What are the current guidelines for partner notification and treatment in cases of gonorrhoea?

Partner Notification Guidelines for Gonorrhoea:

• People diagnosed with a sexually transmitted infection (STI) should be advised on the importance and benefits of partner notification, the possibility of sexual partners being infected even if asymptomatic, and the risk of reinfection ².
• They should be encouraged to engage in partner notification, regardless of where they are tested, and discuss the different methods available ².
• Help people decide how to notify their sex partners, discussing ways to have difficult conversations and suggesting methods based on relationship status and other circumstances ². Alternative methods of disclosure may be needed in contexts such as risk of domestic violence or a need for anonymity ².
• If a person feels unable to tell their sex partners or shows signs of difficulty dealing with their diagnosis, they should be referred to specialist sexual health services for more support with partner notification ².
• There must be a clear referral pathway to specialist sexual health services for partner notification, ensuring seamless referral without the need for self-referral ².
• Partner notification on behalf of a person with an STI should be carried out by professionals with expertise in contact tracing and counselling, in line with British Association for Sexual Health and HIV (BASHH) guidance ².
• Consider how geospatial networking apps (e.g., Grindr or Tinder) may be used for partner notification, such as suggesting users notify partners to contact a sexual health service for testing or using app profiles to inform contacts when notifying partners on behalf of a person ².
• Patients should be encouraged to lead partner notification ¹. They should be advised on the importance and benefits of partner notification, the possibility of sexual partners being infected even if asymptomatic, and the risk of reinfection ¹.

Treatment Guidelines for Gonorrhoea:

• All people with gonorrhoea should be referred promptly to specialists in genito-urinary medicine (GUM) or other local specialist sexual health services for management ¹.
• If a person is unwilling or unable to attend a GUM clinic, management can be undertaken in primary care if appropriate expertise is available and in line with local procedures and protocols ¹.
• Treatment is recommended for a confirmed positive nucleic acid amplification test (NAAT) for Neisseria gonorrhoeae, a positive culture for N. gonorrhoeae, laboratory identification of intracellular Gram-negative diplococci on microscopy, or being a sexual partner of a confirmed case of gonococcal infection ¹.
• For uncomplicated anogenital or pharyngeal infection, when antimicrobial susceptibility is not known prior to treatment, the first-line choice is ceftriaxone 1 g intramuscular (IM) injection as a single dose ¹. Dual therapy with azithromycin is no longer recommended due to increased azithromycin resistance ¹.
• If antimicrobial susceptibility is known prior to treatment and the infection is quinolone sensitive, ciprofloxacin 500 mg orally as a single dose can be prescribed, but only when other commonly recommended antibiotics are inappropriate due to potential long-lasting side effects ¹. Ciprofloxacin resistance is high in the UK ¹.
• Alternative regimens for people with an allergy, needle phobia, or other contraindications include gentamicin 240 mg IM as a single dose plus azithromycin 2 g orally, OR cefixime 400 mg orally as a single dose plus azithromycin 2 g orally (advisable only if an IM injection is contraindicated or refused) ¹. These alternative regimens should ideally be used as dual therapy with azithromycin 2g, as monotherapy has been associated with treatment failure, especially for pharyngeal infection ¹.
• For people with penicillin allergy, ceftriaxone and cefixime are suitable treatment options unless there is a history of severe hypersensitivity (e.g., anaphylactic reaction) to any beta-lactam antibacterial agent ¹.
• For pregnant or breastfeeding women, prescribe ceftriaxone 1 g IM injection as a single dose ¹. Azithromycin 2 g as a single oral dose can be used if adequate alternatives are not available and the isolate is known to be susceptible; otherwise, specialist advice should be sought ¹. Ciprofloxacin should not be prescribed for pregnant or breastfeeding women ¹.
• Advise the person to abstain from sex until 7 days after they and their partner(s) have completed treatment ¹.
• A test of cure (TOC) is recommended for all people who have been treated for gonorrhoea ¹. Prioritize TOC for people with persistent symptoms or signs, pharyngeal infection, those treated with anything other than the first-line antibiotic regimen when antimicrobial susceptibility was unknown, or those who acquired the infection in the Asia-Pacific region when antimicrobial susceptibility was unknown ¹.
• Possible ceftriaxone treatment failure in England should be reported to Public Health England (PHE) via their online HIV and STI web portal ¹.