Indication

• Screening
  • Females: When pelvic examination is indicated
  • Males: Urine might be more acceptable to asymptomatic males
• Endocervicitis
• Urethritis (males)
• Diseases at other anatomic locations possibly caused by sexually acquired N. gonorrhoeae infection
  • Pelvic inflammatory disease
  • Urethral syndrome
  • Bartholinitis
  • Epididymitis
  • Perihepatitis (Fitz-Hugh-Curtis syndrome) (females)
  • Proctitis
  • Disseminated gonococcal infections
  • Conjunctivitis
• Not recommended for prepubertal children

Test selection

• Gram-stained smear as a point-of-care test for males with urethral discharge
  • For males with urethral discharge, the sensitivity and specificity are similar to culture with oxidase testing and Gram-staining of any colonies with N. gonorrhoeae morphology
  • Culture after a positive Gram-stained smear might be useful for quality assurance, but additional testing is not usually otherwise indicated
• Culture
  • Preferred if ambient conditions during holding and transport of inoculated media are adequate to maintain the viability of organisms
    Sensitivity and specificity of culture with additional testing approaches or surpasses that of other tests
    A culture isolate should be tested for antimicrobial resistance if a patient fails therapy
    Culture allows monitoring for antimicrobial resistance
• Nucleic acid amplification tests (NAATs) or nucleic acid hybridization tests
  • Recommended when conditions during holding and transport of inoculated culture media are not adequate to maintain the viability of organisms
  • Commercial polymerase chain reaction (PCR)* and strand displacement assays †; have cross-reacted with nongonococcal Neisseria; such cross-reactivity has not been reported for commercial ligase chain reaction (LCR) and unamplified probe assays
• Additional testing is recommended after an initial positive screening test if a low positive predictive value can be expected or if a false-positive result would have serious psychosocial or legal consequences

Indication

• Conjunctivitis among adults
• Newborn or infant
  • Neonatal conjunctivitis

Test selection

• Gram stain as point-of-care test
  • Recommended to establish a presumptive diagnosis of N. gonorrhoeae during a patients visit for conjunctivitis
  • Adequate sensitivity because of high concentration of organisms
  • Gram stain should be followed by laboratory-based testing because Gram-negative diplococci other than N. gonorrhoeae are occasionally isolated from conjunctiva
• Culture
  • Preferred

    High sensitivity because of high concentration of organisms

    Oxidase-positive and Gram-stain positive bacteria other than N. gonorrhoeae occasionally isolated from conjunctiva

    Inoculation onto nonselective media might increase sensitivity

• Only a limited number, if any, nonculture tests are FDA-cleared for conjunctival specimens

Test selection

• Gram stain as point-of-care test
  • Recommended on any synovial fluid and cerebrospinal fluid collected for other tests and on endocervical and urethral swab specimens
  • Gram stain should be followed by laboratory-based testing, which is ore sensitive and specific
• Culture
  • Preferred
  • Blood, synovial fluid from affected joints, and, if indicated, cerebrospinal fluid specimens should be inoculated onto nonselective as well as selective medias
  • Swab specimens from the endocervix (adult female), vagina (neonate), urethra (adult male), rectum, and pharynx should be inoculated onto selective media
  • Additional testing recommended after an initial positive test to verify diagnosis
• No other tests are recommended