Gonorrhoea

The bacterium Neisseria gonorrhoeae causes a disease spectrum very similar to that of chlamydia. In up to 3% of patients, bacteraemic (bloodstream) spread can result in disseminated gonorrhoea with presentations of septic arthritis, polyarthralgias or dermatitis. There was a concerning 16% increase in gonococcal infection notifications in Australia in 2023 (40,404) compared to 34,745 in 2019.

Symptoms
- Up to 70% of women with genital gonococcal infection are asymptomatic, while approximately 80% of men present with mostly mild symptoms.
- Symptoms may include dysuria, penile urethral and vaginal discharge, conjunctivitis (purulent, sight-threatening) and dyspareunia with cervicitis.
- Anorectal symptoms may include discharge, irritation, painful defecation and disturbed bowel function.
- Gonorrhoea can also cause a wide range of complications such as pelvic inflammatory disease (dyspareunia, intermenstrual bleeding, post-coital bleeding, discharge), Bartholin gland abscess, and epididymoorchitis, although this is rare.
Treatment
- Treatment depends on the site of infection.
- Please refer to the guidelines at sti.guidelines.org.au for treatments regarding uncomplicated genital and anorectal infections, uncomplicated pharyngeal infections and adult gonococcal conjunctivitis.
Test of Cure
- Test of cure should be performed 2 weeks after completion of treatment. As re-infection is common, it is recommended that patients are tested again at 3 months.
- If test of cure or re-infection testing is positive, please seek specialist advice.
How to Order Gonorrhoea Testing
Request Form Instructions:
- Complete the Clinical Labs general pathology request form, listing gonorrhoea and any other required STIs.
- If all recommended STIs for asymptomatic screening are required (gonorrhoea, chlamydia, syphilis, HIV, Hepatitis B and Hepatitis C), write “STI Screen” in the Clinical Notes.
Specimen Details:
- Urethral swabs, first-pass urine (FPU) and vaginal/endocervical swabs. Note: Vaginal/endocervical swabs are more sensitive than FPU samples in female patients.
- Additionally, for Men Who Have Sex with Men (MSM): - Collect anorectal and pharyngeal swabs, even if patient is asymptomatic at these sites. - Collect an additional penile urethral swab for culture if discharge is present or before antibiotics.
- If patient has symptoms, collect a clinician-collected endocervical swab. Swabs should be collected for culture to enable resistance testing prior to treatment.
- Serology for HIV, syphilis, Hepatitis B and Hepatitis C if these tests are also required.
Test Cost:
- Bulk-billed, subject to Medicare eligibility criteria.
Additional Resources: