Chapter last reviewed and updated in September 2018.
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 test for diagnosis
Laboratory definitive evidence for a confirmed case requires at least one of the following:
- isolation (culture) of N. gonorrhoeae from a clinical specimen
- detection of N. gonorrhoeae nucleic acid (eg, nucleic acid amplification test, NAAT, or polymerase chain reaction, PCR).
- Specificity of NAAT/PCR tests may be lower for non-genital sites. Many laboratories carry out supplementary testing, depending on the test regime they use.
- Culture remains important for the ongoing surveillance of antimicrobial resistance.
Spread of infection
Usually 1 to 14 days (but can be longer) for symptomatic cases, with most of the cases symptomatic 2 to 5 days after infection.
Mode of transmission
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.