CSTE Position Statement(s)
Gonorrhea is a common sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae, which can be transmitted during vaginal, anal, or oral sex and at birth to a newborn. Gonorrhea can be effectively treated by antibiotics; however, infection can result in painful symptoms and adverse sequelae, including reproductive health complications1.
Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. Gonococcal infection can result in urethritis, epididymitis, cervicitis, acute salpingitis, proctitis, pharyngitis, or other syndromes when sexually transmitted; however, infections at the endocervix, pharynx, and rectum are often asymptomatic. Perinatal exposure to endocervical infection may result in gonococcal conjunctivitis in newborns. Disseminated gonococcal infection (DGI) is an additional syndrome caused by Neisseria gonorrhoeae.
DGI occurs when Neisseria gonorrhoeae from a mucosal site infection (urogenital, pharyngeal, rectal) invades the bloodstream and spreads to distant sites in the body. Clinical manifestations of DGI include petechial or pustular acral skin lesions, tenosynovitis, asymmetric polyarthralgia, bacteremia, oligoarticular septic arthritis, or, on rare occasions, endocarditis, osteomyelitis, or meningitis.
Confirmatory laboratory evidence:
- Isolation of Neisseria gonorrhoeae by culture of a clinical specimen, minimally with isolation of typical gram-negative, oxidase-positive diplococci,
- Detection of Neisseria gonorrhoeae by nucleic acid amplification (e.g., Polymerase Chain Reaction [PCR]) or hybridization with a nucleic acid probe in a clinical specimen
Presumptive laboratory evidence:
- Observation of gram-negative intracellular diplococci in a urethral or an endocervical smear
Note: The categorical labels used here to stratify laboratory evidence are intended to support the standardization of case classifications for public health surveillance. The categorical labels should not be used to interpret the utility or validity of any laboratory test methodology.
Criteria to Distinguish a New Case from an Existing Case
For surveillance purposes2, a new case of Neisseria gonorrhoeae infection meets the following criteria:
- There is no evidence of a prior Neisseria gonorrhoeae infection that has been reported as a case;
- There is evidence of a prior Neisseria gonorrhoeae infection that has been reported as a case, but the prior infection’s specimen collection date or treatment date was >30 days prior to the current infection’s specimen collection date;
- There is evidence of a prior Neisseria gonorrhoeae infection that has been reported as a case with a treatment date ≤30 days from the current infection’s specimen collection date, AND there is evidence of re-infection.*
* Reinfection can occur from condomless sexual intercourse with a new partner, with an untreated partner, or with a treated partner prior to eradication of partner’s infection (seven days post-treatment and after resolution of symptoms, if present).
Meets presumptive laboratory evidence in the absence of confirmatory laboratory evidence.
Meets confirmatory laboratory evidence.
Case Classification Comments
The following provides guidance for health departments to use for the classification and notification of cases of Neisseria gonorrhoeae infection that result in DGI. Cases should be reported to the Centers for Disease Control and Prevention (CDC) through voluntary notification as Neisseria gonorrhoeae infection and should be marked as DGI in the CDC case notification data, as defined below.
Classification of Neisseria gonorrhoeae infection cases to identify DGI:
- Verified: Isolation or detection of Neisseria gonorrhoeae from a disseminated site of infection (e.g., skin, synovial fluid, blood, or cerebrospinal fluid [CSF]) by culture or nucleic acid amplification test (NAAT).
- Likely: Clinical manifestations of DGI without other known causes AND isolation or detection of Neisseria gonorrhoeae from a mucosal site of infection by culture or nucleic acid amplification test (NAAT).
- Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Vol. 70 No. 4.
- Centers for Disease Control and Prevention. De-Duplication Guidance for Gonorrhea and Chlamydia Laboratory Reports.