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Gonorrhoea

NICE CKS Gonorrhoea. Last revised Mar 2024. BASHH Gonorrhoea 2025: Updated Guideline. Last updated Apr 2025.

Guidelines

Test of choice: NAAT.

Sample collection methods:
  • Male 1st line: first pass urine (alterantive: urethral swab)
  • Female 1st line: vulvovaginal swab (alternative: endocervical swab)

If MSM → also take rectal and pharyngeal samples


Other tests:
Test Description
Culture Should be obtained simultaneously with NAAT and BEFORE starting treatment

For drug susceptibility testing
Urethral swab For quick diagnosis in the presence of penile urethral discharge

Interpretation:
    • Polymorphonuclear leukocytes + gram -ve diplococci → gonococcal urethritis
    • Polymorphonuclear leukocytes alone → non-gonococcal urethritis (NGU)
 

Refer ALL patients to GUM (genito-urinary medicine) clinic / local specialist for management.
 

Abstain from all sexual activity until 7 days after they and their partner(s) have completed treatment

Take swabs for culture BEFORE starting treatment, and initiate empirical treatment immediately without awaiting susceptibility result:
  • 1st line: ceftriaxone 1g IM single dose
  • 2nd line:
    • Needle-sparing option (e.g. if needle phobia) → ceftixime 400mg PO (2 doses 6-12 hours apart) + azithromycin 2g PO
      • BASHH recommends to only use this regimen if antimicrobial susceptibility results are available
    • Penicillin-sparing option → gentamicin 200mg IM + azithromycin 2g PO

  • If symptomatic men → notify all partners within the past 2 weeks (or most recent partner if more than 2 weeks ago)

  • If all other patients (i.e. asymptomatic men and women) → notify all partners within the past 12 weeks (3 months)

All sexual contacts should be tested:
  • Empirical treatment is NOT needed routinely for all sexual contacts:
  • Principle: only offer empirical treatment to those who test +ve for gonorrhoea
  • If present within 2 weeks of exposure → repeat testing after 2 weeks

Offer test of cure using NAAT to all patients at least 2 weeks after treatment completion
  • BASHH recommends if treated with ceftriaxone + susceptible to ceftriaxone, there is no need for test of cure

At follow-up also:
  • If symptoms resolved or not
  • Adherence
  • Any adverse reactions
  • Confirm partner notification has been carried out
  • Ask about recent sexual history
  • Reinforce advice on safe sexual practice

 

Note the window period of gonorrhoea testing is 2 weeks, meaning false -ve is possible if tested within this period. Therefore, the test of cure should be performed>2 weeks after completion of treatment.

References

Author: Adams Lau
Reviewer:
Last edited: 03/05/25