When should I consider referring a patient with gonorrhoea for specialist sexual health services?

All people diagnosed with gonorrhoea from age 13 years onwards should be referred to a genito-urinary medicine (GUM) clinic or other local specialist sexual health service for management. Consider referral especially if:

• There is suspected disseminated gonorrhoea, indicated by systemic symptoms such as fever, malaise, joint pain and swelling, and rash.
• Women have severe or complicated pelvic inflammatory disease or suspected ascending infection.
• There are complications of gonorrhoea.
• The patient has conjunctival gonorrhoea.
• The patient does not respond to, or is allergic to, recommended antibiotics.
• The patient is unwilling or unable to attend specialist services despite receiving appropriate information and advice.

Referral is important because specialist services have the expertise for complex management, including contact tracing, partner notification, and follow-up testing such as test of cure (TOC).

If a patient cannot attend specialist services, management in primary care is possible only if appropriate expertise and local protocols are in place.

Follow-up about 1 week after treatment is recommended to confirm adherence, symptom resolution, partner notification, and reinforce safe sexual practices.

Test of cure is recommended for all treated patients, prioritizing those with persistent symptoms, pharyngeal infection, treatment with non-first-line antibiotics, or infection acquired in the Asia-Pacific region.

Cases of possible treatment failure should be reported to Public Health England.

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