Untreated gonorrhea can lead to severe reproductive health problems for women, including infertility (i.e., difficulty or inability to get pregnant). Pelvic inflammatory disease (PID) is a common result of untreated gonorrheal infection in women. In PID, the bacteria move from the vagina up through the cervix and into the uterus, fallopian tubes, and ovaries. Blockage and scarring can damage the tubes, causing women who get pregnant to be more likely to have ectopic (“tubal”) pregnancies. Left untreated, PID can cause infertility and chronic pelvic pain. Gonorrhea can lead to PID in women even when there are no symptoms. Gonorrhea during pregnancy can cause preterm birth and miscarriage.
Men with untreated gonorrhea can occasionally develop epididymitis, a painful infection of the testicles. Untreated gonorrheal infections can also cause inflammation of the prostate and urethral scarring, sometimes leading to male infertility.
If you are living with HIV and are not taking antiretroviral medications, a gonorrhea infection can lead to highly concentrated amounts of HIV virus in the genital tissue, causing 8-10 times more HIV to be shed in your semen or vaginal secretions. If you are HIV negative and have gonorrhea, your immune cells are especially susceptible to HIV if your partner is carrying the virus. Rectal gonorrhea may increase your chance of getting HIV by 10-20 times. However, taking medication to prevent HIV (PrEP) can significantly decrease the risk of getting HIV even when there is an STD present.
In about 1% of people with untreated gonorrhea, the infection can spread beyond the genital area to the bloodstream, skin, heart, or joints. This is called Disseminated Gonococcal Infection (DGI). Symptoms include fever, multiple skin lesions, arthritis, infection of the inner lining of the heart, and meningitis. DGI can be treated with antibiotics.