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Gonorrhoea vaccination in a high-risk GBMSM with current infection — DFSRH MCQ

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EasyGonorrhoeaGonorrhoea vaccination in a high-risk GBMSM with current infectionDFSRH

A 32-year-old gay man attends a specialist sexual health service in England. A rectal nucleic acid amplification test is positive for Neisseria gonorrhoeae, and he is receiving treatment today. He is systemically well and has no vaccine contraindications. He reports sex with six male partners during the preceding 3 months and has never received 4CMenB vaccine. Which is the most appropriate gonorrhoea vaccination plan?

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

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Correct answer: C — Give the first 4CMenB dose today and a second dose at least 4 weeks later

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

He meets operational eligibility for opportunistic 4CMenB vaccination because he is a gay man who has sex with men at increased risk of gonorrhoea: he has current bacterial STI management and reports at least five sexual partners in the preceding 3 months. Active gonorrhoea is not a reason to delay vaccination in an otherwise well patient. UKHSA advises offering eligible individuals 4CMenB at the same attendance as testing or management of gonorrhoea, reducing missed opportunities and delay in potential protection. The course comprises two 0.5 mL doses separated by at least 4 weeks. A is incorrect because completion of antimicrobial treatment is not required before vaccination, although vaccination may be deferred during an acute febrile systemic illness. B is incorrect because neither microbiological clearance nor a negative test of cure is a prerequisite. C is incorrect because natural gonococcal infection does not confer reliable protective immunity and does not replace the second vaccine dose. E is incorrect because he already meets eligibility criteria; a further STI diagnosis is unnecessary. The vaccine provides partial cross-protection through antigenic relatedness between N. meningitidis and N. gonorrhoeae, but it neither treats the current infection nor removes the need for standard prevention and follow-up measures.

Reference: Immunisation against infectious disease: Gonorrhoea (16 June 2025) — https://assets.publishing.service.gov.uk/media/6849655ea970ac461a23d1d9/Green_book_chapter_gonorrhoea_6June2025.pdf 4CMenB vaccine for prevention of gonorrhoea: information for healthcare practitioners (8 July 2025) — https://www.gov.uk/government/publications/4cmenb-vaccine-for-gonorrhoea-information-for-healthcare-practitioners/4cmenb-vaccine-for-prevention-of-gonorrhoea-information-for-healthcare-practitioners