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Gonorrhoea is the most commonly reported notifiable disease in Australia. It is contagious and mainly spread by sexual intercourse. It predominantly affects mucosal and glandular structures of the genital tract and, less commonly, the rectum, oropharynx or conjunctivae. The causative organism is Neisseria gonorrhoeae, a fastidious, gram negative, kidney -shaped diplococcus.

B-lactamase (penicillinase) producing N gonorrhoeae (PPNG) is resistant to penicillin and is common in South East Asia and endemic in Australia. Spectinomycin and cephalosporins are effective in treating these infections. Spectinomycin-resistant PPNG strains have been reported but are not yet a problem. A high incidence of PPNG indicates poor STD control. Although the total number of cases of gonorrhoea in Australia has been falling for several years, the proportion of cases with PPNG infection is increasing.

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The following aspects of the patient’s sexual history should be explored:

What recent sexual contacts including regular partners, casual partners, prostitutes etc. has the patient had?

Has the patient ever had homosexual contacts?

If contacts have included homosexual encounters, what form did the encounters take?

Did a partner have STD or was a partner in a risk group for STD (illicit drug user, prostitute, bisexual man etc.)?

Have there been sexual contacts in overseas countries (e.g. South East Asia, other tropical or third world countries or the United States)?

If oral or anal sex was involved, did the patient take an insertive or receptive role?

Have condoms and other appliances or apparatus been used?

Information about contacts is sought to identify the source contact and to identify people to whom the infection may have been spread. Patients are often incorrect in attributing the source of infection. Remember to enquire specifically about sexual contact with the spouse or regular partner subsequent to infectioa

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