Gonorrhoea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It is one of the most common STIs worldwide and remains an important public health issue in Australia as well as globally.

The infection usually affects the genitals, throat, and rectum, and can occasionally infect the eyes. A major concern is that many people have no symptoms, especially women and those with throat or rectal infection. This means the infection can spread unknowingly to others.

Treatment is normally straightforward with antibiotics. However, antibiotic resistance is increasing worldwide, making management more challenging. Untreated gonorrhoea can lead to pelvic inflammatory disease, infertility, and, rarely, serious bloodstream infections.

In recent years, the number of gonorrhoea cases has been increasing both in Australia and globally, particularly among younger adults. Regular testing, safe sex practices, and early treatment are essential.

Symptoms

• Men (urethra): burning on urination, pus-like discharge.
• Women (cervix): changes in discharge, bleeding after sex, pelvic pain (often none).
• Rectum: discharge, itching, pain.
• Throat: usually no symptoms.
• Eyes: red, swollen eye with pus (urgent).

Testing at our clinic

• Urine test or swabs from cervix/vagina, throat, and rectum (NAAT test).
• Additional STI testing is also available.

Treatment

• Genital/rectal infection:
  Ceftriaxone 500 mg intramuscular (IM) injection + Azithromycin 1 g oral, single dose.
• Throat infection:
  Ceftriaxone 500 mg IM injection + Azithromycin 2 g oral, single dose.

Ceftriaxone is not available as a tablet. It must be given as an injection into the muscle, which requires attending our clinic for safe administration by a doctor or nurse.

After treatment

• No sex for 7 days after treatment (or until symptoms resolve).
• Test of cure (TOC): 2 weeks after treatment for throat infections.
• Re-test at 3 months to check for reinfection.

Partner management

• Sexual partners from the past 2 months should be notified and tested/treated.
• Our clinic can assist with partner notification, and Queensland Health provides additional support.

Trends: Australia vs Global

Australia

• In 2023, there were 40,029 reported cases of gonorrhoea.
• This represents a 127% increase compared to 2014.
• The rate rose from 67.9 per 100,000 people in 2014 to 153.9 per 100,000 in 2023.
• About 69% of cases are in men, with the highest rates in people aged 20–39 years.

Worldwide

• The World Health Organization (WHO) estimates there are over 82 million new cases of gonorrhoea globally each year.
• The Western Pacific region (including Australia, Southeast Asia, and the Pacific) has some of the highest rates worldwide.
• Rising antimicrobial resistance is a global concern: strains resistant to ceftriaxone and azithromycin have been reported in Asia, Europe, and North America.
• WHO has classified gonorrhoea as a “priority pathogen” due to the risk of becoming untreatable in the future.

References

1. Australian STI Management Guidelines – Gonorrhoea
   https://sti.guidelines.org.au/sexually-transmissible-infections/gonorrhoea/
2. Kirby Institute, UNSW Sydney. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2024
   https://kirby.unsw.edu.au/report/annual-surveillance-report-2024
3. WHO – Global and regional estimates of sexually transmitted infections
   https://www.who.int/news/item/06-07-2023-who-sti-estimates
4. WHO Western Pacific Region Gonococcal Antimicrobial Surveillance Programme (GASP) Reports 2023
   https://www.who.int/westernpacific/activities/gonococcal-antimicrobial-surveillance-programme
5. Australian Department of Health – Gonorrhoea notifications (NNDSS Data)
   https://www.health.gov.au/topics/sexually-transmissible-infections/data/gonorrhoea
6. CDC (US) – Gonorrhea: Signs and Symptoms
   https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm