Need to know:

Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae, a Gram-negative diplococcus (see figure 1). Notifications have been increasing, although in 2020 there were 29,497 gonorrhoea notifications in Australia,¹ a slight decrease on previous years, likely due to changes in sexual behaviour and restrictions reducing testing during the COVID-19 pandemic. The true burden of gonorrhoea is likely much higher than notifications suggest because of asymptomatic infection and under-testing.

Infections are transmitted through sexual contact and occur in the pharynx, urethra, cervix and rectum. Vertical transmission from mother to newborn may also occur. Infections have disproportionately affected gay, bisexual and other men who have sex with men and Aboriginal and Torres Strait Islander people in remote areas.¹ Higher rates have also been seen in gay, bisexual and other men who have sex with men who are taking HIV pre-exposure prophylaxis (PrEP).² Asymptomatic gonorrhoea in the pharynx and rectum is infectious and can be transmitted via various forms of sexual contact including kissing, oral sex, anal sex and oro-anal contact. 

Gonorrhoea is a readily identifiable and treatable infection, although over time, the gonococcus has developed resistance to multiple classes of antibiotics, which has limited treatment options. Adequate treatment with antibiotics ends the infectious state, preventing further transmission. As such, it is vital for sexual health and primary care physicians to be vigilant and consider testing and treatment, particularly in populations at risk.