Demonstration of gonococcal nucleic acid in first void urine is suitable for screening.
Culture is the basic diagnostic method and it also provides determination of antimicrobial sensitivity. It is obtained in clinical suspicion of gonorrhoea or always if the nucleic acid detection test is positive.
A combination of ceftriaxone and azithromycin is the drug of choice if the sensitivity of the gonococcal strain is not known.
Decreased sensitivity to ceftriaxone has been reported in some parts of the world.
Gonorrhoea should not be treated with oral antimicrobials if the strain is not known to be sensitive to ciprofloxacin.
Epidemiology
Caused by Neisseria gonorrhoeae (gonococcus), which is a gram-negative diplococcus.
The incidence of gonorrhoea varies considerably between countries, as does resistance to drugs.
The swab sample is taken according to the location of transmission, also from the pharynx or anus if needed.
The same sample can be used to test for both gonorrhoea and chlamydial infection.
Antimicrobial sensitivity can only be determined by bacterial culture. The culture should be performed in addition to the nucleic acid detection test if the patient's history suggests gonorrhoea (partner has gonorrhoea) and/or there are clear symptoms suggesting the infection.
The sample may be obtained with a dacron swab from the urethra, cervix, pharynx and rectum. It is placed into a special transport tube (storage at +4°C, if necessary).
If the gonococcal nucleic acid detection test is positive, a culture sample has to be obtained in order to determine antimicrobial sensitivity before any antimicrobial treatment is started.
In patients allergic to cephalosporins, gentamicin 240 mg i.m. + azithromycin 2 g p.o. may be used.
Complicated infection: ceftriaxone 1 g once daily i.m. for 3 to 5 days
The patient should abstain from sex for a period of one week and thereafter use a condom until a negative follow-up examination result has been obtained.
Contact tracing and post-treatment follow-up
Special attention should be paid to tracing contacts in the community. This should preferably be centralized in STD outpatient clinics or to other experts.
A control sample after treatment is important for verifying cure.
Nucleic acid detection test 3 weeks after treatment
The infection is reported to the health authorities according to the local regulations.
References
Unemo M, Ross J, Serwin AB ym. 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS 2020;(Oct 29):956462420949126. [PubMed]