Increasing urogenital and oropharyngeal gonorrhoea positivity in women attending a sexual health service in Melbourne, Australia, 2015–2024

BACKGROUND: Gonorrhoea notifications among women have increased, but the determinants of this trend are unclear. We aimed to examine temporal trends in gonorrhoea positivity and associated clinical characteristics among women attending a major sexual health clinic in Melbourne, Australia between 2015 and 2024. METHOD: We conducted a retrospective analysis of women diagnosed with gonorrhoea between 2015 and 2024. Demographic, behavioural and clinical data were extracted from routine clinical records, including sexual practices, sex work status and condom use. A chart review of a subset of positive cases was performed to obtain symptom characteristics and microscopy findings. RESULTS: Over the study period, we included a total of 91,332 consultations (47,013 women), with a gonorrhoea test performed on the day. Overall, the gonorrhoea positivity was 1.9% (1693/91,332), and it increased from 1.3% (61/4711) in 2015 to 2.3% (243/10,497) in 2024 (Ptrend < 0.001), representing a 78.9% relative increase. Oropharyngeal gonorrhoea increased from 4.4% (21/482) to 5.8% (96/1653; Ptrend < 0.001), and urogenital gonorrhoea increased from 1.0% (49/4673) to 1.7% (181/10,435; Ptrend < 0.001), whereas anorectal gonorrhoea remained stable. Of the 1693 women who were diagnosed with gonorrhoea, most were born overseas (52.9%, n = 896), and resided in high socioeconomic areas (76.1%, n = 1289). Co-infection with bacterial vaginosis (14.9%) and chlamydia (13.6%) was frequent. Among symptomatic women who underwent chart review, vaginal discharge was the most common symptom (59.5%), but only 8.7% reported a 'typical' yellow, green or pus-like discharge. CONCLUSION: Gonorrhoea positivity among women increased over the past decade, particularly at the oropharyngeal site, suggesting broader transmission within the general population. As many women did not present with a typical gonorrhoea discharge, general practitioners and other healthcare providers should consider gonorrhoea in women presenting with genital symptoms and offer testing, including at extragenital sites where clinically indicated.