Traditional approaches to the diagnosis of gonorrhea have used direct smear or culture. Culture for Neisseria gonorrhoeae is typically performed on media such as chocolate (cooked sheep’s blood) agar, Thayer-Martin, or GC medium incubated in a 5% CO2 atmosphere. Selective medium which incorporates antibiotics such as vancomycin, colistin and amphotericin is used to inhibit the growth of commensal organisms and other potential pathogens in the genitourinary tract which could overgrow the gonococci. Identification of Neisseria is confirmed by the oxidase reaction, and species-specific confirmation is performed utilizing either carbohydrate fermentation or monoclonal antibody techniques.

Because of the specific transport and environmental requirements for gonococcal culture, newer non-culture techniques have evolved in the past 10 years. Genetic probe methods include techniques which are as sensitive as culture but use genetic hybridization technology for diagnosis (van Ulsen, 1986). In the past 3 years major advances in DNA and RNA amplification have allowed the development of nucleic acid amplification techniques. The most commonly used and recently approved for use in the United States include polymerase chain reaction and ligase chain reaction (Ching et al., 1995). Both techniques are at least as sensitive as culture, and may be more sensitive in certain situations. Furthermore, the high sensitivity of these techniques have allowed them to be used in urine (Smith et al., 1995). The use of urine as a diagnostic technique has facilitated the expansion of gonorrhea screening efforts (Zenilman, 1997), especially in populations where clinical service provision is difficult and/or inadequate.

Treatment for mucosal gonorrhea infections is based on providing singledose regimens, preferably oral, that are effective against most or all of the known resistant determinants (CDC, 1998). Periodic antimicrobial susceptibility testing of a sample of isolates is recommended, preferably as part of an ongoing surveillance program. Current single-dose oral regimens include: ciprofloxacin (Cipro) 500 mg, ofloxacin (Floxin) 400 mg and cefixime (Suprax) 400 mg. Ceftriaxone (Rocephin) 125 mg i.m. is the recommended parenteral regimen for uncomplicated gonorrhea. For patients with pelvic inflammatory disease or epididymitis, 250 mg ceftriaxone is the recommended dose. All patients treated for gonorrhea should also be treated for chlamydia, with either azithromycin (Zithromax, Zmax) I g (single dose) or  (Vibramycin, Adoxa, Monodox, Periostat) 100 mg twice daily for 1 week. These represent the general recommendations. Advice on the treatment of more complex disease, or in pregnant patients or children, is provided in the CDC STD treatment guidelines (CDC, 1998).