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Last updated:
06 September 2004
1. Reason for surveillance
- To monitor the epidemiology of the disease to inform prevention strategies
- To monitor the susceptibility of isolates to ensure continuing appropriate and effective management.
2. Case definition
A confirmed case requires laboratory definitive evidence. Laboratory evidence
- Isolation of Neisseria gonorrhoeae
- Detection of Neisseria gonorrhoeae by nucleic acid testing
- Detection of typical Gram-negative intracellular diplococci in a smear from a genital tract specimen.
Clinical evidence
Not applicable Epidemiological evidence
Not applicable. Factors to be considered in case identification
Gonococcal susceptibility surveillance is essential because of emerging and changing antibiotic resistance. All isolates of gonococci should be sent to the Australian Gonococcal Surveillance Program (AGSP) reference laboratory for susceptibility testing. In NSW the reference laboratory is South Eastern Area Laboratory Service (SEALS).
3. Notification criteria and procedure
Gonorrhoea is to be notified by:
- Laboratories (ideal reporting by routine mail).
Only confirmed cases should be entered onto NDD.
4. The disease
Infectious agent
The bacterium Neisseria gonorrhoeae. Mode of transmission
Contact with exudate from mucous membranes of infected people, almost always as a result of sexual activity or during childbirth. Non-sexual transmission to infants and young children has been reported. Timeline
The typical incubation period is 2 to 7 days, sometimes longer. Gonorrhoea may be communicable from the time of infection for several months in untreated persons. Effective therapy ends communicability within a matter of hours. Inappropriate treatment can result in the patient remaining infectious. Asymptomatic persons are generally as infectious as those with symptoms. The attack rate among women exposed to infected men is generally higher than that of men exposed to infected women. Clinical presentation
Infection may be asymptomatic (ano-rectal and pharyngeal is usually asymptomatic). The usual clinical presentation in males is a purulent urethral discharge with dysuria. In females it may be asymptomatic, or present as an abnormal vaginal discharge, abnormal menses, pelvic pain and dysuria.
5. Managing single notifications
Response times
Data entry
Within 5 working days of notification enter confirmed cases on NDD. Response procedure
Where a case is reported in a child <16 years old, the PHU must send a letter to the caring doctor outlining his/her obligation to notify the Department of Community Services. Case management
Investigation and treatment
In general, the attending medical practitioner is responsible for treatment. The treatment will depend on whether the disease was acquired in Australia or overseas. Penicillins should not be used for routine treatment of gonorrhoea in NSW. Since late 1999, ceftriaxone has been recommended as the treatment of choice. Because of the changing patterns of sensitivity to antibiotics, specialist advice should be sought. Treatment effective against chlamydial infection should be considered in communities where co-infection is prevalent. See Therapeutic Guidelines: Antibiotic for details. Education
In general, the case's doctor provides counselling, testing and treatment. The medical practitioner should provide information to the case about the nature of the infection and the mode of transmission. Contact Management
Identification of contacts
Sexual contacts of the patient while infectious (up to the preceding six months) are at risk of infection. Investigation and treatment
The treating doctor is responsible for contact tracing. PHU's should work with Sexual Health Service staff to assist where requested by the doctor. Contacts require counselling, examination and testing, and empirical treatment. See Therapeutic Guidelines: Antibiotic for details.
6. Managing Special Situations
Case clustering, for example among clients of a sex industry establishment, may indicate the need to initiate an education and/or screening program.
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