• Notifications of gonorrhoea with antimicrobial resistance (AMR) are increasing in NSW
• If symptomatic, ensure a swab is collected for culture and antimicrobial sensitivities
• Take swabs for culture following any positive nucleic acid amplification test (PCR)
• Follow Australian STI management guidelines for patients diagnosed with gonorrhoea:
o treat with IM ceftriaxone PLUS oral azithromycin
o confirm partners have been notified and tested
o perform a PCR test of cure 2 weeks after treatment
Current situation
• Gonorrhoea notifications in NSW increased by almost 20% from 2022 to 2023, and further in 2024
• Notifications with resistance to azithromycin or ceftriaxone are increasing rapidly
• Cases include heterosexual males and females, sex workers, and men who have sex with men (MSM)
from a broad age range
• Globally there is evidence of further emergence of extensively drug resistant gonorrhoea, which is
difficult to treat
Swab for culture – this is critical for detecting antimicrobial resistance
• If symptomatic (discharge, dysuria), swab for culture at relevant sites (rectum, urethra/endocervix)
• If PCR positive swab/urine, take swabs for culture before initiating treatment, but don’t delay treatment
Other testing
• For MSM patients, ensure samples for PCR have been collected from all 3 sites (urine, throat, rectum)
as per recommendations for asymptomatic screening in the Australian STI management guidelines
https://sti.guidelines.org.au/populations-and-situations/men-who-have-sex-with-men/
• Test for other STIs, including blood for HIV and syphilis serology
Always treat confirmed or suspected gonorrhoea
• IM ceftriaxone 500mg (in 2mL of 1% lignocaine) AND oral azithromycin (dose based on infection
site)
o For ano-genital gonorrhoea, use azithromycin 1g stat
o For oro-pharyngeal gonorrhoea, use azithromycin 2g stat
• Patients already treated for ano-genital gonorrhoea on clinical grounds with ceftriaxone and 1g
azithromycin do not require re-treatment with azithromycin 2g if pharyngeal infection is detected
• Do not use ciprofloxacin, penicillin or tetracycline for treatment of gonorrhoea
Follow up after treatment
• Advise symptomatic patients to return if symptoms have not resolved within 48 hours
• Undertake a PCR test of cure 2 weeks after treatment and test for re-infection at 3 months
• If test of cure or retesting is positive, seek specialist advice
Contact tracing is a high priority and the responsibility of the treating clinician to discuss with patients
• Partner notification is essential for all cases to control gonorrhoea and prevent re-infection
• The Sexual Health Infolink (SHIL 1800 451 624) can provide assistance, and the following websites
can help patients to tell their partners: www.letthemknow.org.au, www.thedramadownunder.info (for
MSM), www.bettertoknow.org.au (for Aboriginal and/or Torres Strait Islander people)
• Advise all cases to avoid sexual contact for 7 days after treatment is commenced or until symptoms
resolve, whichever is later, and to not have unprotected sex with partners from the last 2 months until
these partners have been tested and, if positive, treated
Get expert advice and referrals when needed
• For AMR infections, discuss with your local sexual health service or local ID physician
• SHIL provides expert sexual health clinical advice on treatment failure, ceftriaxone allergy and
complicated infections
• Call SHIL on 1800 451 624 Monday to Friday 9am-7pm and select option 1 to be prioritised for health
professional support
Further information - Australian STI management guidelines www.sti.guidelines.org.au