Routine Gonorrhea Screening in Kathmandu — NAAT, Symptoms & Treatment Site-matched NAAT screening for asymptomatic and symptomatic infection

Why Routine Gonorrhea Screening Matters

Gonorrhoea, caused by Neisseria gonorrhoeae, is one of the most common bacterial STIs and a major public health concern globally. Like chlamydia, it is frequently asymptomatic — particularly in women and at extragenital sites — meaning infections go undetected without routine screening. Untreated gonorrhoea can cause pelvic inflammatory disease, infertility, ectopic pregnancy, and disseminated infection.

The epidemiology of gonorrhoea is complicated by rising antimicrobial resistance. Neisseria gonorrhoeae has progressively developed resistance to multiple antibiotic classes, and current treatment relies on ceftriaxone as first-line therapy. This makes accurate diagnosis and appropriate treatment critical — incorrect or incomplete treatment contributes to resistance.

Routine screening is recommended for sexually active adults, particularly those under 25, people with multiple partners, men who have sex with men, sex workers, and pregnant women. Screening frequency depends on risk — annual for most, every 3 to 6 months for higher-risk individuals. Site-specific testing ensures infections at rectal and throat sites are not missed.

This guide explains gonorrhoea testing methods, symptoms, treatment with ceftriaxone, drug resistance concerns, prevention strategies, and how Thamel Clinic provides comprehensive screening and treatment in Kathmandu.

Gonorrhea Testing Methods and Specimen Types

NAAT (nucleic acid amplification test) is the gold standard for gonorrhoea diagnosis, offering sensitivity and specificity exceeding 95 percent. NAAT can be performed on urine samples (first-catch for men) or swabs from the cervix, urethra, rectum, or throat. For women, vaginal or cervical swabs are preferred; for men, urine or urethral swabs.

Site-specific testing is critical. Gonorrhoea can infect the genital tract, rectum, and throat independently. A person with genital gonorrhoea may also have rectal or throat infection — testing only one site misses others. Guidelines recommend testing all exposed sites based on sexual practices.

Culture remains important for antimicrobial susceptibility testing, particularly in cases of treatment failure or suspected resistance. While NAAT is more sensitive, culture allows antibiotic sensitivity testing — important given rising resistance. Thamel Clinic can arrange culture when indicated.

• NAAT: gold standard, >95% sensitivity/specificity, urine or swab specimens.
• Site-specific: genital, rectal, throat tested separately based on exposure.
• Women: vaginal/cervical swabs preferred; Men: urine or urethral swabs.
• Culture: needed for susceptibility testing in treatment failure or resistance.
• Combined chlamydia/gonorrhoea NAAT panels available for efficiency.

Symptoms, Complications, and Who Should Screen

Gonorrhoea symptoms vary by site and sex. In men, urethritis causes burning urination and penile discharge — often severe and noticeable. In women, symptoms are often mild or absent — abnormal discharge, bleeding between periods, pelvic pain, and painful urination may occur but are frequently overlooked. Rectal infection may cause discharge, pain, or be asymptomatic. Throat infection is usually asymptomatic.

Untreated gonorrhoea can cause serious complications. In women, ascending infection leads to pelvic inflammatory disease (PID), tubal infertility, ectopic pregnancy, and chronic pelvic pain. In men, epididymitis can cause testicular pain and fertility issues. Disseminated gonococcal infection (DGI) — rare but serious — causes joint pain, skin lesions, and can affect the heart or meninges.

Screening is recommended for sexually active adults under 25, people with multiple partners, MSM, sex workers, pregnant women (to prevent neonatal conjunctivitis and blindness), people diagnosed with other STIs, and anyone with symptoms suggestive of gonorrhoea. Annual screening is standard; higher-risk individuals may need every 3 to 6 months.

• Men: burning urination, penile discharge — often severe and noticeable.
• Women: often asymptomatic — discharge, bleeding, pelvic pain may be subtle.
• Rectal/throat: may be asymptomatic or cause mild symptoms.
• Complications: PID, infertility, epididymitis, disseminated infection.
• Screening: under 25, multiple partners, MSM, sex workers, pregnancy, other STIs.

Treatment with Ceftriaxone and Resistance Concerns

Ceftriaxone is the current first-line treatment for uncomplicated gonorrhoea — typically a single intramuscular injection of 500 mg (or 1 g depending on weight/site). This replaced earlier regimens as resistance to fluoroquinolones, penicillin, and oral cephalosporins became widespread. Treatment must be completed as prescribed.

Antimicrobial resistance is a major concern with Neisseria gonorrhoeae. The bacterium has sequentially developed resistance to sulfonamides, penicillin, tetracyclines, fluoroquinolones, and oral cephalosporins. Ceftriaxone remains effective but resistance monitoring is essential — treatment failures are reported globally.

If treatment fails — persistent symptoms or positive test of cure — culture with susceptibility testing is essential to guide alternative therapy. Patients should avoid sexual activity until treatment is complete and partners are treated. Partner notification for partners from the past 60 days is critical to prevent reinfection.

• First-line: ceftriaxone 500 mg IM single dose (1 g if >150kg or pharyngeal).
• Resistance history: sulfonamides → penicillin → tetracyclines → fluoroquinolones → oral cephalosporins.
• Ceftriaxone remains effective but resistance monitoring essential.
• Treatment failure: culture with susceptibility testing required.
• Avoid sex until treatment complete; partners from 60 days need testing/treatment.

Prevention, Retesting, and Follow-Up

Prevention strategies include consistent condom use for vaginal, anal, and oral sex; limiting number of partners; mutual monogamy with tested partners; and regular screening. Condoms significantly reduce but do not eliminate transmission risk. Vaccines for gonorrhoea are under development but not yet available.

Retesting is recommended approximately 3 months after treatment to detect reinfection — particularly for those at ongoing risk. This is because reinfection is common and many infections are asymptomatic. Test of cure (repeat NAAT 7–14 days post-treatment) is recommended for pregnant women, pharyngeal infections, or suspected treatment failure.

For patients with recurrent gonorrhoea, evaluation for other STIs, sexual health counselling, and assessment of risk behaviours is important. HIV testing should be offered to all patients diagnosed with gonorrhoea due to shared risk factors and increased HIV acquisition risk.

• Condoms for all sexual activities reduce but do not eliminate risk.
• Retest at 3 months — reinfection is common and often asymptomatic.
• Test of cure for pregnancy, pharyngeal infection, or treatment failure.
• HIV testing recommended for all gonorrhoea patients.
• Recurrent infection: evaluate other STIs and risk behaviours.

Gonorrhea Screening and Treatment — Pricing

Prices are indicative; confirm current rates when booking.

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