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The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests (NAATs) and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1\u2009g plus azithromycin 2\u2009g) OR ceftriaxone 1\u2009g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and\/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. This review provides the detailed background, evidence base and discussions, for the 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et\u00a0al. Int J STD AIDS. 2020).<\/jats:p>","DOI":"10.1177\/0956462420948739","type":"journal-article","created":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T02:33:08Z","timestamp":1608085988000},"page":"108-126","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":46,"title":["Background review for the \u20182020 European guideline for the diagnosis and treatment of gonorrhoea in adults\u2019"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1710-2081","authenticated-orcid":false,"given":"M","family":"Unemo","sequence":"first","affiliation":[{"name":"WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, \u00d6rebro University Hospital and Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JDC","family":"Ross","sequence":"additional","affiliation":[{"name":"University Hospital Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AB","family":"Serwin","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Medical University of Bia\u0142ystok, Bia\u0142ystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Gomberg","sequence":"additional","affiliation":[{"name":"Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Cusini","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7464-7435","authenticated-orcid":false,"given":"JS","family":"Jensen","sequence":"additional","affiliation":[{"name":"Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,12,15]]},"reference":[{"key":"bibr1-0956462420948739","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0128-6"},{"key":"bibr2-0956462420948739","unstructured":"Hook EWIII, Handsfield HH. 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