Gonorrhea

Gonorrhea testing is used to screen for, diagnose, and verify successful treatment of infections caused by the bacteria Neisseria gonorrhoeae. Gonorrhea is a common sexually transmitted disease (STD) in the U.S. and can cause serious complications if not treated. Screening for, diagnosing, and treating gonorrhea is very important to prevent long-term complications and spread of the infection to others. (For more, see the "What is being tested?" section.) Photo source: National Institute of Allergy and Infectious Diseases (NIAID)

A definitive diagnosis is important because signs and symptoms of gonorrhea can resemble chlamydia and the two infections require different antibiotic treatment. Since the disorders have similar symptoms, healthcare practitioners often test for Neisseria gonorrhoeae and Chlamydia trachomatis, the bacteria that causes chlamydia, at the same time. Repeat testing is recommended to ensure that treatment has been effective. This is done about three months after a person has completed treatment.

Nucleic acid amplification test (NAAT) is the recommended method of testing for gonorrhea. NAAT is a molecular test that detects the genetic material (DNA) of Neisseria gonorrhoeae. It is generally more sensitive and specific than other gonorrhea tests and can be performed on a vaginal swab on women, or urine from both men and women, which eliminates the need for a pelvic exam in women.

Besides NAAT, another test to detect gonorrhea is a gonorrhea culture, which grows the bacteria. In men, a quick method that may be used in a clinic or healthcare provider's office is the gram stain, which allows the healthcare practitioner to look at a sample from the urethra for the presence of the bacteria using a microscope. While this method can diagnose gonorrhea, it is not sufficient to rule out an infection in asymptomatic men. This method is not reliable for samples from women since other bacteria normally found in the female genital tract will look the same under the microscope.

Screening

Because many infected people do not have any noticeable symptoms, a number of health organizations recommend regular screening for certain people.

Women

All sexually active women younger than age 25 and sexually active women age 25 and older who are at increased risk should get yearly screening for gonorrhea, according to the U.S. Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG). The U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) also recommend routine screening for these women (the USPSTF says age 24 and younger).

Examples of risk factors for gonorrhea infection include:

• Previous gonorrhea infections, even if they were treated
• Having other STDs, especially HIV
• Having new or multiple sex partners
• Having a sex partner diagnosed with an STD
• Using condoms inconsistently
• Exchanging sex for money or drugs
• Using illegal drugs
• Living in a detention facility

For pregnant women, the CDC recommends screening women less than 25 years old and older women at risk for gonorrhea during the first trimester or first prenatal visit. Those who remain at risk should be retested during the third trimester. Those women diagnosed with gonorrhea should be treated and then retested within 3 months. (See Pregnancy & Prenatal Testing.)

Men

The CDC recommends that men who have sex with men have gonorrhea screening at least annually. Health organizations do not recommend routine screening for sexually active, heterosexual males. Healthcare practitioners may recommend screening to their patients when, for example, there is a high number of cases (prevalence) of STDs in the community.

Diagnosis

Gonorrhea testing may also be ordered when a person's sex partner has been diagnosed with gonorrhea or when a person has signs and symptoms of the infection.

For women, if symptoms occur, they may include:

• Bleeding between menstrual periods and after sexual intercourse
• Abdominal pain
• Painful intercourse
• Painful and/or frequent urination
• Abnormal vaginal discharge

Men may have no noticeable symptoms. If they do, they may include:

• A white, yellow or greenish discharge from the penis
• Pain or burning when urinating
• Pain, tenderness, and swelling of the testicles

Both men and women can get an infection in their rectum and may be tested when they have symptoms such as itching, inflammation, pain, discharge, and/or bleeding from the rectum. Testing for both chlamydia and gonorrhea may be done when a newborn has symptoms of conjunctivitis, such as redness and swelling of the eye, and discharge.

Women or men treated for gonorrhea should be retested three months after their treatment.

A positive test indicates an active gonorrhea infection that requires treatment with a course of antibiotics.

A negative test means only that there is no evidence of infection at the time of the test. It is important for those who are at increased risk of infection to have screening tests performed on a annual basis to check for possible infection.

If you are infected, your sexual partner(s) should also be tested and treated as well.

The Centers for Disease Control and Prevention (CDC) recommends the NAAT testing method for gonorrhea, except in cases of child sexual abuse in boys or rectal and oral infections in preteen girls. In these cases, culture is recommended.

If you are infected, your risk of contracting other sexually transmitted diseases, including HIV, is increased.

Molecular tests are only FDA-approved for use with urine samples or samples from genital sites such as the vagina and penis; they have not been FDA-approved for performance with ocular (eye), pharyngeal (throat), or rectal samples. Individual laboratories may perform molecular testing on these samples, but they are required to validate the methods themselves.