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Like chlamydia, testing for gonorrhoea diagnosis is usually undertaken using highly sensitive and specific NAAT/PCR methodology. The sensitivity of these tests is very high for all specimens types (endocervical swabs, self-taken vaginal swabs, urethral swabs and male urines), except for female urines, where the sensitivity is much lower. Detection of gonococcal infection in rectal and throat samples using NAATs is more sensitive than culture and NAATs are the test of choice at these sites in men who have sex with men (MSM) and other high risk individuals. Although culture for N. gonorrhoeae is less sensitive than NAATs, it is still needed to identify resistance. Ideally, gonorrhoea treatment should not be commenced until the culture has been confirmed. However, unnecessary delays to treatment should be avoided to prevent onward transmission. Clinicians treating a patient with gonorrhoea should follow the latest evidence-based guidelines developed by the BASHH/Royal College of General Practitioners.
Repeat testing is recommended for all cases of gonorrhoea to monitor treatment failure. Patients with persisting symptoms should be tested with culture at least 72 hours after completion of therapy. Asymptomatic patients should be tested with NAATs, followed by culture if positive, at least two weeks after completion of therapy.
Patients diagnosed with gonorrhoea are at high risk of other STIs and should be additionally tested for syphilis and HIV (and chlamydia if not already performed).