Gonorrhea Testing Center in Kathmandu Site-Matched NAAT — Accurate Diagnosis & Complete Treatment

Overview of Gonorrhea Testing

Gonorrhea — caused by the bacterium Neisseria gonorrhoeae — is one of the most common bacterial STIs worldwide and is frequently asymptomatic, particularly in women and at extragenital sites. Accurate testing is essential because untreated infection leads to serious complications including pelvic inflammatory disease, infertility, and increased HIV susceptibility.

The diagnostic standard is nucleic acid amplification testing (NAAT), which detects the bacterium’s genetic material with high sensitivity and specificity. The critical factor is site-matched sampling: urine detects only urogenital infection, while rectal and pharyngeal infections require their own swabs. Testing only urine misses extragenital infections entirely — a common and consequential error.

Gonorrhea is curable with antibiotics — currently injectable ceftriaxone is the recommended treatment — but antibiotic resistance is a growing global concern. Correct diagnosis, appropriate treatment, partner management and test-of-cure where indicated form the complete pathway.

At Thamel Clinic, gonorrhea testing is integrated with treatment planning: site-matched NAAT, co-testing for chlamydia and other STIs, ceftriaxone treatment for positives, partner notification guidance and retesting to confirm cure and detect reinfection.

What Is Gonorrhea?

Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that infects mucous membranes of the reproductive tract, rectum, throat and eyes. It is transmitted through sexual contact — vaginal, anal or oral intercourse — and can also be transmitted from mother to baby during childbirth.

The infection is frequently asymptomatic — particularly in women, where up to 50% or more of infections cause no noticeable symptoms, and at extragenital sites where asymptomatic rates are even higher. When symptoms do occur, they include urethral or vaginal discharge, burning on urination, pelvic pain, testicular pain and swelling, sore throat and rectal discharge or pain.

Untreated gonorrhea causes serious complications. In women, it can lead to pelvic inflammatory disease (PID), tubal infertility, ectopic pregnancy and chronic pelvic pain. In men, it can cause epididymitis and infertility. It also increases HIV transmission and acquisition risk by disrupting mucosal barriers and recruiting immune cells.

• Caused by Neisseria gonorrhoeae bacterium
• Infects reproductive tract, rectum, throat and eyes
• Transmitted through vaginal, anal or oral sex; mother-to-baby at birth
• Frequently asymptomatic — especially in women and extragenital sites
• Untreated leads to PID, infertility, epididymitis and increased HIV risk

How Gonorrhea Testing Works

NAAT is the recommended diagnostic method for gonorrhea — it detects bacterial DNA with high sensitivity and specificity, far superior to older culture or microscopy methods. For urogenital infection, first-catch urine (men) or vaginal swab (women) is used. For rectal infection, a rectal swab is required; for pharyngeal infection, a throat swab.

The critical principle is site-matched sampling. Each anatomical site requires its own specimen — a urine test detects only urethral infection, a rectal swab detects only rectal infection, and a throat swab detects only pharyngeal infection. Testing only urine misses extragenital infections that are common in people with receptive anal or oral sex.

NAAT results are typically available within 1–3 working days. Because gonorrhea and chlamydia are so frequently co-transmitted, testing for both together (combined NAAT) is standard practice. Additional testing for syphilis, HIV and hepatitis completes the STI screen.

• NAAT is the gold standard — high sensitivity and specificity
• Urogenital: first-catch urine (men) or vaginal swab (women)
• Rectal infection: rectal swab required
• Pharyngeal infection: throat swab required
• Each site needs its own specimen — urine misses extragenital
• Results typically within 1–3 working days

Extragenital Gonorrhea — Rectal & Throat

Extragenital gonorrhea — infection of the rectum or throat — is common and frequently missed. Rectal gonorrhea occurs in people with receptive anal sex; pharyngeal gonorrhea in those with oral sex. Both are predominantly asymptomatic, yet they persist as infectious reservoirs and increase HIV transmission risk.

