Culture and Identification of Neisseria gonorrhoeae : A Narrative Review of Current Laboratory Methods

BACKGROUND: Neisseria gonorrhoeae (GC) culture remains critical for gonorrhea treatment and surveillance, as antimicrobial susceptibility testing currently depends on culture-based methods. Here we aim to describe how GC culture and identification methods have changed since they were last described by the US Centers for Disease Control and Prevention. METHODS: We performed a systematic literature search to address the questions, "Have culture methods for GC changed since they were last described in 2009," "What biochemical tests can be used for the identification of GC," "What is the utility of MALDI-TOF for detecting GC," and "When should GC culture be performed?" Using defined search terms across 5 electronic databases, we identified 4926 papers published between 2009 and 2024, of which 51 met inclusion criteria for narrative review. RESULTS: GC culture conditions have remained largely unchanged, but there has been continued improvement in preanalytical processing products and procedures. Patient-collected specimens, including urine, demonstrate equivalent culture yield compared with clinician-collected specimens, offering opportunities to enhance GC surveillance. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry has emerged as a reliable, rapid, cost-effective, and accurate method of GC identification, offering numerous advantages over traditional biochemical methods for GC identification. CONCLUSIONS: Although the evidence suggests that GC cultures from urogenital specimens of symptomatic patients yield the highest recovery rates, the potential for antimicrobial-resistant GC in the pharynx underscores the importance of culturing all anatomical sites of exposure. Maintaining GC culture capacity remains critically important for surveillance and antimicrobial susceptibility testing of GC.