Gonorrhoea

Gonorrhoea is a bacterial sexually transmitted infection (STI) which can present with penile/vaginal discharge, dysuria, dyspareunia, lower abdominal pain, testicular pain/swelling, abnormal pv bleeding or no symptoms at all. The throat, rectum or eyes may also be affected.

Untreated gonorrhoea can result in reproductive issues including pelvic inflammatory disease,  ectopic pregnancy and tubal infertility in women and epididymitis in men. Disseminated infection  can affect joints, skin and rarely cause endocarditis or meningitis. Gonococcal infection among  infants usually results from exposure to infected cervical exudates at birth.

Testing is either by the more sensitive NAAT (nucleic acid amplification test), or by culture of a swab from an affected area. Local protocols will depend on clinical setting, prevalence and range of tests available in the laboratory.

Risk factors for gonorrhoea infection include:

• Young age (15–24 years)
• New or more than one sexual contact in the last year
• Inconsistent condom use
• Certain sexual activities e.g. men who have sex with men (MSM)
• Current/previous STI
• Sexual/physical abuse

Where possible, patients should be referred to a sexual health service for further investigation when gonorrhoea is suspected. When the person is unwilling or unable to do so, a NAAT sample should be taken following local protocols:

• Women: vulvovaginal swab (may be self-taken); rectal /pharyngeal samples on assessment of clinical risk
• Men: first-pass urine specimen; rectal /pharyngeal samples in MSM
• Both: pharyngeal sampling when the risk of antibiotic resistance is high e.g. infection acquired in the Asia-Pacific region, or contact with known antibiotic resistant strain.

Specimens for culture and antibiotic sensitivity testing (urethral, endocervical, neovaginal, anorectal, and pharyngeal swabs) should ideally be taken alongside NAATs when infection is suspected clinically , or following confirmation by NAAT prior to commencing treatment.

No specific recommendations.

A test of cure is recommended for all people who have been treated for gonorrhoea (at least 2 weeks after completion of treatment, if asymptomatic).

1. NICE Clinical Knowledge Summaries (CKS) Gonorrhoea. Last revised Aug 2022 Available from: https://cks.nice.org.uk/topics/gonorrhoea/
2. Public Health England Guidance for the detection of gonorrhoea in England. Updated guidance 2021. Available here
3. Fifer H, Saunders J, Soni S, Sadiq ST, FitzGerald M. 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae. Int J STD AIDS. 2020 Jan;31(1):4-15. Available from: 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae (bashhguidelines.org) doi: 10.1177/0956462419886775.
4. Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2020 Oct 29:956462420949126. Available from: https://iusti.org/wp-content/uploads/2020/10/IUSTI-Gonorrhoea-2020.pdf doi: 10.1177/0956462420949126