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Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention

Self-Study STD Modules for Clinicians
        - Gonorrhea

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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 35-37 C.

To assist in diagnosis, culture samples should be taken from anatomic sites in response to complaints, clinical findings, and anatomic sites of exposure.

In men:

         The urethra should be tested routinely.

         The pharynx and rectum should be tested based on exposure history, including history of receptive anal sex or performing fellatio or cunnilingus, as most infections are asymptomatic at these sites.

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, as most infections are asymtomatic at these sites.

         Skenes glands or Bartholins 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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