• Gonorrhoea
• screening
• diagnosis
• sexually transmitted diseases
• molecular technique
• testing

The current low incidence of gonorrhoea, new options for gonococcal diagnosis and increased pressure to reduce costs suggest that we need to review our current approach to testing. If confirmatory testing is carried out, then an accurate diagnosis of gonorrhoea can be made even in areas of low prevalence, although once the population prevalence drops below around 1% even this approach starts to become unreliable. Screening of all patients for gonorrhoea should be retained in sexual health clinics, and offered to high-risk individuals (such as sexual contacts of patients with gonorrhoea) in all healthcare settings. The low marginal costs support the addition of gonorrhoea testing to those attending a national chlamydia screening programme, unless the local prevalence of gonorrhoea is very low.

Rates of gonorrhoea in the UK continue to fall, down over 10% year on year and at a 10-year low,1 while there is increasing pressure to reduce service costs and deliver healthcare more cost effectively. For those with genital discharge, epididymo-orchitis or pelvic inflammatory disease there can be little argument that tests for gonorrhoea are appropriate, but can they be justified for those without symptoms requesting a sexual health screen? As gonorrhoea becomes an increasingly rare disease we need to step back and review screening to determine the most appropriate approach. The value of routine screening for gonorrhoea has been questioned even in dedicated sexually transmitted infection (STI) clinics, where it has been suggested that the resources currently being used for this purpose might be better employed to improve contraceptive services.2 A recent audit of sexual health clinic attendees in the UK suggests that over a third of asymptomatic men, and almost half of men who have sex with men, are now screened for gonorrhoea using urine nucleic acid amplification tests (NAATs).3 Should the increasing …