At a glance

Why get tested?

To test for the presence of Neisseria gonorrhoeae, which causes the sexually transmitted disease gonorrhoea

When to get tested?

If you have symptoms of gonorrhoea or are pregnant or if you have had sexual contact with a person known to be onfected with Neisseria gonorrhoeae

Sample required?

A swab of secretion or discharge from the infected area and/or the first portion of urine

Test preparation needed?

None

What is being tested?

The test is looking for evidence of the bacterium Neisseria gonorrhoeae, which causes the sexually transmitted disease gonorrhoea. Gonorrhoea is usually easily treated but can cause severe reproductive and health problems if left untreated. If the organism can be cultured its susceptibilty to antimicrobials can be determined.

How is the sample collected for testing?

The type of sample collected will vary depending on which test for Neisseria gonorrhoeae is going to be performed, culture or PCR. For culture, a swab is used to get a sample of secretion or discharge from the infected area such as the cervix, urethra, penis, anus or throat. The swab may be inserted into the urethra at least 2 cm. The swab then may be rolled onto a slide (not smeared) to better preserve morphological characteristics. Cotton or wooden swabs should not be used because they may be toxic to fastidious organisms. For Nucleic Acid Amplification tests (NAATs) less material is required and a special swab (a “flocked” swab) is used. For genital infection the first portion of a urine sample is used. Many doctors will take a sample from more than one body site to increase the likelihood of finding the bacteria and will usually collect samples for NAAT or both NAAT and culture.

Is any test preparation needed to ensure the quality of the sample?

As Neisserias are relatively fastidious bacteria, when culture is attempted efforts should be made to minimise the transportation time between clinic and a laboratory. A black top swab with charcoal transport media are recommended for culture.

The Test

How is it used?

The test is used in two ways:

  • to diagnose the cause of symptoms, and
  • to screen sexually active people for sexually transmitted diseases.

A definitive diagnosis is important because gonorrhoea can resemble chlamydia infection and the two disorders require different treatment.

When is it requested?

A doctor may request the test if you have symptoms such as (for women) a yellow or bloody vaginal discharge, bleeding associated with vaginal intercourse or burning/painful urination; or (for men) pus discharging from the penis or a burning sensation during urination.

What does the test result mean?

Several tests can be performed:

  1. Gram stain for Neisseria gonorrhoeae is a quick and inexpensive test that works by detecting incomplete phagocytosis of Gram-negative diplococci (the gonorrhoea bacteria) under a microscope. The presence of bacteria resembling Neisseria gonnorhoea in a man is diagnostic of Gonnorhoea, however in women the presence of other species of Neisseria in the genital tract means that Gram staining can give false positive results.
  2. Bacterial culture remains the ‘gold standard’ for diagnosis of gonococcal infection. The drawback of this method is slow turn-around time (48-72 hours) and lower rates of detection of Gonorrhoea. Blood culture is important when disseminated infection is clinically suspected.
  3. Nucleic acid amplification based techniques (polymerase chain reaction (PCR), ligase chain reaction (LCR) and others) are sensitive, specific, quick and less affected by delays in the transportation of specimens to a laboratory.
  4. A positive test indicates an 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.
About Reference or “Normal” Ranges

Is there anything else I should know?

While many men with gonorrhoea will experience symptoms, most women do not or they are mistaken for a bladder or other vaginal infection. For men, symptoms usually appear within 2 to 5 days of infection, but can take up to 30 days; for women, those who have symptoms usually experience them within 10 days of infection. Symptoms include, for females, burning or painful urination, increased vaginal discharge and sometimes bleeding between menstrual periods or brought on by vaginal intercourse. For men, symptoms include a white, yellow or green discharge from the penis, a burning sensation when urinating and sometimes painful or swollen testicles. Symptoms of rectal infection include discharge, itching and painful bowel movements. If you test positive for gonorrhoea, you should also be screened for other sexually transmitted diseases and your sexual partner(s) should be tested and treated as well.

If you are infected, your risk of contracting other sexually transmitted diseases increases, including HIV, the virus that causes AIDS.

The diagnosis of a sexually transmitted disease should not be ruled out if the test is negative; patients' clinical symptoms and history should also be considered.

Common Questions

What are the symptoms of gonorrhoea?

For women, early symptoms (which are often mistaken for a bladder or vaginal infection) include bleeding brought on by vaginal intercourse, burning/painful urination and a yellow or bloody vaginal discharge. For men, early symptoms include a discharge of pus from the penis, pain in the penis and a burning sensation when urinating. Symptoms of rectal infection include discharge, itching and painful bowel movements with blood on the faeces.

The symptoms usually appear 2 to 10 days after sexual contact with an infected partner. The early symptoms can be mild and most women and many men can be infected without showing any symptoms.

What will happen if I don’t get treated?

The natural history of gonorrhoea is spontaneous resolution after weeks or months of unpleasant symptoms, during which time transmission of the organism is likely. In some individuals untreated gonorrhoea will lead to severe complications. Women can develop pelvic inflammatory disease (PID), an infection that spreads from the vagina and cervix to the uterus and fallopian tubes. PID can cause scarring of the fallopian tubes, which can lead to ectopic (or tubal) pregnancy or sterility. The symptoms of PID include heavier periods with more cramps, abnormal mucus discharges, pain in the lower abdomen, weakness, fever, vomiting and pain during intercourse. If infected during pregnancy the organism can be transmitted to their baby during birth.

Other long-term complications include abscesses and infection around the liver. In men, the infection can lead to an inflammation of the testicles that can result in sterility. The bacteria can also spread to the bloodstream and infect the joints, heart valves or brain, resulting in long-term or permanent organ damage.

How is gonorrhoea transmitted?

It is generally transmitted through sexual contact (oral, vaginal or anal) with an infected partner. An infected mother can spread the disease to her baby during childbirth.

How is it treated?

Gonorrhoea can be treated with a course of antibiotics.

How can it be prevented?

For information on prevention, see Safe sex and Sexual health.

Last Review Date: December 19, 2015