Diagnosis and management of gonorrhoea and syphilis
Authors: Jespers Vicky , Stordeur Sabine , Desomer Anja , Carville Serena , Jones Clare , Lewis Sedina , Perry Mark , Cordyn Sam , Cornelissen Tine , Crucitti Tania , Danhier Céline , De Baetselier Irith , De Cannière Anne-Sophie , Dhaeze Wouter , Dufraimont Els , Kenyon Chris , Libois Agnes , Mokrane Saphia , Padalko Elizaveta , Van Den Eynde Sandra , Vanden Berghe Wim , Van Der Schueren Thierry , Dekker Nicole 
Published: January 2025

SCIENTIFIC REPORT 14 -- 1 INTRODUCTION .14 -- 1.1 BACKGROUND 14 -- Etiology, transmission, clinical features and epidemiological trends .14 -- Notification of infectious diseases in Belgium . 21 -- 1.2 THE NEED FOR A NATIONAL GUIDELINE .22 -- 1.3 SCOPE .23 -- 1.4 REMIT OF THE GUIDELINE .24 -- Overall objectives .24 -- Patient-centred care 24 -- Policy relevance and target users of the guideline .24 -- 1.5 STATEMENT OF INTENT 25 -- 1.6 FUNDING AND DECLARATION OF INTEREST 25 -- 2 METHODOLOGY 26 -- 2.1 THE GUIDELINE DEVELOPMENT GROUP 26 -- 2.2 INTERNATIONAL COLLABORATION .26 -- 2.3 GENERAL APPROACH AND CLINICAL RESEARCH QUESTIONS 26 -- General approach 26 -- Research questions 28 -- 2.4 SEARCH FOR GUIDELINES AND QUALITY APPRAISAL 34 -- Databases and date limits 34 -- Search strategy 34 -- Quality appraisal 36 -- 2.5 ADDITIONAL LITERATURE SEARCH: DIAGNOSTIC TESTS FOR GONORRHOEA 36 -- Diagnostic tests of choice for diagnosis of gonorrhoea in primary care 36 -- Quality appraisal 37 -- 2.6 ADDITIONAL LITERATURE SEARCH: TREATMENT FOR GONORRHOEA 38 -- Treatment for gonorrhoea in primary care 38 -- Quality appraisal 39 -- 2.7 ADDITIONAL LITERATURE SEARCH: DIAGNOSTIC TESTS FOR SYPHILIS 39 -- Search strategy .39 -- Quality appraisal 40 -- 2.8 ADDITIONAL LITERATURE SEARCH: TREATMENT FOR SYPHILIS .40 -- Treatment for syphilis in primary care 40 -- Quality appraisal 42 -- 2.9 DATA EXTRACTION .43 -- 2.10 STATISTICAL ANALYSES .43 -- 2.11 GRADING EVIDENCE .44 -- 2.12 FORMULATION OF RECOMMENDATIONS 47 -- 2.13 EXTERNAL REVIEW 49 -- 2.14 FINAL VALIDATION 50 -- 3 CLINICAL RECOMMENDATIONS 51 -- 3.1 ASSESSMENT OF RISK FOR GONORRHOEA 51 -- 3.2 DIAGNOSIS OF GONORRHOEA 52 -- Recommendations from international guidelines .53 -- Additional literature search: Diagnosis of gonorrhoea 56 -- Recommendations: Who to test for gonorrhoea 76 -- Recommendations: Diagnostic tests for gonorrhoea in men .77 -- Recommendations: Diagnostic tests for gonorrhoea in women 78 -- Diagnosis of gonorrhoea: Good practice statements .79 -- 3.3 TREATMENT OF GONORRHOEA: INFORMATION AND ADVICE FOR THE PATIENT 79 -- Recommendations from international guidelines .79 -- Recommendations regarding information and advice for the patient 80 -- 3.4 TREATMENT OF GONORRHOEA: TIMING OF INITIATION OF THERAPY .81 -- Recommendations from international guidelines .81 -- Recommendations regarding testing and surveillance for resistance 82 -- Recommendation regarding initiation of therapy .82 -- 3.5 TREATMENT OF GONORRHOEA: WHEN TO REFER TO SECOND LINE 83 -- Recommendations from international guidelines .83 -- Referral to the second line for gonorrhoea: Good practice statements 84 -- 3.6 TREATMENT OF GONORRHOEA: REFINING ACCORDING TO ANTIMICROBIAL RESISTANCE 84 -- Recommendations from international guidelines .84 -- Antimicrobial resistance: Belgian data 85 -- 3.7 TREATMENT OF GONORRHOEA: TREATMENT CHOICE IN MEN AND WOMEN .87 -- Recommendations from international guidelines .87 -- Recommendations from national guides .92 -- Additional literature search: Treatment of gonorrhoea in women and men, including young people 93 -- Recommendation for treatment of gonorrhoea in women and men including young people 99 -- Treatment of gonorrhea: Good