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Diagnostic Methods
A complex array of technologies is available for laboratory diagnosis of Neisseria gonorrhoeae. This technology has changed significantly over the past 10 years and represents a vast improvement in
sensitivity and
specificity. Tests include both culture and non-culture diagnostics.
The most commonly used newer non-culture tests are nucleic acid detection tests, which include both amplified and non-amplified tests and are used for both diagnosis and screening.
Gram stain, another non-culture test, is used for the diagnosis of gonorrhea in symptomatic males.
Culture
Culture is the historical standard for detection of N. gonorrhoeae. It has several advantages over non-culture tests, including:
- Low cost
- Suitable for a variety of specimen sites
- Antimicrobial susceptibility testing can be
performed
Thayer-Martin medium is one example of a medium used for N. gonorrhoeae culture. Direct inoculation of culture plates with swab specimens is best. The inoculated culture plate should be promptly placed into a CO2-enriched (3%-10%) environment and incubated at 35º-37º C.
To assist in diagnosis, culture samples should be taken from anatomic sites in response to complaints,
clinical findings, and exposure history.
In men:
- The urethra should be tested routinely.
- The pharynx and rectum should be tested depending on symptoms and exposure history, including history of receptive anal sex or performing fellatio or cunnilingus.
In women:
- The cervix should be tested routinely.
- The pharynx and rectum should be tested if there is a history of receptive anal sex or performing fellatio or cunnilingus.
- Skene’s glands or Bartholin’s glands may be cultured if overt exudate
is expressed.
- The vagina or urethra may be tested if the cervix is absent.
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