Gonorrhoea

• Gonorrhoea is the second most commonly notified STI in WA.
• For treatment of adults and mature minors (aged 14 years or older) with, or who are sexual contacts of, gonorrhoea under a Structured Administration and Supply Arrangement, see Structured Administration and Supply Arrangement - CEO of Health SASA. This is suitable for use in a health service operated or managed by a Health Service Provider of the WA Department of Health, or contracted entity.
• Practitioners working in the Goldfields and Kimberley, please see Information specific to the Goldfields and the Kimberley regions
• Point of care NAAT testing for gonorrhoea is available in some WA Aboriginal Community Controlled Health Services. If gonorrhoea was diagnosed on a point of care test, it is essential to send the specimen to a laboratory for molecular-based antimicrobial resistance testing because antimicrobial resistant strains are emerging with few treatment options
• This is a notifiable infection. Medical practitioners must complete the appropriate notification form for all patients diagnosed with a notifiable STI/HIV, as soon as possible after confirmed diagnosis.
• It is a legal requirement to report all reasonable beliefs of child sexual abuse to the Department of Communities.
• Real time WA and national (external site) notification data.
• Free gonorrhoea testing is available from Get the Facts (external site)
• Patient information: Gonorrhoea (HealthyWA)

Gonorrhoea is caused by Neisseria gonorrhoeae (N. gonorrhoeae), a Gram-negative intracellular diplococcus.

Anal and pharyngeal gonorrhoea infections are asymptomatic in most people. Gonococcal cervicitis is asymptomatic in 80% of infections. Urethral gonorrhoea is asymptomatic in 10% to 15% of infections so testing is important irrespective of symptoms.

Uncomplicated gonorrhoea can present with one or more of the following:

• Urethral discharge (urethritis) and/or burning sensation (dysuria)
• Cervical/vaginal discharge (cervicitis)
• Anorectal infection (proctitis) is usually asymptomatic but can present with discharge, painful defecation, disturbed bowel function or irritation 
• Pharyngeal infection is usually asymptomatic
• Conjunctivitis due to gonorrhoea can be sight-threatening

Untreated gonorrhoea can lead to complications including:

• Pelvic inflammatory disease (PID) can present with dyspareunia (pain during vaginal intercourse), intermenstrual or post-coital bleeding, discharge, and in the long-term, tubal infertility and ectopic pregnancy
• Bartholin’s gland abscess
• Epididymo-orchitis presents as painful testicular swelling (uncommon)
• Prostatitis (very rarely)
• Urethral stricture (rare) causing urinary retention
• Disseminated infection is uncommon but serious; it can present as septic arthritis, meningitis, endocarditis, sepsis, and macular rash that may include necrotic pustules. 

Gonorrhoea transmitted vertically (via birth canal) can cause sight-threatening neonatal conjunctivitis.

STI Atlas (external site)

Gonorrhoea infection is diagnosed by detecting Neisseria gonorrhoeae from anatomical sites appropriate to the patient’s sexual practices. For example:

• If the patient has had receptive anal sex, oro-anal sex, rimming or fingering, collect a rectal swab.
• If the patient has had receptive oral sex, take a throat swab. 

Swabs for gonococcal culture should always be collected if the patient has discharge and the specimen is collected in the metropolitan area or can reach a laboratory within 24 hours of collection. Culture results are essential for anti-microbial resistance surveillance.

If the patient presents with a positive self-test result, ensure it is confirmed with a laboratory test. 

1. Dry swab, no transport medium

2. Swab with transport medium

Point of care NAAT testing for gonorrhoea is available in some WA Aboriginal Community Controlled Health Services. If gonorrhoea was diagnosed on a point of care test, it is essential to send the specimen to a laboratory for molecular-based antimicrobial resistance testing because antimicrobial resistant strains are emerging with few treatment options in the future being available.

Offer patient information: Gonorrhoea (HealthyWA)

2. For treatment of adults and mature minors (aged 14 years or older) under a Structured Administration and Supply Arrangement, see Structured Administration and Supply Arrangement - CEO of Health SASA. This is suitable for use by Registered Nurses and Aboriginal Health Practitioners employed by a health service operated or managed by a Health Service Provider of the WA Department of Health, or contracted entity.

3. Seek specialist advice from a sexual health or infectious disease physician if your patient has contra-indications to these antibiotics.

4. Practitioners working in the Goldfields and Kimberley, please see 'Information specific to Goldfields and Kimberley regions'

5. If a patient received the recommended treatment for genital or anorectal gonorrhoea at the time of testing, and if they are found to also have pharyngeal gonorrhoea, they do not need to be re-treated with the higher dose of azithromycin, but a test of cure is recommended.

• Contact tracing is important to prevent re-infection and reduce transmission
• All partners in at least the past 2 months should be traced.
• The diagnosing doctor is responsible for initiating and documenting a discussion about contact tracing.
• Offer testing of exposed anatomical sites to all sexual contacts.
• Consider presumptive treatment if there has been sexual contact within the past 2 weeks or when the person’s individual circumstances mean later treatment may not occur.
• For empirical treatment of sexual contacts who are adults and mature minors (aged 14 years or older) under a Structured Administration and Supply Arrangement, see Structured Administration and Supply Arrangement - CEO of Health SASA. This is suitable for use by Registered Nurses and Aboriginal Health Practitioners employed by a health service operated or managed by a Health Service Provider of the WA Department of Health, or contracted entity.
• See Australasian contact tracing guidelines (external site)

Follow up is important to:

• confirm patient adherence with treatment and assess for symptom resolution,
• confirm contact tracing has been undertaken or offer more contact tracing support, and
• educate about condom use, contraception, HIV PrEP/PEP, safe injecting practices, consent, cervical screening, and vaccinations for HAV, HBV, HPV and mpox as indicated. 

Test of cure is recommended:

• for pregnant people,
• for rectal chlamydia treated with azithromycin,
• if there is doubt about compliance with treatment and advice, or
• if symptoms persist

As NAAT can remain positive after treatment, repeat testing should be undertaken no earlier than 2 weeks after treatment.

Test for re-infection is recommended 3 months after treatment as re-infection is common and provides an opportunity to repeat tests for syphilis, HIV and HBV after the window period.

Free gonorrhoea testing is available from Get the Facts (external site)