Gonorrhoea is a sexually transmitted bacterial infection that most commonly infects the urethra and the cervix. It can also infect the anus and throat.

Current Situation

As of 20 October 2023, 34 cases of Penicillinase-producing Neisseria gonorrhoeae (PPNG) have been detected in the Northern Territory (NT), mostly in Central Australia. Their sexual contacts have been from urban and remote locations in the NT and interstate.

When Neisseria gonorrhoeae produces the enzyme called penicillinase it is resistant to penicillin treatment (including ZAP packs) and is called PPNG. While penicillin resistance has been prevalent for some time in most other parts of Australia, remote Top End and Central Australia have historically had low rates of penicillin resistance.

For all suspected or confirmed uncomplicated genital and anorectal gonorrhoea infections in patients outside of Darwin, the Centre for Disease Control (CDC) recommends a change in first-line treatment per the most current health alert.

Testing for PPNG 

  1. Since September 2023, Western Diagnostic Pathology has joined Territory Pathology in routinely testing all positive gonorrhoea specimens for PPNG 

  2. You will notice a PPNG PCR result in all positive gonorrhoea results from these labs. 

Treatment

All cases of suspected or confirmed uncomplicated genital and anorectal gonorrhoea should be treated with: 

  1. Ceftriaxone 500mg in 1.8mL 1% lignocaine IM single dose AND 

  2. Azithromycin 1g oral single dose 

  3. Ensure complete STI testing has been completed, including serology for HIV and syphilis. 

  4. Retest three months after treatment as the risk of reinfection is high. 

Amoxicillin/probenecid/azithromycin combinations (ZAP packs) are no longer considered effective 1st line treatment of gonorrhoea in the NT. 

Contact tracing for PPNG cases 

Urgent contact tracing is needed. Sexual contacts in the previous two months should: 

  1. Have a full STI screen (consider including a swab or urine for culture)

  2. Be treated on the same day with ceftriaxone and azithromycin as above 

Contact & advice 

  1. Clinic 34 is the NT’s specialist sexual health service and their staff can provide further clinical advice if needed. Contact through [email protected] or via your local CDC unit. 

CDC Darwin 

Ph 8922 8044 

Fax 8922 8310 

[email protected] 

CDC Alice Springs 

Ph 8951 7540 / 0436 667 809 

Fax 8951 7900 

[email protected] 

CDC Katherine 

Ph 8973 9049 

Fax 8973 9048 

[email protected] 

CDC Nhulunbuy 

Ph 8987 0357 

Fax 8987 0500 

[email protected] 

CDC Tennant Creek 

Ph 8962 4259 

Fax 8962 4420 

[email protected]

  

For more information, visit the NT Health Website - https://health.nt.gov.au/public-health-notifiable-diseases/gonorrhoea