A definitive diagnosis is important because symptoms of gonorrhea can resemble chlamydia clinically and the two disorders require different treatment. Since the disorders have similar symptoms, doctors often test for Neisseria gonorrhoeae and Chlamydia trachomatis simultaneously.
There are several methods available, but the preferred methods of testing for gonorrhea currently are molecular tests, including the nucleic acid amplification test (NAAT). NAAT allows testing of the widest variety of specimen types, including endocervical swabs, vaginal swabs, urethral swabs (men), and urine (from both men and women). The sensitivity of NAATs for the detection of N. gonorrhoeae is superior to culture.
The Centers for Disease Control and Prevention (CDC) recommends that victims of sexual assaults get NAAT testing for both C. trachomatis and N. gonorrhoeae, which are among the diseases most commonly transmitted in such cases, so that they can receive treatment if infected. However, molecular tests should not be used to verify cases with legal implications such as sexual assault. Until the legal system changes, only a positive culture result proving infection with gonorrhea is admissible in court.
In men, a quick method that may be used in a clinic or doctor's office is the gram stain, which allows the doctor to look at a sample from the urethra for the presence of the bacteria using a microscope. While this method can diagnose gonorrhea, it is not sufficient to rule out an infection in asymptomatic men. This method is not reliable for samples from women.
A health care provider may order a gonorrhea test if a person has symptoms, such as (for women) increased vaginal discharge, bleeding associated with vaginal intercourse, or burning/painful urination; or (for men) pus discharging from the penis, a burning sensation during urination, or proctitis (inflammation of the rectal or anal area). However, because many infected people do not have any symptoms, a number of organizations have published screening recommendations.
The U.S. Centers for Disease Control and Prevention (CDC), U.S. Preventive Services Task Force (USPSTF), the American Academy of Family of Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) recommend gonorrhea screening for sexually active women at increased risk. This may include women under the age of 25 and those with a new or multiple sex partners as well as other risk factors. The CDC and ACOG specifically recommend annual screening.
These organizations do not recommend routine screening for sexually active, heterosexual males. Health care providers may, however, use their judgment and consider risks, such as prevalence of these STDs in the community. The CDC does recommend that sexually active men who have sex with other men have gonorrhea screening at least annually.
A person may be at increased risk for gonorrhea if they:
For pregnant women, the CDC recommends screening at-risk women for gonorrhea during the first prenatal visit. Those diagnosed with gonorrhea during the first trimester should be retested within 3 to 6 months, preferably in the third trimester. (See Pregnancy & Prenatal Testing.)
Testing for both chlamydia and gonorrhea may be done when a newborn has symptoms of conjunctivitis, such as redness and swelling of the eye, and discharge.
A positive test indicates an active infection that requires treatment with a course of antibiotics.
A negative test means only that there is no evidence of disease at the time of the test. It is important for those who are at increased risk of infection to have screening tests performed on a regular basis to check for possible exposure.
If you are infected, your sexual partner(s) should also be tested and treated as well.
Molecular tests are only FDA-approved for use with urine samples or samples from genital sites such as the vagina and penis; they have not been FDA-approved for performance with ocular (eye), pharyngeal (throat), or rectal samples. Individual laboratories may perform molecular testing on these samples, but they are required to validate the methods themselves.
This article was last reviewed on September 27, 2012. | This article was last modified on June 25, 2014.
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