The diagnostic challenge is that these infections are invisible to urine testing. A person with rectal gonorrhea and no urethral infection tests negative on urine — false reassurance while the rectal infection persists. Site-specific swabs are essential for detection.

Treatment of extragenital gonorrhea uses the same ceftriaxone regimen as genital infection. However, test-of-culture or test-of-NAAT may be considered for pharyngeal infection where treatment failure is more common, and for rectal infection where reinfection risk is high. Complete extragenital screening — testing all sites where exposure occurred — is the standard for people with relevant sexual practices.

• Rectal gonorrhea: receptive anal sex; usually asymptomatic
• Pharyngeal gonorrhea: oral sex; usually asymptomatic
• Invisible to urine testing — site-specific swabs essential
• Same ceftriaxone treatment as genital infection
• Pharyngeal infection may need test-of-cure due to higher failure rates
• Complete extragenital screening recommended for relevant exposures

Treatment: Ceftriaxone & Partner Care

Gonorrhea is treated with injectable ceftriaxone — currently the recommended first-line treatment globally due to escalating antibiotic resistance. The standard regimen is a single intramuscular injection of ceftriaxone 500 mg (1 g for patients weighing 150 kg or more). Oral alternatives exist but are less reliable due to resistance.

Chlamydia is so frequently co-transmitted that co-treatment is standard — azithromycin or doxycycline is added when chlamydia has not been excluded. This dual approach prevents persistent chlamydia after gonorrhea treatment.

Partner management is essential. All sexual partners within the relevant period must be tested and treated to prevent reinfection. Partners should abstain from sex until both complete treatment. Test-of-cure is recommended for pharyngeal infection and in cases of persistent symptoms or treatment failure.

• Ceftriaxone 500mg IM single injection — first-line treatment
• 1g dose for patients ≥150kg
• Chlamydia co-treatment added when not excluded
• All partners tested and treated to prevent reinfection
• Test-of-cure for pharyngeal infection and treatment failure
• Abstain from sex until both partners complete treatment

Antibiotic Resistance & Why It Matters

Gonorrhea has developed resistance to nearly every antibiotic used against it — penicillin, tetracyclines, fluoroquinolones and oral cephalosporins have all been compromised over decades. Ceftriaxone is currently the last reliable first-line option, though decreased susceptibility is being monitored globally.

This resistance pattern is why correct treatment matters. Incomplete courses, incorrect dosing, or using inferior antibiotics (like azithromycin alone or fluoroquinolones) promote further resistance and treatment failure. Completing the full ceftriaxone regimen as prescribed is essential.

In Nepal, international treatment guidelines are followed — ceftriaxone is available and used as first-line. Patients should complete treatment as prescribed and attend test-of-cure where recommended, both to confirm cure and to contribute to resistance surveillance.

• Gonorrhea has resisted penicillin, tetracyclines, fluoroquinolones and oral cephalosporins
• Ceftriaxone is currently the reliable first-line option
• Incomplete treatment promotes resistance — complete the full regimen
• Avoid inferior antibiotics like azithromycin alone or fluoroquinolones
• Test-of-cure confirms eradication and monitors for resistance

Complete Testing & Treatment Pathway

A gonorrhea testing center provides more than a test result — it provides a complete pathway. The process begins with a confidential consultation assessing exposures, symptoms and risk, followed by site-matched specimen collection for NAAT.

Positive results trigger a defined pathway: confirmatory testing where indicated, ceftriaxone treatment prescription, chlamydia co-treatment, partner notification guidance, and retesting to confirm cure. Negative results still include prevention counseling and advice on window periods for future testing.

The complete pathway ensures that a positive result leads to cure, not just information. This integrated approach — testing, treatment, partner management and follow-up — is what distinguishes a testing center from a laboratory that only reports results.

• Confidential consultation and exposure assessment
• Site-matched NAAT specimen collection
• Co-testing for chlamydia and other STIs
• Positive results → ceftriaxone treatment + partner guidance
• Retesting to confirm cure and detect reinfection

Gonorrhea Testing & Treatment Costs

Indicative NPR pricing; confirm current rates when booking. Treatment costs vary by medication and partner management.

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