Current situation
• Gonorrhoea notifications in NSW almost doubled from 2022 to 2024, with over 14,000 notifications in 2024. This is
the highest number of gonorrhoea notifications ever received in one year.
• There is an increase in the prevalence of multidrug resistant (MDR) and extensively drug resistant (XDR)
gonococcal infection with cases of XDR cases emerging globally especially in South-East Asia.
• MDR and XDR gonorrhoea are determined by their levels of resistance to both ceftriaxone and
azithromycin on culture-based susceptibility testing.
• NSW recorded two XDR gonorrhoea cases in March 2025. One was acquired in Cambodia, while the
other is a locally acquired case with unknown source.
History-taking and testing of cases
• Obtain travel history as part of history-taking. Have a high index of suspicion for drug-resistant gonorrhoea if
the patient has recently travelled overseas, particularly to South-East Asia.
• If symptomatic, collect appropriate swab(s) for culture and PCR from relevant sites.
• Collect a swab for culture before starting treatment for PCR-positive gonorrhoea to enable detection of
antimicrobial resistance.
• Opportunistically screen for other STIs, including chlamydia, syphilis, HIV, and hepatitis B.
Treatment – correct treatment of gonorrhoea prevents the emergence of resistant strains
• For ano-genital gonorrhoea, treat with IM ceftriaxone 500mg (in 2mL of 1% lignocaine) and oral
azithromycin 1g stat.
• For oro-pharyngeal gonorrhoea, treat with IM ceftriaxone 500mg (in 2mL of 1% lignocaine) and oral
azithromycin 2g stat.
• Treatment with ceftriaxone and azithromycin for positive gonorrhoea PCR-postiive cases can be
initiated while waiting for culture results.
• Treatment for MDR and XDR gonorrhoea can be discussed with your local sexual health service or
infectious diseases physician.
Follow up after treatment - test of cure is recommended for all gonorrhoea cases
• Advise patients to avoid sexual contact for 7 days after treatment is commenced or until symptoms
resolve (whichever is later) and avoid unprotected sex with untested or untreated sexual partners from
the last 2 months.
• Test of cure should be performed from each site of infection by PCR 2 weeks after treatment is
completed.
Contact tracing is a high priority and the responsibility of the treating clinician to discuss with patients
• Contact tracing is essential for all people with gonorrhoea to reduce transmission and prevent reinfection. All partners should be traced back for a minimum of 2 months.
• The following websites can help patients to tell their partners: www.letthemknow.org.au,
www.thedramadownunder.info (for men who have sex with men), and www.bettertoknow.org.au (for
Aboriginal and/or Torres Strait Islander people)
• NSW Sexual Health Infolink (SHIL) can help on 1800 451 624 between Monday to Friday 9am-7pm.
Further information is available at https://sti.guidelines.org.au/
Thank you for testing, treating and contact tracing gonorrhoea.
Dr Christine Selvey PSM
Director, Communicable Diseases Branch, Health Protection NSW
28 March 2025