**1.3 Diagnosis of gonorrhea**

In case of symptomatic men infection with urethral discharge, diagnosis can be observed by microscopy, identifying gonococci as intracellular Gram-negative diplococci in polymorphonuclear leukocytes (magnification, ×1000). This cheap method is highly sensitive and specific, can provide rapid results and enables a complete AMR testing. Nonetheless, this method depends on the presence of discharge or secretions, and requires good optimization of many parameters, such as sample collection, storage and transport, culture methodology, as gonococci are fastidious i.e. highly sensitive to external environmental factors [13].

However, in the case of cervical, rectal, or pharyngeal gonorrhea, microscopy is not recommended, especially for asymptomatic patients; in fact that negative results do not exclude the presence of infection due to the low sensitivity of this method. Generally, the microscopy method does not provide any data on antimicrobial sensitivity. In settings with more resources, nucleic acids amplification tests could replace culture for the detection of gonococci. This method allows the detection of nonviable bacterium, with a higher sensitivity than other diagnostic methods, especially for rectal and pharyngeal samples. This method is also rapid, could be automated, and enable simultaneous detection of several pathogens, but it does not inform about antimicrobial resistance profile testing [13].
