Primary prevention
Primary prevention measures include encouraging the delay of first sexual activity, promoting monogamy (or at least a reduction in the number of partners), and using condoms during any penetrative sex. Many behavioural modification methods, particularly high-intensity counselling on sexual risk reduction, have been shown to reduce risk behaviours that lead to sexually transmitted infections, but the problem is how to deliver counselling interventions in a time-constrained environment.[38] In general, the approach should be non-judgemental and person-centred.[39] Following a risk history, the discussion should focus on sexual risk behaviours to clarify misconceptions, review successes and failures of previous attempts to change behaviour, and set concrete goals for the future.[40] It is important to note that spermicides and non-barrier forms of contraception do not prevent gonorrhoea or other STIs.
The US Preventive Services Task Force and US Centers for Disease Control and Prevention recommend prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum.[26][41]
There are no vaccines available for gonorrhoea. However, a retrospective case-control study involving adults aged 15 to 30 years in New Zealand found that outer membrane vesicle meningococcal B vaccine (MeNZB) has a protective effect against gonorrhoea.[42] Further studies are required to verify these findings.
Secondary prevention
Treatment of gonorrhoea is also a means of secondary prevention to interrupt transmission within the community. For the healthcare professionals, partner management is an important aspect of treating the patient to prevent re-infection. Partners should be sought from the last 60 days or the last partner before 60 days if no recent partners are reported.[26]
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If possible, the partner should be engaged for counselling and testing or, at the very least, the patient should be told to refer his/her partners to medical care. Use of electronic partner notification is another option in some jurisdictions; however, uptake by index cases is low and evidence for proper evaluation of partners is lacking.[90]
Partners of patients with documented Neisseria gonorrhoeae infection should be evaluated and treated. To avoid re-infection, sex partners should abstain from sexual intercourse until they and their partner(s) are adequately treated.
Infection in mothers of gonorrhoea-infected neonates should be confirmed, and they should be treated as well as their partners.
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