Notification requirement for gonorrhoea
Gonorrhoea is a ‘routine’ notifiable condition and must be notified by medical practitioners and pathology services in writing within 5 days of diagnosis.
Notification of selected sexually transmissible infections (STIs) is required under the Public Health and Wellbeing Regulations 2009. To maintain confidentiality, only the name code (the first two letters of the surname followed by the first two letters of the first name) is required.
Registered medical practitioners have a statutory obligation under the Children, Youth and Families Act 2005 to notify the department’s Child Protection, Placement and Family Services Branch if they believe that a child is in need of protection on the basis of sexual abuse.
This is a Victorian statutory requirement.
Primary school and children’s services centre exclusion for gonorrhea
Exclusion is not applicable.
Infectious agent of gonorrhoea
The infectious agent is Neisseria gonorrhoeae.
Identification of gonorrhoea
Infection with N. gonorrhoeae may present with a number of clinical syndromes.
The most common presenting symptom in males is a painful purulent urethral discharge (urethritis). If left untreated, complications may include epididymitis, prostatitis and urethral stricture. Anorectal infection is more common in men who have sex with men and is usually asymptomatic. It may cause rectal pain, pruritis, tenesmus and discharge. Pharyngeal infection is usually asymptomatic.
In females, an initial urethritis or cervicitis occurs a few days after exposure. Vaginal bleeding and dyspareunia may also occur. It is frequently mild and passes unnoticed. Females may have abnormal vaginal discharge and postcoital bleeding. Later, pelvic inflammatory disease may develop, which can cause ectopic pregnancy, infertility or chronic pelvic pain. It may result in an asymptomatic infection in pregnancy, but carries a higher risk of disseminated disease, and potential for fetal and neonatal complications.
Conjunctivitis can occur in neonates and rarely in adults. It may cause blindness if not rapidly and adequately treated.
Disseminated disease with septicaemia, skin lesions and/or septic arthritis is a rare complication.
Swabs taken from the urethra, cervix, pharynx, rectum or other site should be rolled onto a slide first and then sent to the laboratory in an appropriate transport medium.
The following tests can be performed on swabs and smears taken from the site of infection:
- Gram stain can be performed on discharges smeared on the slide.
- Culture on both selective and nonselective media should be used. Culture of N. gonorrhoeae provides definitive diagnosis, and isolates provide valuable information on patterns of antibiotic resistance and other epidemiological markers.
- Nucleic acid testing can be performed on cervical and urethral swabs, and urine. In women, polymerase chain reaction (PCR) testing of urine is less sensitive than PCR testing of endocervical swab specimens. Overall, PCR testing has excellent sensitivity and specificity, and has become increasingly used in many laboratories. In cases diagnosed by PCR, further specimens should be obtained, if possible, for culture to allow monitoring of antibiotic resistance.
Co-infection with Chlamydia trachomatis sometimes occurs, particularly in imported cases. Screening for other sexually transmissible infections such as chlamydia should be considered when testing for N. gonorrhoeae.
Incubation period of Neisseria gonorrhoeae
The incubation period is usually 2–7 days.
Public health significance and occurrence of gonorrhoea
Gonorrhoea is common worldwide and affects both sexes. Infection may be symptomatic or asymptomatic. Infections of the cervix, anus and throat usually cause no symptoms. Gonorrhoea can have acute and chronic sequelae.
Strains of gonococci resistant to penicillin are common and widespread. Resistance to fluoroquinolone antibiotics such as ciprofloxacin is common among isolates from infections acquired in Asia. Ciprofloxacin resistance in gonococcal isolates in Victoria is increasing.
Gonorrhoea may increase susceptibility to the sexual acquisition of HIV infection and increase HIV infectiousness.
Other serious complications, such as blindness from neonatal conjunctival infection and the various complications of pelvic inflammatory disease, are currently rare in Victoria. The rate of notified cases of gonorrhoea increased in Victoria in the late 1990s to a level not seen since the mid 1980s. The increase involved men who have sex with men, who comprised approximately two-thirds of cases, and heterosexual men. A similar phenomenon was noted elsewhere in Australia and overseas. This increase has been sustained in Victoria, with a further quadrupling of rates over the past 10 years, although this may be partly due to more frequent and effective testing.
Reservoir of Neisseria gonorrhoeae
Humans are the reservoir.
Mode of transmission of Neisseria gonorrhoeae
Gonorrhoea is transmitted by contact with exudates from mucous membranes of infected people, almost always as the result of sexual activity.
Gonococcal conjunctivitis can occur in neonates who have had contact with the mother’s infected birth canal during childbirth.
Period of communicability of gonorrhoea
Communicability may extend for months in untreated individuals.
Susceptibility and resistance to gonorrhoea
Everyone is susceptible to infection.
Control measures for gonorrhoea
Preventive measures include education about safe sex practices, including use of condoms, and early detection of infection by testing of those at risk.
Control of case
Ceftriaxone plus azithromycin or doxycycline (to cover coexisting chlamydial infection) are used to treat gonorrhoea. Routine co-treatment might also hinder the development of antimicrobial-resistant N. gonorrhoeae. Ciprofloxacin is no longer recommended as an alternative to ceftriaxone unless a susceptible strain has been identified. Advice on the clinical management of patients with gonococcal infection can be found in Therapeutic guidelines: antibiotic and the National management guidelines for sexually transmissible infections.
Specialist consultation should be sought for complicated or disseminated infections, and for infection during pregnancy.
Control of contacts
Sexual partners of individuals with gonorrhoea should be examined and investigated, then treated empirically.
The department’s notification officers can assist with contact tracing.
Control of environment
Outbreak measures for gonorrhoea