What are the recommended diagnostic tests for confirming a Neisseria gonorrhoeae infection in adults?

For confirming a Neisseria gonorrhoeae infection in adults, recommended diagnostic tests include culture and nucleic acid amplification tests (NAATs) ¹ (Olshen and Shrier, 2005). Ideally, a culture should be taken before prescribing antibiotics to test for antimicrobial susceptibility and identify resistant strains ¹. NAATs offer increased sensitivity for detecting Neisseria gonorrhoeae ¹.

Following treatment, a test of cure (TOC) is recommended for all individuals treated for gonorrhoea in the UK, as per British Association for Sexual Health and HIV (BASHH) and Health Protection Surveillance Centre (HPSC) guidelines ¹ (Fifer, 2020; HPSC, 2016). This approach differs from the US Centers for Disease Control and Prevention (CDC), which states that TOC is not needed for uncomplicated urogenital or rectal gonorrhoea treated with recommended regimens ¹ (CDC, 2021).

For TOC, if signs or symptoms persist, culture should be performed at least 3 days after treatment completion ¹. If this culture is negative, additional NAAT testing can be considered after 1 week for increased sensitivity ¹. If the person is asymptomatic, nucleic acid amplification testing (NAAT) is recommended where available, followed by culture if positive, at least 2 weeks after treatment completion ¹. The time for a negative TOC using NAATs varies, but most individuals should test negative 7 days following treatment with an RNA NAAT or 14 days following treatment with a DNA NAAT ¹. All individuals diagnosed with gonorrhoea should be referred promptly to a genito-urinary medicine (GUM) clinic or other local specialist sexual health service for comprehensive management ¹ (RCGP, 2013).