Gonorrhoea
NICE CKS Gonorrhoea. Last revised Mar 2024.
BASHH Gonorrhoea 2025: Updated Guideline. Last updated Apr 2025.
Guidelines
Investigation and Diagnosis
Test of choice: NAAT
Sample collection methods:
- Male 1st line: first pass urine (alternative: urethral swab)
- Female 1st line: vulvovaginal swab (alternative: endocervical swab)
If MSM → also take rectal and pharyngeal samples
Other tests:
| Test | Description |
|---|---|
| Culture | Should be obtained simultaneously with NAAT and BEFORE starting treatment
For drug susceptibility testing |
| Urethral swab | For quick diagnosis in the presence of penile urethral discharge
Interpretation:
|
Management
Refer ALL patients to GUM clinic / local specialist for management.
General Advice
Abstain from all sexual activity until 7 days after they and their partner(s) have completed treatment
Pharmacological Management
Take swabs for culture BEFORE starting treatment, and initiate empirical treatment immediately without awaiting susceptibility result:
- 1st line: ceftriaxone 1g IM single dose
- 2nd line:
- Needle-sparing option (e.g. if needle phobia) → cefixime 400mg PO (2 doses 6-12 hours apart) + azithromycin 2g PO
- BASHH recommends only using this regimen if antimicrobial susceptibility results are available
- Penicillin-sparing option → gentamicin 200mg IM + azithromycin 2g PO
- Needle-sparing option (e.g. if needle phobia) → cefixime 400mg PO (2 doses 6-12 hours apart) + azithromycin 2g PO
Partner Notification and Sexual Contacts Management
Partner Notification
- If symptomatic men → notify all partners within the past 2 weeks (or most recent partner if more than 2 weeks ago)
- If all other patients (i.e. asymptomatic men and women) → notify all partners within the past 12 weeks (3 months)
The partner notification period for gonorrhoea is 1/2 that of chlamydia
- In chlamydia
- Symptomatic men → 4 week lookback (vs 2 weeks)
- All other patients (i.e., asymptomatic men and women) → 6 month lookback (vs 3 months)
Sexual Contacts Management
All sexual contacts should be tested:
- Empirical treatment is NOT needed routinely for all sexual contacts:
- Principle: only offer empirical treatment to those who test +ve for gonorrhoea
- If present within 2 weeks of exposure → repeat testing after 2 weeks
Follow Up
Offer test of cure using NAAT to all patients at least 2 weeks after treatment completion
- BASHH recommends if treated with ceftriaxone + susceptible to ceftriaxone, there is no need for test of cure
At follow-up also:
- If symptoms resolved or not
- Adherence
- Any adverse reactions
- Confirm partner notification has been carried out
- Ask about recent sexual history
- Reinforce advice on safe sexual practice
Note the window period of gonorrhoea testing is 2 weeks, meaning false -ve is possible if tested within this period. Therefore, the test of cure should be performed ≥2 weeks after completion of treatment.
References
Original Guideline