Assessment of Neisseria gonorrhoeae infection

Neisseria gonorrhoeae infection is more common amongOng, 2023:

  • gay, bisexual and other men who have sex with men, and transgender women
  • people who have recently had sex with a new partner in a country with a high prevalence of gonorrhoea (eg developing countries)
  • remote Aboriginal and Torres Strait Islander populations.

Health outcomes are significantly impacted by geographical, historical, socioeconomic, spiritual, emotional and cultural determinants. In Aboriginal and Torres Strait Islander peoples, the incidence of infection and increased risk of poor health outcomes can be linked to complex socioeconomic factors, including poverty, reduced access to health services, incarceration, discrimination and intergenerational trauma. A shared strengths–based approach to healthcare that recognises each patient's unique cultural determinants and circumstances is essential.

N. gonorrhoeae can cause the following syndromes:

Untreated gonococcal infection can lead to serious complications including pelvic inflammatory disease (PID) and infertility or ectopic pregnancy due to tubal scarringWorkowski, 2021.

Gonococcal infection in neonates can lead to serious complications including blindness (see Treatment of gonococcal conjunctivitis) and septicaemia requiring urgent management; for more information, see the Australasian Society for Infectious Diseases (ASID) Management of Perinatal Infections guidelines.

The majority of N. gonorrhoeae cases are asymptomatic infections of the pharynx, rectum or cervix. Gonococcal infection is detected by nucleic acid amplification testing (NAAT) (eg polymerase chain reaction [PCR]). Self-collected1 vaginal and rectal swab samples are preferred for asymptomatic testing. Another option is to collect a first-pass2 urine sample. A throat swab is indicated for gay, bisexual and other men who have sex with men, and transgender women, and people with multiple sexual partnersOng, 2023.

Note: Self-collected vaginal and rectal swab samples are preferred over urine samples for asymptomatic testing for Neisseria gonorrhoeae.

Take a sample for culture and susceptibility testing before starting antibiotic therapy because antimicrobial resistance is emerging and NAAT does not detect resistance.

Note: Take a sample for culture and susceptibility testing before starting antibiotic therapy.

Perform investigations for other sexually transmissible infections (STIs) (including HIV, syphilis and Chlamydia trachomatis).

Undertake contact tracing for patients with N. gonorrhoeae infection. Test sexual contacts from the last 2 months and consider presumptive treatment for anorectal or genital infection for sexual contacts within the past 2 weeks or when the clinician is concerned that the person’s circumstances mean later treatment may not occurOng, 2023.

For general principles of STI management, including advice on counselling, and considerations for children in whom a STI is identified, see Principles of STI management.

1 For information on methods of self-collection of vaginal and rectal swab samples, see the diagnosis section of the relevant condition in the Australian STI Management Guidelines for Use in Primary Care.Return
2 A first-pass urine specimen is the first part of the urine stream, and can be collected at any time of the day; see the diagnosis section of the relevant condition in the Australian STI Management Guidelines for Use in Primary Care for more information.Return