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Sexual health testing guide · 2026
Gonorrhoea is the one common STI where the laboratory method affects your treatment options, not just your diagnosis.
Neisseria gonorrhoeae is detected most sensitively by PCR, but PCR cannot tell you which antibiotics will work. Because gonorrhoea has developed resistance to successive antibiotic classes — and ceftriaxone-resistant strains have now been reported internationally, including in the Asia-Pacific region — culture with antimicrobial susceptibility testing remains important, particularly where treatment fails or where infection persists. Throat infection is common, usually symptomless and harder to cure, so pharyngeal swabs matter. A test of cure is recommended for gonorrhoea, unlike chlamydia.
| Screening method | PCR — most sensitive, and works on urine and self-collected swabs |
|---|---|
| Susceptibility testing | Culture, which requires a clinician-collected swab and prompt transport |
| Sites | Urethral or vaginal, plus rectal and pharyngeal where exposure occurred |
| Test of cure | Recommended, typically around 1–2 weeks after treatment |
| Collection | Clinic, at-home in Bangkok or 20+ MedEx sites nationwide; at-home kits also available |
| Price | Listed on the MedEx STD and STI testing page and the lab test catalogue |
PCR is the better screening test. It is more sensitive than culture, works on first-void urine and self-collected swabs, and does not depend on keeping fragile organisms alive during transport. For finding infection, it wins.
Culture does something PCR cannot: it grows the organism, allowing susceptibility testing against individual antibiotics. As resistance spreads, that information becomes more valuable. Guidelines recommend culture before treatment where practical, and specifically where treatment appears to have failed, where infection persists, or in someone who acquired infection in a region with documented resistance.
Culture is more demanding: it needs a clinician-collected swab into the correct transport medium and prompt delivery to the laboratory. Discuss with the team when booking through the MedEx STI testing service whether culture should be added.
Gonorrhoea has progressively developed resistance to sulphonamides, penicillins, tetracyclines, fluoroquinolones and macrolides. Ceftriaxone is now the backbone of treatment in most guidelines, and cases of ceftriaxone-resistant and extensively drug-resistant gonorrhoea have been reported in several countries, including within the Asia-Pacific region.
The practical implications:
Treatment should always come from a clinician. Book through MedEx doctor consultations or the 24/7 doctor on call.
Test the right sites — and ask about culture if you have been treated before.
Pharyngeal gonorrhoea is common in people who have oral sex and is almost always asymptomatic. It matters for two reasons: it is a reservoir for transmission, and it is harder to eradicate than genital infection because antibiotic penetration into pharyngeal tissue is poorer.
Rectal infection is likewise often asymptomatic, though it can cause discharge, discomfort or tenesmus. Neither site is detected by a urine sample.
If you have had receptive oral or anal sex, ask specifically for those swabs. This is the single most common gap in routine screening, and it is why a full history at booking produces a better test than a generic panel — see the STI PCR panel guide for how sites map to samples.
When symptomatic, gonorrhoea typically causes urethral discharge and pain on passing urine in men, often within a week of exposure. In women, symptoms are less specific — increased discharge, pelvic discomfort or bleeding between periods — and many infections are silent. Untreated infection can cause pelvic inflammatory disease, epididymo-orchitis and, rarely, disseminated infection with joint and skin involvement.
A test of cure is recommended for gonorrhoea, in contrast to uncomplicated chlamydia. Timing depends on the method: PCR needs a longer interval than culture because residual genetic material can persist. Follow the interval your clinician specifies.
Partners from the preceding 60 days should be tested and treated, and sex should be avoided until treatment is complete and any test of cure is clear. Where reinfection risk is ongoing, discuss PrEP and broader sexual health support as part of the plan.
PCR is more sensitive for finding infection and works on urine and self-collected swabs. Culture is needed to test which antibiotics will work, which matters given rising resistance, and is particularly important where treatment has failed or infection persists.
No. Pharyngeal infection requires a throat swab, and it is usually asymptomatic. The same applies to rectal infection, which needs a rectal swab.
Yes. It has progressively developed resistance to several antibiotic classes, and ceftriaxone-resistant strains have been reported in several countries including within the Asia-Pacific region. This is why treatment should come from a clinician and be completed in full.
Yes, a test of cure is recommended, unlike uncomplicated chlamydia. The interval depends on the method used, since PCR can detect residual genetic material for longer than culture.
In men, urethral discharge and pain on passing urine often appear within a week of exposure. In women symptoms are less specific and many infections cause none at all.
Partial or incorrect treatment can suppress symptoms without clearing the infection and contributes to antibiotic resistance. It also makes subsequent culture less likely to yield a usable result.
Symptoms after treatment should never be ignored.
Medical disclaimer: This article is general health information and does not replace medical advice, diagnosis or treatment. Laboratory reference ranges differ between laboratories and results must be interpreted alongside your symptoms, medicines and medical history. Speak with a qualified clinician before starting, stopping or changing any treatment. Service details, inclusions and prices can change — confirm them with MedEx before booking.
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