Referral recommendations are based on expert opinion in the National guideline on the diagnosis and treatment of gonorrhoea in adults, published by the British Association for Sexual Health and HIV (BASHH), which states that referral to a genito-urinary medicine clinic is 'strongly encouraged' [BASHH, 2005b].

Referral

• Genito-urinary medicine clinics and general practices providing enhanced sexual health services have the resources to ensure effective diagnosis and treatment of gonorrhoea, as well as screening for other sexually transmitted infections (including HIV), counselling, follow up, and contact tracing (partner notification).
• Men who are suspected of having complications caused by gonorrhoea require specialist management (for example extended courses of antibiotics) [Handsfield and Sparling, 2005; Bignell, 2009].
• Gonorrhoea in pregnancy is associated with spontaneous abortion, premature labour, early rupture of fetal membranes, perinatal mortality, and gonococcal conjunctivitis in the newborn [Handsfield and Sparling, 2005].
• Pelvic inflammatory disease requires treatment with intramuscular ceftriaxone, which is not always available in primary care [BASHH, 2005a; RCOG, 2009].

Admission

• Admission is required for disseminated gonorrhoea because it can develop into life-threatening infection (for example gonococcal meningitis). Treatment in secondary care will typically involve higher doses of an intramuscular or intravenous cephalosporin for up to a week [Bignell, 2009].
• Pelvic inflammatory disease that is severe or has complications requires admission for specialist management, such as intravenous antibiotics [BASHH, 2005a; RCOG, 2008].

Sexually transmitted infection and HIV screening

• Screening for other sexually transmitted infections is in line with guidelines from BASHH and the Health Protection Agency [BASHH, 2006; RCGP and BASHH, 2006; HPA, 2008].