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Image: Gonorrhea05.jpeg|Intracellular Gram-negative diplococcal<ref name=CDCGonorrheapic>Centers for Disease Control and Prevention. Public Health Image Library (PHIL) http://phil.cdc.gov/phil/details.asp Accessed on September 22, 2016</ref>
Image: Gonorrhea05.jpeg|Intracellular Gram-negative diplococcal<ref name=CDCGonorrheapic>Centers for Disease Control and Prevention. Public Health Image Library (PHIL) http://phil.cdc.gov/phil/details.asp Accessed on September 22, 2016</ref>
</gallery>
</gallery>
===Cultures===
===Cultures===
Culture is the historical standard for detection of ''[[Neisseria gonorrhea]]''.
Culture is the historical standard for detection of ''[[Neisseria gonorrhea]]''.
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**[[Synovial fluid]] culture
**[[Synovial fluid]] culture
**[[Blood cultures]]
**[[Blood cultures]]
===Nucleic Acid Amplification Tests (NAATs)===
===Nucleic Acid Amplification Tests (NAATs)===
NAATs are the most sensitive test to detect infections.
NAATs are the most sensitive test to detect infections.
Line 50: Line 48:
*Antimicrobial susceptibility cannot be determined with these tests. However, the same specimen can be evaluated for ''[[Chlamydia trachomatis]]''.
*Antimicrobial susceptibility cannot be determined with these tests. However, the same specimen can be evaluated for ''[[Chlamydia trachomatis]]''.
*There is a concern about cross-reactivity with other Neisseria species when used at the oropharyngeal site.<ref name=Lab-Gono>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</ref>
*There is a concern about cross-reactivity with other Neisseria species when used at the oropharyngeal site.<ref name=Lab-Gono>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</ref>
===Non-amplified tests===
===Non-amplified tests===
Non-amplified tests used for ''[[Neisseria gonorrhea]]'' include:
Non-amplified tests used for ''[[Neisseria gonorrhea]]'' include:
*DNA probe (e.g., Gen-Probe PACE 2 and Digene Hybrid Capture II)
*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]]''.
Antimicrobial susceptibility cannot be determined with these tests. However, the same specimen can be evaluated for ''[[Chlamydia trachomatis]]''.
====Sexual Abuse/Sexual Assault Diagnosis====
 
=====Sexual Abuse/Sexual Assault Diagnosis=====
In cases of suspected sexual abuse or assault, the legal standard is '''culture'''. All positive specimens should be retained for additional testing.<ref name=CDC-Guid>Workowski, Kimberly A., and Gail A. Bolan. "Sexually transmitted diseases treatment guidelines (2015)." Reproductive Endocrinology 24 (2015): 51-56.http://www.cdc.gov/std/tg2015/gonorrhea.htm Accessed on September 2015</ref><ref name=Lab-Gono>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</ref>
In cases of suspected sexual abuse or assault, the legal standard is '''culture'''. All positive specimens should be retained for additional testing.<ref name=CDC-Guid>Workowski, Kimberly A., and Gail A. Bolan. "Sexually transmitted diseases treatment guidelines (2015)." Reproductive Endocrinology 24 (2015): 51-56.http://www.cdc.gov/std/tg2015/gonorrhea.htm Accessed on September 2015</ref><ref name=Lab-Gono>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</ref>
*In '''adults''', NAATs are preferred for the diagnostic evaluation of sexual assault regardless of penetration.
*In '''adults''', NAATs are preferred for the diagnostic evaluation of sexual assault regardless of penetration.
*In '''children''', data on use of NAATs for detection of N. gonorrhoeae are limited, and consultation with an expert is necessary before using NAATs in this context to minimize the possibility of cross-reaction with nongonococcal Neisseria species.
*In '''children''', data on use of NAATs for detection of N. gonorrhoeae are limited, and consultation with an expert is necessary before using NAATs in this context to minimize the possibility of cross-reaction with nongonococcal Neisseria species.
==Non disseminated gonococcal infection==
==Disseminated gonococcal infection==
===Blood Culture===
*Blood cultures are diagnostic and more likely to be positive in patients with arthritis-dermatitis syndrome (two sets of blood cultures need to be taken)
*Blood cultures are helpful in differentiating DGI from other conditions such as [[septic arthritis]] due to ''[[Neisseria meningitidis]]'' or ''[[Staphylococcus aureus]]''
===Synovial fluid===
*Synovial fluid analysis is usually sent for cell count, differential, [[Gram stain]], [[culture|bacterial culture]] and NAAT in patients with suspected DGI
*Synovial fluid cultures are positive for ''[[Neisseria gonorrhoeae]]'' in approximately 50% patients with purulant arthritis 
*Synovial fluid cultures are less likely to be positive in patients with arthritis-dermatitis syndrome
===Mucosal sites specimens===
*[[Urogenital]], [[rectal]], and [[pharyngeal]] specimens should be sent for culture and NAAT in all patients with suspected DGI.
*Positive urogenital, rectal, or pharyngeal infection are generally seen in patients with DGI. However, most patients with DGI are asymptomatic at these sites.
===Skin lesion specimens===
*In the pustular skin lesions, the specimens can be sent for Gram stain, culture and NAAT
*NAAT, cultures are not routinely done in patients with suspected DGI
<gallery>


