Gonorrhoea (limited chapter)

February

• Extensively drug-resistant (XDR) gonorrhoea – new section.
• Direct laboratory notification process – new subsection.

For an overview of all updates made to the Communicable Disease Control Manual, see Updates to the Communicable Disease Control Manual – Health New Zealand | Te Whatu Ora.

Clinical evidence is not required for notification; for surveillance purposes, only laboratory-confirmed gonorrhoea is notifiable.

Infections due to Neisseria gonorrhoeae can cause dysuria and/or urethral discharge in males and dysuria and/or vaginal discharge in females. Asymptomatic genital infection occurs in up to 5 percent of males and 50 percent of females. Pharyngeal and rectal infections are usually asymptomatic. Untreated gonococcal infection may lead to serious disease, including pelvic inflammatory disease in females, epididymo-orchitis in males, and disseminated disease and severe conjunctivitis in neonates.

• Under investigation: A case that has been notified, but information is not yet available to classify it as a confirmed case.
• Probable: Not applicable.
• Confirmed: Laboratory definitive evidence.
• Not a case: A case that has been investigated and subsequently found not to meet the case definition.

Laboratory definitive evidence for a confirmed case requires at least one of the following.

• Isolation of Neisseria gonorrhoeae from a clinical specimen.
• Detection of N. gonorrhoeae nucleic by polymerase chain reaction (PCR).

Note:

1. Specificity of PCR tests may be lower for non-genital sites. Many laboratories carry out supplementary testing, depending on the test regime they use.
2. Culture remains important for the ongoing surveillance of antimicrobial resistance.

Refer to Appendix 4: Direct laboratory notification of communicable diseases flowcharts for the direct laboratory notification process for gonorrhoea.

Reservoir

Humans.

Incubation period

Usually 1 to 14 days (but can be longer) for symptomatic cases, with most of the cases symptomatic 2 to 5 days after infection.

Transmission is through exudates from mucous membranes of infected people infecting other mucosal surfaces by:

• sexual contact (oral, vaginal, or anal)
• sexual practices such as fingering, or sharing of sex toys
• vertical transmission from mother to baby at delivery (e.g. neonatal conjunctivitis).

Disease may be communicable for months in untreated cases.

For information on case management and contact tracing and management, please refer to the New Zealand Sexual Health Society’s gonorrhoea management guidelines (external link).

Extensively drug resistant (XDR) gonorrhoea is characterised by high-level resistance and decreased susceptibility to first-line antibiotics (azithromycin and ceftriaxone) used in the treatment of gonorrhoea. If a case is not already under the care of a sexual health physician, management should be transferred to one, where available.

The requesting clinician remains responsible for overall case management, including contact tracing, which particularly important in XDR cases. Contacts of XDR cases should have culture swab taken from relevant sites, in addition to PCR swab samples.

Sexual health clinicians should discuss any XDR cases with their local medical officer of health, without providing identifying information unless requested. While specific public health service actions may be not always be needed, assistance may be required in situations such as non-adherence to treatment or follow up, multiple anonymous sexual contacts, circumstances requiring broader awareness-raising, or where communication with overseas public health units is needed (e.g. infection acquired overseas or overseas contacts identified).