Gonorrhoea

Gonorrhoea is the second most common bacterial sexually transmitted infection (STI) in the UK. The main risk groups in the UK include men who have sex with men (MSM) and black ethnic populations. The symptoms and signs depend on the site of infection. Both local and disseminated complications may occur. The diagnosis is established by the identification of Neisseria gonorrhoeae at an infected site either by culture or nucleic acid amplification tests. These are more expensive than culture and lack the advantage of enabling antibiotic sensitivity testing, and there are some false-positive results. The aims of treatment are to eliminate the organism from all sites of infection, and to minimize the risk of complications and the potential for ongoing transmission. The antibiotic chosen should be guided by known local sensitivities of gonococci. In recent years gonococcal antibiotic resistance has become a worldwide problem and providing effective therapy is becoming a challenge. In some countries, the gonococcus no longer responds reliably to available antibiotics. Continued surveillance is essential to identify drift or emergence of resistance to the currently effective agents. Coexistent STIs should be sought and treated with appropriate medication. It is essential that all recent and current sexual partners are seen and tested for gonorrhoea and other STIs.