==Gallery==


<gallery>


Image: Gonorrhea08.jpeg| Image depicts the morphologic appearance of Neisseria gonorrhoeae colonies after having grown for a period of 24 hours on GC media base agar supplemented with IsoVitaleX (50X mag). GC media base agar is used in the isolation of N. gonorrhoeae bacteria, and is often used in conjunction with various antibiotics, in order to determine N. gonorrhoeae antimicrobial sensitivity/selectivity. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Gonorrhea08.jpeg| Image depicts the morphologic appearance of Neisseria gonorrhoeae colonies after having grown for a period of 24 hours on GC media base agar supplemented with IsoVitaleX (50X mag). GC media base agar is used in the isolation of N. gonorrhoeae bacteria, and is often used in conjunction with various antibiotics, in order to determine N. gonorrhoeae antimicrobial sensitivity/selectivity. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>

Revision as of 19:37, 26 September 2016

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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

Laboratory tests

Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected (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][2]

Gram stain

  • Neisseria gonorrhoeae in cervical smear using the Gram-stain[3]

    Neisseria gonorrhoeae in cervical smear using the Gram-stain[3]

  • Urethral discharge for Neisseria gonorrhea revealed Gram-negative intracellular rods[3]

    Urethral discharge for Neisseria gonorrhea revealed Gram-negative intracellular rods[3]

  • Intracellular Gram-negative diplococcal[3]

    Intracellular Gram-negative diplococcal[3]

Cultures

Culture is the historical standard for detection of Neisseria gonorrhea.

  • Culture test dvantages over non-culture tests include:[1][4]
    • Low cost
    • Suitable for a variety of specimen sites
    • Antimicrobial susceptibility testing can be performed

Thayer-Martin medium is one example of a medium used for Neisseria gonorrhoeae culture. Cultures can provide a preliminary diagnosis often within 24 hours and a confirmed diagnosis within 72 hours.

Nucleic Acid Amplification Tests (NAATs)

NAATs are the most sensitive test to detect infections. Amplified tests include:[1][5][6]

NAAT is FDA-cleared for:

  • Endocervical swabs from women
  • Urethral swabs from men
  • Urine specimens from both males and females
  • Vaginal swabs (some NAATs are clear)

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

  • Some laboratories have met CLIA regulatory requirements and established performance specifications for using NAAT with rectal and oropharyngeal swab specimens that can inform clinical management.
  • Antimicrobial susceptibility cannot be determined with these tests. However, the same specimen can be evaluated for Chlamydia trachomatis.
  • There is a concern about cross-reactivity with other Neisseria species when used at the oropharyngeal site.[4]

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.

Sexual Abuse/Sexual Assault Diagnosis

In cases of suspected sexual abuse or assault, the legal standard is culture. All positive specimens should be retained for additional testing.[1][4]

  • In adults, NAATs are preferred for the diagnostic evaluation of sexual assault regardless of penetration.
  • In children, data on use of NAATs for detection of N. gonorrhoeae are limited, and consultation with an expert is necessary before using NAATs in this context to minimize the possibility of cross-reaction with nongonococcal Neisseria species.

