Gonorrhoea is normally diagnosed presumptively by the presence of intracellular Gram-negative cocci on a Gram stain and confirmed by culture of the causative organism, Neisseria gonorrhoeae. Alternative methods have been evaluated extensively for the detection of gonococci in clinical specimens including immunological techniques such as ELISA and immunofluorescence, DNA probes, genetic transformation and the limulus lysate assay. Some of these tests have proved as sensitive and specific for the detection of gonorrhoea in symptomatic men as the Gram stain but offer no advantage in time or cost. In women, no test has been found that shows a sensitivity and specificity sufficiently adequate for clinical use. Culture in men and women remains the method of choice for diagnosis. In addition the need to obtain the infecting organism for antibiotic susceptibility testing has not been overcome. In contrast, the rapid identification of N gonorrhoeae can be achieved within four hours using either monoclonal antibodies or by the detection of preformed enzymes. New methods for both the detection and identification of N gonorrhoeae should be carefully evaluated particularly for use in cases of child and sexual abuse where medico-legal problems may arise.
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