider.

Yes. Gonorrhea can cause PID in people with a uterus and epididymitis in people with testes. Both conditions can result in infertility. PID is more common.

STIs like gonorrhea and chlamydia are often asymptomatic. You may have an infection for a long time, even years, and not know it.

There is no definitive time frame for the damage they may cause. However, time is not on your side. Early treatment is essential for avoiding internal scarring and complications like infertility.

You and your partner must take antibiotics and abstain from sex for one week after finishing all of your medication. You'll both need to be tested again in around three months to make sure you're negative.

At that time, you and your healthcare provider can discuss when the right time is for you to start trying to get pregnant. Keep in mind that prior treatment for gonorrhea won't stop you from getting reinfected.

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The Fertility and Gynaecology Academy. 7 STIs that affect male fertlity.

Urology Care Foundation. What are epididymitis and orchitis?

Zhao H, Yu C, He C, Mei C, Liao A, Huang D. The immune characteristics of the epididymis and the immune pathway of the epididymitis caused by different pathogens. Front Immunol. 2020;11:2115. doi:10.3389/fimmu.2020.02115

Centers for Disease Control and Prevention. Pelvic inflammatory disease (PID) CDC detailed fact sheet.

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By Corey Whelan Corey Whelan is a freelance writer specializing in health and wellness conntent.

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