Non disseminated gonococcal infection

Disseminated gonococcal infection

Blood Culture

  • Blood cultures are diagnostic and more likely to be positive in patients with arthritis-dermatitis syndrome (two sets of blood cultures need to be taken)
  • Blood cultures are helpful in differentiating DGI from other conditions such as septic arthritis due to Neisseria meningitidis or Staphylococcus aureus

Synovial fluid

  • Synovial fluid analysis is usually sent for cell count, differential, Gram stain, bacterial culture and NAAT in patients with suspected DGI
  • Synovial fluid cultures are positive for Neisseria gonorrhoeae in approximately 50% patients with purulant arthritis
  • Synovial fluid cultures are less likely to be positive in patients with arthritis-dermatitis syndrome

Mucosal sites specimens

  • Urogenital, rectal, and pharyngeal specimens should be sent for culture and NAAT in all patients with suspected DGI.
  • Positive urogenital, rectal, or pharyngeal infection are generally seen in patients with DGI. However, most patients with DGI are asymptomatic at these sites.

Skin lesion specimens

  • In the pustular skin lesions, the specimens can be sent for Gram stain, culture and NAAT
  • NAAT, cultures are not routinely done in patients with suspected DGI
  • Image depicts the morphologic appearance of Neisseria gonorrhoeae colonies after having grown for a period of 24 hours on GC media base agar supplemented with IsoVitaleX (50X mag). GC media base agar is used in the isolation of N. gonorrhoeae bacteria, and is often used in conjunction with various antibiotics, in order to determine N. gonorrhoeae antimicrobial sensitivity/selectivity. From Public Health Image Library (PHIL). [7]

    Image depicts the morphologic appearance of Neisseria gonorrhoeae colonies after having grown for a period of 24 hours on GC media base agar supplemented with IsoVitaleX (50X mag). GC media base agar is used in the isolation of N. gonorrhoeae bacteria, and is often used in conjunction with various antibiotics, in order to determine N. gonorrhoeae antimicrobial sensitivity/selectivity. From Public Health Image Library (PHIL). [7]

  • Photomicrograph of Neisseria gonorrhoeae in cervical smear using the Gram-stain technique. From Public Health Image Library (PHIL). [7]

    Photomicrograph of Neisseria gonorrhoeae in cervical smear using the Gram-stain technique. From Public Health Image Library (PHIL). [7]

  • Urethral discharge for Neisseria gonorrhea revealed Gram-negative intracellular rods, NOT diplococci. From Public Health Image Library (PHIL). [7]

    Urethral discharge for Neisseria gonorrhea revealed Gram-negative intracellular rods, NOT diplococci. From Public Health Image Library (PHIL). [7]

  • Photomicrograph reveals presence of intracellular Gram-negative, Neisseria gonorrhoeae diplococcal bacteria. From Public Health Image Library (PHIL). [7]

    Photomicrograph reveals presence of intracellular Gram-negative, Neisseria gonorrhoeae diplococcal bacteria. From Public Health Image Library (PHIL). [7]

  • This Gram-stained photomicrograph revealed the presence of what was termed as “deceptive” extracellular diplococcal bacteria. From Public Health Image Library (PHIL). [7]

    This Gram-stained photomicrograph revealed the presence of what was termed as “deceptive” extracellular diplococcal bacteria. From Public Health Image Library (PHIL). [7]

  • Photomicrograph reveals Gram-negative rods, and Gram-negative cocci, which were determined to be Haemophilus influenzae, and non-meningococcal Neisseria sp. organisms respectively. From Public Health Image Library (PHIL). [7]

    Photomicrograph reveals Gram-negative rods, and Gram-negative cocci, which were determined to be Haemophilus influenzae, and non-meningococcal Neisseria sp. organisms respectively. From Public Health Image Library (PHIL). [7]

  • Photomicrograph (1000X mag) reveals Gram-negative rods, and Gram-negative cocci, which were determined to be Haemophilus influenzae, and non-meningococcal Neisseria sp. organisms respectively. From Public Health Image Library (PHIL). [7]

    Photomicrograph (1000X mag) reveals Gram-negative rods, and Gram-negative cocci, which were determined to be Haemophilus influenzae, and non-meningococcal Neisseria sp. organisms respectively. From Public Health Image Library (PHIL). [7]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Workowski, Kimberly A., and Gail A. Bolan. "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 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
  3. ↑ 3.0 3.1 3.2 Centers for Disease Control and Prevention. Public Health Image Library (PHIL) http://phil.cdc.gov/phil/details.asp Accessed on September 22, 2016
  4. ↑ 4.0 4.1 4.2 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
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 "Public Health Image Library (PHIL)".

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