Synopsis
Recognise gonorrhoea at genital and extragenital sites, secure culture for resistance surveillance, prescribe ceftriaxone correctly, and target test of cure and partner care.
- Sample every exposed anatomical site by NAAT and obtain culture from each suspected or NAAT-positive site before treatment whenever this causes no unsafe delay.
- The 2025 guideline recommends pharyngeal testing for every person with urogenital gonorrhoea and every gonorrhoea contact, even without reported oral exposure.
- Treat uncomplicated anogenital or pharyngeal gonorrhoea with ceftriaxone 1 g intramuscularly once when susceptibility is unknown.
Key red flags
A painful swollen joint, fever, tenosynovitis or sparse pustular rash requires urgent assessment for disseminated gonococcal infection.
Hyperacute purulent conjunctivitis, eye pain, photophobia or visual change can progress to corneal perforation and needs emergency ophthalmology.
Pelvic pain with cervical motion or adnexal tenderness requires immediate broad PID treatment in addition to gonococcal coverage.
Sudden severe scrotal pain remains testicular torsion until assessed even when urethral discharge suggests infection.
Persistent symptoms or a positive post-treatment test may signal reinfection or antimicrobial failure and needs culture plus specialist resistance action. For symptomatic test-of-cure assessment, take culture at least 72 hours after treatment; in an asymptomatic patient use NAAT at least two weeks after treatment and culture any positive result.
Fever, migratory arthralgia, tendon-sheath pain, sparse pustules or septic monoarthritis suggests bloodstream spread and demands admission.
Copious purulent discharge with severe conjunctival inflammation can rapidly injure the cornea and requires urgent ophthalmological care.
Investigation priorities
Detect N. gonorrhoeae sensitively from genital, rectal and pharyngeal sites selected by diagnosis and exposure.
Management branches
Symptoms, screening or contact notification creates clinical suspicion of gonorrhoea.
- Record exposure sites and timing, symptoms, pregnancy, previous antibiotics, allergy and any travel or prior resistant infection.
- Take genital, rectal and pharyngeal NAAT as indicated, always adding a pharyngeal sample for a urogenital diagnosis or contact.