If you are applying for a U.S. Green Card, you’ll need to complete a medical exam with a USCIS-designated civil surgeon. The results of that exam are recorded on Form I-693, the Report of Medical Examination and Vaccination Record.

This exam ensures you don’t have certain diseases that could be spread to others. One part of this medical exam is testing for gonorrhea, a common infection that can pass from one person to another.

Don’t worry, it’s not as scary as it sounds. The test is quick, simple, and something every civil surgeon is trained to do. USCIS follows strict rules set by the CDC to make sure every applicant gets the right tests and treatment if needed.

Why Gonorrhea Testing Is Required for Immigration Applicants

Gonorrhea is a bacterial infection that spreads through sexual contact. Many people who have it don’t show any symptoms, so they may not even know they’re infected. If left untreated, it can cause serious problems like infertility, pelvic pain, or infection in the joints and bloodstream.

For this reason, the Centers for Disease Control and Prevention (CDC) requires every immigration applicant to be screened for gonorrhea. The goal is simple: find and treat infections early so they don’t spread to others. This is especially important for people moving to the U.S., since public health laws are designed to keep the entire community safe.

Testing also ensures that everyone gets the right care, no matter where they come from. The immigration exam isn’t just about meeting a government rule; it’s a chance to catch and treat an infection before it causes harm. When done properly, it protects you, your family, and the people around you.

But the question is, did all the applicants have to be tested?

Who Must Be Tested?

Not everyone taking the immigration medical exam needs a gonorrhea test. The CDC gives clear rules about who must be screened.

All applicants ages 18 through 24 are required to be tested during their I-693 exam. Because the age group has the highest risk of infection, even if there are no symptoms. Testing helps find infections early so treatment can start right away. This could be because of:

• Symptoms such as pain, burning when urinating, or unusual discharge

• A history of gonorrhea or another sexually transmitted infection

• A medical exam that gives the civil surgeon reason to suspect an infection

The civil surgeon makes the final decision about whether testing is needed. They’ll review your health history, ask a few private questions, and decide what’s appropriate for your situation. These rules make sure testing is accurate, fair, and based on real health needs, not guesswork.

What Type of Test Is Used (Laboratory Testing)

For the immigration medical exam, civil surgeons must use a Nucleic Acid Amplification Test (NAAT) to screen for gonorrhea. This test is the gold standard because it’s highly accurate, quick, and can detect even very small amounts of the bacteria that cause gonorrhea (Neisseria gonorrhoeae).

The Centers for Disease Control and Prevention (CDC) requires this specific test because it’s much more reliable than older methods like cultures or Gram stains. Studies show that NAATs have a sensitivity of over 90%, meaning they can identify almost all true cases of gonorrhea. That level of accuracy helps avoid missed infections or unnecessary repeat testing.

 

Civil surgeons must order the test at the time of the immigration exam. Tests done before or somewhere else are not accepted for I-693 paperwork. This rule ensures that all testing follows the same official process and that the results are valid for USCIS.

The NAAT can use different types of samples, depending on the applicant:

• Urine samples for both men and women (the least invasive and most common)

• Self-collected vaginal swabs for women

• Oral or rectal swabs if there are risk factors or symptoms suggesting infection in those areas

The civil surgeon will decide which sample type is best based on your health history and any symptoms you may have.

It’s also important to note that Gram stains, while sometimes used to diagnose gonorrhea in symptomatic men, are not accepted for the immigration exam. They can miss infections in people without symptoms and in women, making them unreliable for official screening.

By using NAAT, civil surgeons can quickly and confidently diagnose gonorrhea, ensure proper treatment, and document accurate results for the immigration medical record. This approach protects applicants’ health and helps maintain consistent national standards for immigration exams.

Gonorrhea Treatment Requirements

If an applicant tests positive for gonorrhea, treatment must be started right away. The CDC requires civil surgeons to follow the most up-to-date Sexually Transmitted Infections (STIs). This ensures that every applicant receives the correct medication and dosage.

Currently, the recommended treatment for uncomplicated gonorrhea is a single dose of ceftriaxone, given as an injection in the clinic. This antibiotic effectively clears the infection in most people. 

Treatment must be directly observed by the civil surgeon, meaning it’s given on-site, not prescribed to be taken at home. This guarantees the medicine is taken correctly and that treatment is officially documented for the Form I-693 medical record.

Civil surgeons are also advised to discuss treatment for other possible infections, especially chlamydia, since both infections often occur together. They counsel applicants on how to avoid reinfection and may recommend that their recent sexual partners get tested and treated, too. This step helps prevent further spread of the disease.

Before moving on, it’s important to note that the gonorrhea evaluation doesn’t end with treatment. Civil surgeons must also ensure that the infection is fully resolved and properly documented, which brings us to the next part.

Post-Treatment Evaluation and Follow-Up

After treatment, follow-up care is an important part of the gonorrhea screening process. Civil surgeons must make sure the infection has been fully treated and that the applicant no longer has active disease before completing the immigration medical paperwork.

If symptoms do not clear up within 3 to 5 days after treatment, or if they return later, the civil surgeon may suspect treatment failure. In this case, additional testing is required. This is important because some strains of Neisseria gonorrhoeae have become resistant to common treatments.

The type of follow-up test depends on the sample site. Civil surgeons may collect:

• Urethral swabs for men

• Endocervical swabs for women

• Oral or rectal swabs if infection was detected in those areas

If the test confirms that the infection is gone, the applicant’s record can be finalized. However, even after successful treatment, the CDC recommends retesting three months later. This isn’t required for completing Form I-693, but it’s a smart step for personal health.

The follow-up phase ensures both the applicant’s health and public safety. Once this step is complete, the next part of the process is crucial.

Documentation on Form I-693

The civil surgeon must carefully document all findings on Form I-693, Report of Medical Examination and Vaccination Record. This step is required for every immigration medical exam and ensures that all health information is officially recorded for USCIS.

Civil surgeons must include:

• Type of laboratory test used (for example, NAAT) and the date the test was performed.

• Treatment details, including the name of the drug, dosage, route of administration (such as injection), start and completion dates, and any interruptions.

• Clinical course, describing how the applicant responded to treatment. This may include symptom improvement, resolution of infection, or any side effects.

Once all information is recorded, the civil surgeon must sign, date, and seal the completed Form I-693 in an envelope. This sealed form is then given to the applicant to include with their immigration paperwork. USCIS will not accept the form if it is opened or incomplete.

Conclusion 

Gonorrhea screening is a key part of the immigration medical exam, and it serves an important purpose, protecting both individual and public health. For civil surgeons, following the CDC’s Technical Instructions ensures every applicant receives accurate testing, prompt treatment, and complete documentation for Form I-693.

By using the approved NAAT test, recording all treatment details, and reporting cases as required by New Jersey state law, civil surgeons help keep the immigration process smooth and compliant. Taking the time to educate applicants about partner treatment and prevention also goes a long way toward stopping reinfection and promoting healthier communities.

At the end of the day, these steps are not just about paperwork. They’re about care, safety, and trust. Each properly completed exam helps an applicant take one step closer to permanent residency, while making sure public health standards are upheld.

At our New Jersey clinic, we follow these CDC rules closely. We use modern, accurate tests to screen for gonorrhea and provide safe, on-site treatment if you test positive. Everything is confidential, and we handle all the paperwork for your I-693 form.