Background Untreated gonorrhoea in women in 20–40% brings to PID and the following tubal infertility. The estimated number of Russian women 15–44y.o. with infertility history around 1.5% due to the tubal factor in 2011. Free access to $4000 in-vitro fertilisation for women with infertility was introduced in Russia to increase national birth rate. Timely diagnosis and treatment of gonorrhoea that can be cost-effective preventive intervention, is however compromised by the low-sensitive microscopy test for gonorrhoea screening in women. In the circumstances of fast spreading of drug-resistant gonorrhoea forms improving gonorrhoea diagnosis and treatment in Russia are urgent priorities. Methods: Desk review and stakeholder interviews were used to review and analyse gonorrhoea trends, policies and guidelines, service delivery, challenges and needs.

Results (1) Free Gs microscopy women can either receive in STI clinic or in women’s consultation. Culture is mostly used as the confirmatory method or in women with gonorrhoea infected partners. Sensitive NAAT methods are available in most urban settings on commercial base. Specificity of the Russian NAAT tests remains challenge. (2) Gs prevalence studies are not available (3) Standards are developing by different institutions, there are not leadership on the development of national guidelines or public health interventions on STI. The vertical structures of STI and reproductive health services under the Ministry of Health in combination with complex region-based health financing provide a challenge for the development of cost-effective public health response when multidisciplinary approaches are needed.

Conclusion Gs prevalence studies in STI clinics and women’s consultations could provide the knowledge base for the cost-effective public health action. Algorithm of final Gs diagnosis should be developed and used in accordance with local situations. Introduction of free sensitive screening test as NAAT or culture among female populations with greater than 1% Gs prevalence might be recommended for public STI or reproductive health settings.