[13] Either sex can become infected in the eyes or rectum if these tissues are exposed to the bacterium,[16] which can lead to pain with bowel movements, rectal discharge, or constipation.

[21] Most infected men with symptoms have inflammation of the penile urethra associated with a burning sensation during urination and discharge from the penis.

[30] A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum.

[36] Tests that use PCR (aka nucleic acid amplification) to identify genes unique to N. gonorrhoeae are recommended for screening and diagnosis of gonorrhea infection.

Culture (growing colonies of bacteria in order to isolate and identify them) and Gram-stain (staining of bacterial cell walls to reveal morphology) can also be used to detect the presence of N. gonorrhoeae in all specimen types except urine.

The chance of a false positive test is also higher for a cervical swab, as Gram-negative diplococci native to the normal vaginal flora cannot be distinguished from N. gonorrhoeae in that context.

Culture is especially useful for diagnosis of infections of the throat, rectum, eyes, blood, or joints—areas where PCR-based tests are not well established in all labs.

[41][42] Culture is also useful for antimicrobial sensitivity testing, analyzing treatment failure, and epidemiological purposes (outbreaks, surveillance).

[41] In patients who may have disseminated gonococcal infection (DGI), all possible mucosal sites should be cultured (e.g., pharynx, cervix, urethra, rectum).

[51] Additionally, the USPSTF also recommends routine screening in people who have previously tested positive for gonorrhea or have multiple sexual partners and individuals who use condoms inconsistently, provide sexual favors for money, or have sex while under the influence of alcohol or drugs.

[18] Screening for gonorrhea in women who are (or intend to become) pregnant, and who are found to be at high risk for sexually transmitted infections, is recommended as part of prenatal care in the United States.

In addition to the use of phone contact, the use of email and text messaging have been found to improve the re-testing for infection.

[55] Newborn babies coming through the birth canal are given erythromycin ointment in the eyes to prevent blindness from infection.

[4][57][58][59] However, due to increasing rates of antibiotic resistance, local susceptibility patterns must be taken into account when deciding on treatment.

This is amplified by the fact that pharyngeal gonorrhoea is mostly asymptomatic, and gonococci and commensal Neisseria species can coexist for long time periods in the pharynx and share anti-microbial resistance genes.

[66] Many antibiotics that were once effective including penicillin, tetracycline, and fluoroquinolones are no longer recommended because of high rates of resistance.

[36] Resistance to cefixime has reached a level such that it is no longer recommended as a first-line agent in the United States, and if it is used a person should be tested again after a week to determine whether the infection still persists.

[19] One of the complications of gonorrhea is systemic dissemination resulting in skin pustules or petechia, septic arthritis, meningitis, or endocarditis.

[76] The World Health Organization warned in 2017 of the spread of untreatable strains of gonorrhea, following analysis of at least three cases in Japan, France and Spain, which survived all antibiotic treatment.

Surgeons' tools on board the recovered English warship the Mary Rose included a syringe that, according to some, was used to inject the mercury via the urinary meatus into crewmen with gonorrhea.

[80][81] The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record.

One of the first reliable notations occurs in the Acts of the English Parliament which, in 1161, passed a law to reduce the spread of "the perilous infirmity of burning".

Pope Boniface VIII rescinded the requirement that physicians complete studies for the lower orders of the Catholic priesthood.

[84] Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as lepers and other epidemic patients.

[85] After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted infection.

Development of a vaccine has been complicated by the ongoing evolution of resistant strains and antigenic variation (the ability of N. gonorrhoeae to disguise itself with different surface markers to evade the immune system).

[60] As N. gonorrhoeae is closely related to N. meningitidis and they have 80–90% homology in their genetic sequences some cross-protection by meningococcal vaccines is plausible.

A study published in 2017 showed that MeNZB group B meningococcal vaccine provided a partial protection against gonorrhea.

[88] In June 2023, GlaxoSmithKline won fast-track designation from the Food and Drug Administration for its vaccine candidate against gonorrhea.