skip to main content

Gonorrhoea — DFSRH MCQ

Instant feedback + full explanation. One question, done properly.

EasyTest of CureGonorrhoeaDFSRH

A 27-year-old woman received witnessed ceftriaxone 1 g intramuscularly for laboratory-confirmed cervical gonorrhoea. Pretreatment culture showed ceftriaxone susceptibility. She completed partner notification, has remained asymptomatic and reports no sexual contact since treatment. At a test-of-cure visit exactly 14 days after treatment, a cervical NAAT remains positive for Neisseria gonorrhoeae, but a simultaneously collected cervical culture is negative. Which is the most appropriate next management step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Report probable treatment failure and repeat the same-site NAAT in 1 week before retreatment

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · B = shown as D · A = shown as E

The positive NAAT 2 weeks after recommended ceftriaxone treatment, together with exclusion of reinfection, fulfils the UKHSA definition of probable gonorrhoea treatment failure and should be reported. However, the negative culture is an important discriminator: a culture-negative, NAAT-positive specimen at exactly 2 weeks may reflect detection of persistent non-viable gonococcal nucleic acid rather than viable infection. UKHSA therefore advises considering a repeat NAAT 1 week later. Immediate empirical retreatment is not indicated in this clinically stable patient while that distinction is clarified. A is incorrect because negative culture does not override a positive NAAT; culture has limited sensitivity and follow-up remains necessary. B recognises possible residual nucleic acid but omits reporting despite the current probable-failure definition being met. C correctly identifies probable failure but premature repeat ceftriaxone could obscure microbiological assessment and may be inappropriate if true resistance exists. D incorrectly labels resistance as confirmed: confirmation requires a resistant isolate or relevant resistance markers demonstrated by the national reference laboratory. If the repeat NAAT remains positive, specialist reassessment, repeat culture where possible, reference-laboratory investigation and treatment guided by expert advice are required.

Reference: Managing incidents of ceftriaxone-resistant Neisseria gonorrhoeae in England (21 November 2022) — https://www.gov.uk/government/publications/ceftriaxone-resistant-neisseria-gonorrhoeae-incident-management/managing-incidents-of-ceftriaxone-resistant-neisseria-gonorrhoeae-in-england GRASP report: data to August 2024 (18 December 2025) — https://www.gov.uk/government/publications/gonococcal-resistance-to-antimicrobials-surveillance-programme-grasp-report/grasp-report-data-to-august-2024