Public health priority: Routine
Case management: Enter confirmed cases on NCIMS within 5 working days.
Contact management: Responsibility of treating doctor.
A confirmed case requires laboratory definitive evidence.
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).
Diagnoses received 29 days or more after the calculated onset date will be considered re-infections and will be notified separately [1, 2, 3, 4, 5].
Gonorrhoea is to be notified by laboratories (ideal reporting by routine mail).
Only confirmed cases should be entered onto NCIMS.
The bacterium Neisseria gonorrhoeae.
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.
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.
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.
Within 5 working days of notification enter confirmed cases on NCIMS.
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.
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.
Sexual contacts of the patient while infectious (up to the preceding six months) are at risk of infection.
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.
In some situations involving case clustering or changes in epidemiology, enhanced data about risks and exposures may be requested.