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Neisseria gonorrhoeae

(Gonorrhoea)

Gonorrhoea Overview

Prevalence
Health effects
  • Gonorrhoea spreads by sexual contact and it requires medical diagnosis. If treated, the infection can be short-term such as days to weeks.
  • Gonorrhoea influences men and women, with primary areas of infection including the mucosal membranes of urethra, cervix, rectum, throat (pharynx) and eye.
Resistance and treatment
  • Gonorrhoea is highly resistant to many antibiotics and is becoming more resistant over time. The continued use of ineffective antibiotics is highly problematic.
  • Extreme drug resistant (XDR) strains of gonorrhoea have been reported in Australia and the UK in 2018, but thankfully, they were susceptible to some earlier antibiotic forms.
  • This is alarming as gonorrhoea may quickly overcome the current antibiotics available if no intervention is made. We have not yet found a completely untreatable infection, but there is the risk that it will arise.
  • New diagnostic tools can let doctors know if your infection is resistant or susceptible to previously used antibiotics, offering a more targeted use of effective antibiotics and preserving the use of last-line therapeutics.

In men
  • Pus and discharge from the penis
  • Pain and/or difficulty when urinating
  • Pain in affected area
  • Swelling and tenderness in testicles and epididymis (rare)
In women
  • Pain and/or difficulty in urinating
  • Increased or altered vaginal discharge
  • Lower abdominal pain
  • Intermenstrual bleeding and abnormally heavy menstruation (rare)
In rectal infections the following symptoms may be experienced:
  • Discharge
  • Pain
  • Discomfort
Pharynx infections are mostly asymptomatic but sometimes may involve a sore throat.

Gonorrhoea is often treated without the knowledge of its antibiotic resistance status. The current standard treatment for gonorrhoea is an intramuscular injection of the antibiotic ‘ceftriaxone’.
  • The intramuscular treatment is uncomfortable and painful for patients, requiring a mandatory local anesthetic.
Resistance Guided Therapy can help identify whether bacteria may be resistant or susceptible to certain to antibiotics. Clinicians can use this information to prescribe the best possible treatment to patients.
  • Using Resistance Guided Therapy clinicians can prescribe an oral tablet of the antibiotic ‘ciprofloxacin’ or the intramuscular injection of ‘ceftriaxone’ depending on the gonorrhoea strain detected. This is outlined in the flowchart below.
  • Ciprofloxacin remains a viable treatment option for gonorrhoea in many regions including the UK, Europe, and the US, if information about resistance status is available.

“The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.”
Dr Teodora Wi, Medical Officer, Human Reproduction, WHO.
  • The 2018 UK national guideline (draft, out for consultation) includes strong recommendations for Resistance Guided Therapy in management of gonorrhoea infections (Grade 1A recommendation).
  • Resistance Guided Therapy can improve antibiotic stewardship through the effective management of antibiotic use, delaying antimicrobial resistance.

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Neisseria gonorrhoeae (Gonorrhoea) under a microscope

Disclaimer: See a health professional if you are experiencing any symptoms. Diagnostic test results must be correlated with clinical history, epidemiological data, laboratory data and any other data available to the clinician.