Gonorrhoea

What is being tested?
The test looks for the bacterium Neisseria gonorrhoeae, which causes gonorrhoea, a sexually transmitted disease. It is estimated that there are more than 700,000 cases a year in the United States, but only half of these infections are reported to the CDC (Centers for Disease Control and Prevention). In the USA, the highest infection rates are found among sexually active teenagers, young adults and African Americans.

While many men with gonorrhoea will have symptoms, most women will not, or will mistake them for bladder or vaginal infections. In men, symptoms usually appear within 2-5 days of infection, but can take up to 30 days; women who have symptoms get them within 10 days of infection. In women, symptoms include burning or painful urination, increased vaginal discharge and sometimes bleeding between periods or after vaginal intercourse. In men, symptoms include a white, yellowish or greenish discharge from the penis, a burning sensation when passing urine and sometimes painful or swollen testicles. Symptoms of rectal infection include discharge, itching and painful bowel movements.

Gonorrhoea can be cured with a course of antibiotics. Untreated gonorrhoea can lead to serious complications. Women can develop pelvic inflammatory disease (PID), an infection that spreads from the vagina and cervix to the uterus and fallopian tubes. PID can scar the fallopian tubes, which can lead to ectopic pregnancy or infertility. In men, the infection can lead to inflammation of the testicles resulting in sterility. In both males and females, the bacteria can also spread into the bloodstream and infect the joints, causing a type of arthritis. Other potentially serious complications include osteomyelitis, meningitis, endocarditis, adult respiratory distress syndrome (ARDS) and fatal septic shock. An infected newborn baby may develop infections of the blood, joints and eyes, which can lead to blindness if not treated

How is the sample collected for testing?
A swab is used to obtain a sample of secretions or discharge from the infected area, such as the cervix, urethra, penis, anus or throat. For some tests a urine sample is used. Many doctors will take a sample from more than one area of the body to increase the chance of finding the bacteria.

How is it used?
When is it requested?
What does the test result mean?
Is there anything else I should know?

How is it used?
The test is used in two ways:

• to diagnose the cause of symptoms, and
• to screen sexually active people.

A definite diagnosis is important because the symptoms of gonorrhoea can clinically resemble those of chlamydia, and the two diseases need different treatments.

Several methods are available, but the preferred method at present is molecular testing. This test is based on amplification of the DNA present in Neisseria gonorrhoeae. Molecular testing for Neisseria gonorrhoeae is now standard and widely used. The advantage of molecular tests is that they are generally more sensitive and more specific than conventional culture and can therefore identify more positive samples.

For men, a quick method that can be used in a clinic or surgery is the Gram stain, which allows the doctor to examine a sample from the urethra for bacteria under the microscope. This method is not used on samples from women.

Tests for Neisseria gonorrhoeae and Chlamydia trachomatis are generally done at the same time, since the two organisms cause similar clinical signs and symptoms

When is it requested?
The doctor may request the test if there are symptoms such as increased vaginal discharge, bleeding during vaginal intercourse or burning or painful urination in women, or pus from the penis, a burning sensation when passing urine or proctitis (inflammation of the anal or rectal area) in men. However, since many infected people have no symptoms, the US Preventive Services Task Force recommends the following:

• All sexually active women aged 25 or under should be tested for gonorrhoea every year
• All other sexually active women who have no symptoms but are at risk of infection should be screened routinely
• All pregnant women are tested

The US Centers for Disease Control and Prevention recommends that men who have sex with men be screened at least once a year for gonorrhoea and other sexually transmitted diseases (STDs), including chlamydia, syphilis and HIV.

What does the test result mean?
A positive test indicates an active infection that needs antibiotic treatment.

A negative test only means that there is no evidence of disease at the time of the test. It is important for people at high risk of infection to be screened regularly to check for possible changes.

If a person is infected, their sexual partner or partners should also be tested and treated.

Is there anything else I should know?
If you are infected, you are at greater risk of catching other sexually transmitted diseases, including HIV.

1. How long does it take to get the results?
2. When would culture be preferable to molecular tests?
3. How can gonorrhoea be prevented?

1. How long does it take to get the results?
Results from culture and DNA amplification methods are normally sent to your doctor within 3-5 days. The Gram stain can be done immediately, but the results are not as reliable as culture.

2. When would culture be preferable to molecular tests?
Molecular tests should not be used to diagnose or verify cases with legal implications. Until the legal system changes, only a positive culture result proving gonorrhoea infection is accepted in court.