What is the recommended timing and method for a gonorrhea test of cure after completing treatment?

Gonorrhea Test of Cure: Timing and Method

A test of cure for gonorrhea should be performed 1 week after treatment if alternative regimens are used (non-ceftriaxone treatments), with culture being the preferred method when available, or NAAT if culture is not available. 1

When to Perform Test of Cure

• Routine test of cure is NOT recommended for patients who receive the standard recommended treatment (ceftriaxone 250 mg IM plus azithromycin 1 g orally) for uncomplicated urogenital or rectal gonorrhea 1, 2

• Test of cure IS recommended in the following situations:

  • Patients treated with alternative regimens (cefixime 400 mg orally or azithromycin 2 g orally) should return for test of cure 1 week after treatment 1
  • Patients with pharyngeal gonorrhea (more difficult to eradicate than urogenital/rectal infections) 2
  • Patients with persistent symptoms after treatment 1, 2
  • Cases of suspected treatment failure 1

Preferred Testing Methods

• Culture is the ideal method for test of cure as it:

  • Allows for antimicrobial susceptibility testing 1
  • Is essential in cases of suspected treatment failure 1
  • Should be performed at the infected anatomic site 1

• If culture is not available, NAAT (Nucleic Acid Amplification Test) can be used:

  • Wait at least 7 days after treatment when using RNA-based NAATs 3, 4
  • Wait at least 14 days after treatment when using DNA-based NAATs 3, 5
  • Be aware that NAATs may detect residual DNA/RNA from dead organisms, potentially leading to false positives if performed too early 1, 3

Special Considerations

• For suspected treatment failures:

  • Obtain specimen for culture and antimicrobial susceptibility testing 1
  • Report the case to local public health officials within 24 hours 1
  • Consult an infectious disease specialist 1
  • Consider alternative treatment regimens based on susceptibility results 1

• Interpretation of positive test of cure results:

  • A positive NAAT result 2-3 weeks after treatment, in the absence of re-exposure, is indicative of treatment failure 1
  • Be aware of possible "blips" (isolated positive results after clearance) which occur in approximately 0.8-4.4% of cases depending on the NAAT type 3
  • Consider the possibility of reinfection from untreated partners 1, 2

Partner Management

• All sex partners from the preceding 60 days should be evaluated and treated 1, 2
• Patients should avoid sexual intercourse until therapy is completed and both they and their partners are asymptomatic 2
• If partners' treatment cannot be ensured, consider expedited partner therapy 1, 2

Common Pitfalls to Avoid

• Testing too early: Median time to clearance is approximately 2 days, but can range up to 7-15 days depending on the test type 3
• Failing to obtain culture in treatment failure cases: Culture is essential for antimicrobial susceptibility testing 1
• Not considering pharyngeal infections: These are more difficult to eradicate and may require test of cure even with standard treatment 2
• Not addressing partner treatment: Untreated partners are a common source of reinfection 1, 2