Gonorrhea and Fertility: Risks, Mechanisms, and Prevention

Untreated Neisseria gonorrhoeae infection can cause infertility in both sexes via ascending infection and inflammatory scarring.

In Men

• Urethritis → epididymitis (inflammation of epididymis)
• Scarring/obstruction of epididymal duct → obstructive azoospermia or oligospermia
• Prostatitis, seminal vesiculitis may impair semen quality

In Women

• Cervicitis → endometritis → salpingitis (fallopian tube inflammation)
• Tubal scarring, adhesions, hydrosalpinx → tubal factor infertility, ectopic pregnancy risk
• Pelvic inflammatory disease (PID) is the major sequela; 10–20% of untreated gonococcal PID leads to infertility

Critical Points

• Asymptomatic infection is common (especially women)—screening essential.
• Early treatment prevents sequelae. CDC: ceftriaxone 500 mg IM (1g if ≥150 kg) + doxycycline 100 mg BID × 7 days (if chlamydia not excluded).
• Partner treatment prevents reinfection.
• Test-of-cure recommended for pharyngeal infection; NAAT at 7–14 days.

Prompt diagnosis and correct antibiotics preserve fertility. Routine STI screening is key for sexually active individuals.