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Page last reviewed: July 2012
Page last updated: April 2013
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 is the historical standard for detection of N. gonorrhoeae. It has several advantages over non-culture tests, including:
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 anatomic sites of exposure.
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.
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.
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.