Gonorrhea laboratory tests

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Empiric treatment for gonorrhea is usually initiated prior to the receipt of laboratory results. A microbiologic diagnosis is important for further management in order to determine the need for test of cure, partner management, and for public health reasons. Any sexually active man or women presenting with signs and symptoms of urethritis, cervicitis, pelvic inflammatory disease, or epididymitis should undergo diagnostic testing for Neisseria gonorrhea. Additionally, disseminated gonococcal infection (DGI) should be considered in all young, sexually active individuals who present with arthralgias or suspected septic arthritis. Common laboratory tests for gonococcal infection may include Gram stain, culture, nucleic acid amplification tests (NAAT), and non-amplified tests. Nucleic acid amplification tests (NAATs) are the test of choice in all individuals who present with urogenital symptoms.[1][2] Additionally, synovial fluid analysis is usually sent for cell count, differential, Gram stain, bacterial culture, and NAAT in patients with suspected DGI.[3]

Laboratory tests

Several laboratory tests are available to diagnose gonorrhea. A clinician can obtain a sample for testing from the parts of the body most likely to be infected (e.g., cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample.[1][4]

Diagnostic Techniques

Gram stain

Cultures

Culture (Thayer-Martin medium) is the historical standard for detection of Neisseria gonorrhea.

Nucleic Acid Amplification Tests (NAATs)

NAATs are the gold standard for diagnosing gonococcal infections.

Amplified tests include:[1][8][9]

NAAT is FDA-cleared for:

  • Endocervical swabs from women
  • Urethral swabs from men
  • Urine specimens from both males and females
  • Vaginal swabs

NAAT is not FDA-cleared for detection of rectal, oropharyngeal, or conjunctival gonococcal infection.

  • There is a concern about cross-reactivity with other Neisseria species when used at the oropharyngeal site.[7]

Non-amplified tests

Non-amplified tests used for Neisseria gonorrhea include:

  • DNA probe (e.g., Gen-Probe PACE 2 and Digene Hybrid Capture II)

Antimicrobial susceptibility cannot be determined with these tests. However, the same specimen can be evaluated for Chlamydia trachomatis.

Non-disseminated gonococcal infection

Empiric treatment for gonorrhea is usually initiated prior to receipt of laboratory results. However, a microbiologic diagnosis is important for further management in order to determine the need for test of cure, partner management, and for public health reasons. Any sexually active man or women presenting with signs and symptoms of urethritis, cervicitis, pelvic inflammatory disease, or epididymitis should undergo diagnostic testing for Neisseria gonorrhea.

Men with urogenital presentation

  • Urethral swabs or first-catch urine (20 to 30 mL of the initial urinary stream) specimens for NAAT are tests of choice
  • Positive Gram stain of urethral swab is also sufficient, in which case NAAT is not necessary
  • Urethral swab specimens for Gram stain, culture, antigen detection, and genetic probe methods are also acceptable (if NAAT is unavailable)

Women with urogenital presentation

Men and women with extragenital presentation

Disseminated gonococcal infection

In general, disseminated gonococcal infection (DGI) should be considered in all young, sexually active individuals (young women and all men who have sex with men) who present with arthralgias, joint pain, or suspected septic arthritis.

  • Gonococcal arthritis and DGI are associated with mild leukocytosis and elevated ESR in about 50% of patient.[10]

Common laboratory findings of disseminated gonococcal infection (DGI) may include the following:[2]

Blood Culture

Synovial fluid

Mucosal sites specimens

Skin lesion specimens

References

  1. 1.0 1.1 1.2 1.3 1.4 "Sexually transmitted diseases treatment guidelines (2015)." Reproductive Endocrinology 24 (2015): 51-56.http://www.cdc.gov/std/tg2015/gonorrhea.htm Accessed on September 2015
  2. 2.0 2.1 Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.
  3. 3.0 3.1 Muralidhar B, Rumore PM, Steinman CR (1994). "Use of the polymerase chain reaction to study arthritis due to Neisseria gonorrhoeae". Arthritis Rheum. 37 (5): 710–7. PMID 8185698.
  4. 4.0 4.1 Unemo M, Ison C. 2013. Gonorrhoea, p 21–54 In Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus. World Health Organization (WHO), Geneva, Switzerland
  5. Centers for Disease Control and Prevention (2014) Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep 63 (RR-02):1-19. PMID: 24622331
  6. 6.0 6.1 6.2 Centers for Disease Control and Prevention. Public Health Image Library (PHIL) https://phil.cdc.gov/phil/quicksearch.asp Accessed on September 22, 2016
  7. 7.0 7.1 Papp, John R., et al. "Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae—2014." MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports/Centers for Disease Control 63 (2014): 1.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm
  8. Schachter J, Moncada J, Liska S, et al. Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sex Transm Dis 2008;35:637–42.
  9. Bachmann LH, Johnson RE, Cheng H, et al. Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae oropharyngeal infections. J Clin Microbiol 2009;47:902–7.
  10. García-De La Torre, Ignacio, and Arnulfo Nava-Zavala. "Gonococcal and nongonococcal arthritis." Rheumatic Disease Clinics of North America 35.1 (2009): 63-73.
  11. Liebling MR, Arkfeld DG, Michelini GA, Nishio MJ, Eng BJ, Jin T; et al. (1994). "Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction". Arthritis Rheum. 37 (5): 702–9. PMID 8185697.
  12. Goldenberg, D. L. "Gonococcal arthritis and other Neisserial infections." Arthritis and allied conditions, 12th ed. Philadelphia: Lea and Febiger (1993): 2025-33.
  13. Read P, Abbott R, Pantelidis P, Peters BS, White JA (2008). "Disseminated gonococcal infection in a homosexual man diagnosed by nucleic acid amplification testing from a skin lesion swab". Sex Transm Infect. 84 (5): 348–9. doi:10.1136/sti.2008.030817. PMID 18809698.


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