What are the other Names for this Test? (Equivalent Terms)

• GC Test
• Gonococcal Testing
• Neisseria Gonorrhoeae by Amplified Detection

What is Gonorrhea Testing? (Background Information)

• Gonorrhea Testing is performed to screen for gonorrhea, a sexually transmitted disease (STD) caused by Neisseria gonorrhoeae bacteria
• Infection with this bacterium can occur through vaginal, oral, or anal routes. It may also be transmitted from a mother to her child, during birth
• Gonorrhea Testing may be used as a screening tool, for sexually-active individuals, any individual at risk for the condition, or even for pregnant women. The test is also used to arrive at a diagnosis of gonorrhea, when the following symptoms are noted in individuals:
  • Painful or burning urination
  • Vaginal discharge
  • Abdominal pain
  • Vaginal bleeding after intercourse
  • Menstrual abnormalities in females
  • Discharge from penis in males
• In newborns, gonococcal infection can cause conjunctivitis (reddish eyes with discharge, caused by an inflammation of the conjunctiva - the transparent sheet that covers the white portion and the underside of the eyelids) or pneumonia

The test sample is either a sample of secretion/discharge, or urine. The tests that may be performed include:

• Gram staining: This involves the usage of chemicals that impart color (stain) to the bacteria in the test sample, which is then identified under a microscope. A positive gram stain confirms the diagnosis; however, a negative stain does not necessarily rule out an infection
• Culture: In this method, the sample is inoculated (placed) on a culture medium, a substance that allows any bacteria present to grow and multiply
• Nucleic acid amplification test (NAAT): In this method, even a small amount of DNA of the bacteria that is present in the test sample is amplified (increased), which is then detected. This is a highly sensitive test; more capable of identifying individuals with the disease, than using other test methods
• DNA probe test: The test uses a nucleic acid probes to identify genetic material of gonococcus in the test sample

While culture or nucleic acid testing may take 3-5 days, a gram stain can be performed on the sample immediately. Samples from multiple sites may be taken. All of these tests may be performed on a sample of secretion obtained from the suspicious/infected area. However, a DNA probe test on a sample obtained from the throat, does not always give accurate results.

What are the Clinical Indications for performing the Gonorrhea Testing?

Clinical indications for Gonorrhea Testing include:

• Any individual presenting with symptoms suggestive of gonococcal infection, such as:
  • In men: Painful/burning urination, discharge from penis, inflammation of the anal/rectal area (proctitis - in men having sex with men)
  • In women: Painful/burning urination, vaginal discharge, bleeding after intercourse or in between periods, abdominal pain, infertility (if the infection progresses to PID)
  • In newborns: Red eyes, discharge from eyes, conjunctivitis
• A small proportion (about 1%) of the infected individuals may have a disseminated infection; in which case, they may have rashes, arthritis (painful, red, swollen joints), meningitis (inflammation of the lining of the brain and spinal cord), sepsis (microorganism spreads through the blood, and there is a huge fall in blood pressure, which is detrimental to survival)
• Screen sexually active women at increased risk - recommended by Centers for Disease Control and Prevention (CDC), U.S. Preventive Services Task Force (USPSTF), American Academy of Family of Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG)
• CDC and ACOG recommend annual testing. The CDC also recommends regular screening of men having sex with other men. The risk factors for infection include:
  • Having multiple sexual partners
  • Having other STDs
  • Previous history of gonorrhea
  • Not using condoms regularly
  • Men having sex with men
  • Becoming sexually active during early adolescence
• Pregnant women are screened during the first prenatal visit and subsequently, during the third trimester, if they test positive. This helps in treating the condition accordingly
• When an individual tests positive, it is necessary to test his/her sexual partner(s), from within the last two months, as well

How is the Specimen Collected for Gonorrhea Testing?

Sample required: Discharge from the infected area (cervix/ vagina in women, penis/urethra in men, anus or throat), or first-catch urine sample

Process:

• A swab is used to collect the secretion/discharge from the infected area
• First-catch urine sample: After abstaining from urinating for 1-2 hours, the first few drops of the urine sample are collected in a container

Preparation required:

• It is necessary to inform the physician about any current antibiotic use, as this may affect the test results
• Women who are going to be tested should not use vaginal creams or douches, for 24 hours prior to the test
• It is advised not to urinate for 2 hours, before giving a urine sample for testing

What is the Significance of the Gonorrhea Testing Result?

Gonorrhea Testing maybe reported as either positive or negative.

• Individuals, who test positive, are treated with antibiotics. Currently, two different types of antibiotics, cephalosporin and either azithromycin/doxycycline, are used for treatment. The sexual partners of the individual should also be tested and treated, if found positive
• A negative test result means there is no infection, only during the time of testing. However, regular screening of individuals, with high-risk behavior is advised to detect infection or re-infection, as early as possible

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario.

Additional and Relevant Useful Information:

• Some kinds of Neisseria gonorrhoeae are becoming resistant to cephalosporin (a type of antibiotic, commonly used to treat gonococcal infections). When the symptoms of infection do not improve with treatment, antibiotic susceptibility testing on culture samples may have to be undertaken, to choose the right drug for treatment
• Any individual, who has tested positive for gonococcus, should abstain from sexual intercourse for at least 7 days, from start of treatment
• In the United States, it is required that the physician inform a positive gonorrhea test result, to the state health department

Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider, the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.