Testing and Treatment Approach for Gonorrhea and Chlamydia
Nucleic acid amplification tests (NAATs) should be used as the primary diagnostic method for detecting gonorrhea and chlamydia infections, followed by appropriate antibiotic treatment based on test results. 1, 2
Diagnostic Testing
Recommended Specimen Types
- First-line specimen options:
Testing Considerations
- NAATs are preferred due to their high sensitivity (86-100%) and specificity (>97%) for both infections 1, 2
- The same specimen can be used to test for both chlamydia and gonorrhea simultaneously 1
- Culture is recommended in specific situations:
- All patients tested for gonorrhea should also be tested for other STIs, including chlamydia, syphilis, and HIV 1
High-Risk Populations (Who Should Be Screened)
- All sexually active females ≤24 years old (annual screening) 1, 3
- Females >24 years with risk factors:
- Men who have sex with men (at least annual screening) 3
- Individuals in communities with high prevalence 1
Treatment Approach
For Gonorrhea
- First-line treatment: Single 500mg dose of intramuscular ceftriaxone for individuals weighing <150kg 3
- Due to increasing quinolone resistance, fluoroquinolones like ciprofloxacin and ofloxacin should be avoided unless susceptibility is confirmed 1
- Antimicrobial resistance monitoring is essential as resistance patterns continue to evolve 1
For Chlamydia
- First-line treatment: Doxycycline 100mg orally twice daily for 7 days 3, 4
- Alternative regimen: Azithromycin 1g orally in a single dose 5
- For pregnant patients: Azithromycin is preferred due to safety profile 1
Dual Therapy Considerations
- Patients with gonorrhea should receive treatment effective against both gonorrhea and chlamydia due to frequent co-infection 1
- If chlamydia test results are not available or if a non-NAAT was negative for chlamydia, treat for both infections 1
- If a patient has a negative chlamydial NAAT at the time of gonorrhea treatment, co-treatment for chlamydia is not necessary 1
Follow-up and Partner Management
Post-Treatment Testing
- Retest all patients diagnosed with chlamydia or gonorrhea approximately 3 months after treatment due to high reinfection rates 1, 3
- For pregnant women: Test of cure 3-4 weeks after treatment 1, 3
Partner Management
- All sex partners from the preceding 60 days should be evaluated, tested, and treated 1
- Consider expedited partner therapy when partners cannot be linked to care 1, 6
- Patients should abstain from sexual intercourse until they and their partners have completed treatment and are asymptomatic 1
Patient Counseling
- Provide post-test counseling on safe sex practices to reduce transmission or reinfection 1
- Offer high-intensity behavioral counseling for patients with current or recent STIs 1
Common Pitfalls to Avoid
- Diagnostic errors: Don't rely on Gram stain for endocervical, pharyngeal, or rectal specimens as they lack sufficient sensitivity 1
- Treatment failures: Don't use quinolones for gonorrhea treatment without confirmed susceptibility due to increasing resistance 1, 7
- Inadequate follow-up: Failure to retest after 3 months may miss reinfections 1
- Missed co-infections: Always test for other STIs when testing for gonorrhea or chlamydia 1
- Partner treatment gaps: Failure to treat partners leads to high reinfection rates 1, 6
By following these evidence-based recommendations for testing and treatment, clinicians can effectively manage gonorrhea and chlamydia infections, reduce complications, and prevent transmission in the community.