Gonorrhoea is caused by infection with Neisseria gonorrhoeae. In men, uncomplicated urethritis is the most common manifestation, with dysuria and urethral discharge. Less typically, signs and symptoms are mild and indistinguishable from those of chlamydial urethritis. In women, the most common site of infection is the uterine cervix, infection of which results in symptoms (such as vaginal discharge, lower abdominal discomfort, and dyspareunia) in less than half of cases. Diagnosis Advances in nucleic acid amplification techniques (NAAT) allow testing on non-invasively collected specimens (urine and self-taken vaginal swabs). NAAT may have sensitivity of >90%, compared with 75% sensitivity of culture. However, NAAT cannot provide data on antimicrobial sensitivity, so culture and sensitivity testing are required before commencement of antimicrobial therapy. In addition, the specificity of NAAT ranges from 98.1% to 99.7% and caution is required when interpreting positive results. NAAT is also used off licence to test pharyngeal and genital sites. The sensitivity of NAAT in extragenital diagnosis is considerably greater than culture, but the specificity of extragenital NAAT is such that all reactive results need to be confirmed using a separate platform. Resistance Resistance to single-dose antimicrobials develops frequently and antimicrobial sensitivity of gonococcal isolates is monitored nationally to monitor and inform prescribing guidelines. Clinicians need to be aware of their local resistance profile and the resistance profiles of individual isolates to make appropriate treatment choices. All infected individuals should have a test of cure 2 weeks after treatment to ensure complete eradication of the organism. All sexual partners of infected individuals should be identified and treated concurrently (see review on Partner notification). The index patient should be advised to refrain from sexual intercourse with any untreated partner. ...read more.
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