Gonorrhoea

Gonorrhoea is the second most common bacterial sexually transmitted infection in the UK and most frequently found in men who have sex with men and black ethnic minorities. It is frequently asymptomatic, especially in women. Rarely, ascending pelvic infection or disseminated infection occurs. In recent years nucleic acid amplification tests for Neisseria gonorrhoeae have been developed in the UK. They have high specificity and sensitivity in both symptomatic and asymptomatic infection, and enable non-invasive sampling. In recent years gonococcal antibiotic resistance has become a worldwide problem. Providing effective therapy is becoming a challenge and, in some countries, the gonococcus no longer responds reliably to available antibiotics. In the UK, dual therapy is now recommended with ceftriaxone and azithromycin to reduce the risk of emergence of further resistance. It is recommended that cultures are obtained from all patients diagnosed with gonorrhoea before treatment in order to obtain antibiotic sensitivity. Patients should be seen 2 weeks following treatment for a test of cure to identify emerging resistance. Management of those failing first-line treatments requires expert involvement. All current and recent sexual partners of a person with gonorrhoea should be tested and treated to prevent re-infection and the further spread of disease.