Gonorrhoea Management - quick summary

If treatment is given, cultures should be taken.

Sampling in contacts of gonorrhoea, or those diagnosed with gonorrhoea at a single site:

Men who are contacts of a female partner with gonorrhoea, or are known to have urethral gonorrhoea:

• NAATs: First void urine and pharyngeal sample
• Cultures: Urethral and pharyngeal for N.gonorrhoeae

Men who are contacts of a male partner with gonorrhoea, or are known to have urethral gonorrhoea:

• NAATs: FVU, rectal and pharyngeal sample
• Cultures: urethral, rectal and pharyngeal culture for N.gonorrhoeae

Women who are who are contacts of a male partner with gonorrhoea or who are to be treated for a presumptive diagnosis of gonorrhoea:

• NAATs: vulvovaginal, rectal and pharyngeal
• Cultures: cervical, rectal and pharyngeal

Uncomplicated gonorrhoea

• Ceftriaxone 1g IM

Penicillin Allergy

Third generation cephalosporins, such as ceftriaxone, show negligible cross reactivity with penicillin. Therefore in penicillin-allergic people, ceftriaxone is a suitable treatment option, unless there is a history of severe sensitivity( e.g. anaphylaxis) to any beta-lactam antibacterial agent ( penicillins, cephalosporins, monobactams and carbapenems).

In severe or immediate reactions:

• Azithromycin 2 g oral single dose (with food)

Complicated infections:

Gonococcal pelvic inflammatory disease · Ceftriaxone 1 g IM as a single dose in addition to the regimen chosen to treat PID. For details, please see BASHH PID guideline

Gonococcal epididymo-orchitis · Ceftriaxone 1 g IM as a single dose in addition to the regimen chosen to treat epididymo-orchitis. For details, please see BASHH epididymo-orchitis guideline

Partner notification

Look back period:

• • 2 weeks in male patients with symptomatic urethral infection
  • 3 months in all other of cases

Management of contacts

Presenting after 14 day of exposure: NAAT testing and treat if positive

Presenting within 14 days of exposure:  consider epidemiological treatment based on a clinical and psychosocial risk assessment.

It may be appropriate to not give epidemiological treatment, and to repeat testing 2 weeks after exposure. In people who have had gonorrhoea vaccination, this is the preferred option.

Routine TOC is not necessary for anogenital infections treated with ceftriaxone, when culture plates have been taken and confirm susceptibility to ceftriaxone.

• NAAT tests done 3 weeks after treatment
• Only required from initially positive sites
• Confirm no problems with treatment and no risk of re-infection
• If a  positive  TOC,  cultures  should  be  repeated  prior  to  any retreatment

Information can be found on BASHH.Org or by scanning the QR code below