practice statements 99 -- 3.8 TREATMENT OF GONORRHOEA: TREATMENT CHOICE IN PREGNANT WOMEN 100 -- Recommendations from international guidelines 100 -- Recommendations from national guides 101 -- Additional literature search: Treatment of gonorrhoea in pregnant women .101 -- Recommendation for treatment of gonorrhoea in pregnant women 104 -- Treatment of gonorrhoea in pregnant women: Good practice statements 104 -- 3.9 TREATMENT OF GONORRHOEA: TREATMENT CHOICE IN PEOPLE WITH AN ALLERGY TO CEPHALOSPORIN 105 -- Background cephalosporin allergy 105 -- Recommendations from international guidelines 105 -- Recommendations from national guides 106 -- Additional literature search: Treatment of gonorrhoea in people with an allergy to cephalosporin 106 -- Treatment of gonorrhoea in people with an allergy to cephalosporin: Good practice statement 106 -- Recommendations for treatment of chlamydia and gonorrhoea co-infection .107 -- 3.10 TEST OF CURE AND FOLLOW-UP FOR GONORRHOEA 107 -- Recommendations from international guidelines 107 -- Recommendations from national guides 109 -- Recommendations regarding a test of cure for gonorrhoea 110 -- Recommendations regarding testing frequency for gonorrhoea 111 -- 3.11 NOTIFICATION OF GONORRHOEA .111 -- Recommendations from international guidelines 111 -- Mandatory notification of gonorrhoea .112 -- 3.12 ASSESSMENT OF RISK FOR SYPHILIS 112 -- 3.13 DIAGNOSIS OF SYPHILIS .113 -- Diagnostic tests and testing approach for syphilis 113 -- Recommendations from international and national guidelines 119 -- Additional literature search: Diagnosis of syphilis .123 -- Recommendations: Who to test for syphilis .140 -- Recommendations: Which sample to take for syphilis diagnosis .141 -- Recommendation: Which tests for syphilis diagnosis .141 -- Choice of tests for syphilis diagnosis: Good practice statements .142 -- 3.14 TREATMENT OF SYPHILIS: INFORMATION AND ADVICE FOR THE PATIENT 142 -- Recommendations from international guidelines 142 -- Recommendations regarding syphilis information and advice for the patient 143 -- 3.15 TREATMENT OF SYPHILIS: INITIATION OF THERAPY AND REFERRAL TO SECOND LINE 143 -- Recommendation regarding initiation of syphilis therapy .143 -- Recognising syphilis clinical symptoms: Good practice statements 144 -- When to refer the patient to the second line for syphilis: Good practice statements 144 -- 3.16 TREATMENT OF SYPHILIS: TREATMENT CHOICE IN MEN AND WOMEN 145 -- Recommendations from international guidelines 145 -- Recommendations from national guides 150 -- Additional literature search: Treatment of uncomplicated syphilis in women and men including young people 151 -- Recommendations for treatment of syphilis in women and men and young people (excluding pregnant women) 163 -- Treatment of syphilis: Good practice statements 163 -- 3.17 TREATMENT OF UNCOMPLICATED SYPHILIS IN CASE OF ALLERGY TO PENICILLIN 164 -- 3.18 TEST OF CURE, FOLLOW-UP AND REFERRAL FOR SYPHILIS 164 -- Recommendations from international guidelines 164 -- Recommendations regarding follow-up of a treated patient 166 -- Testing frequency for syphilis: Good practice statements 167 -- 3.19 NOTIFICATION OF SYPHILIS 167 -- Recommendations from international guidelines 167 -- Mandatory notification of syphilis 167 -- 4 IMPLEMENTATION 168 -- 4.1 IMPLEMENTATION OF THE SCIENTIFIC REPORT DOCUMENT 168 -- 4.2 TRANSLATING THE GUIDELINE INTO A PRIMARY CARE SEXUAL HEALTH CONSULTATION STI TESTING TOOL 168 -- Clinical guidance 168 -- Overview of guidance documents .168 -- Structure of the STI consultation tool 170 -- 4.3 POLICY AND OTHER IMPLEMENTATION OF THIS GUIDELINE 171 -- Barriers and facilitators 171 -- Actors 172 -- 5 GUIDELINE UPDATE 172 -- REFERENCES 173