Gonorrhoea is a common sexually transmitted disease (STD) that affects men and women, caused by Neisseria gonorrhoeae which is transmitted through mucosal secretions. Although considered as an STD, in rare cases, Neisseria gonorrhoeae (NG) can also be affect extragenital locations such as the rectum or anorectal. The increasing number of cases of anorectal gonorrhoea among men is likely due to the patient being bisexual or homosexuals. The presence of gonorrhoea at any site also increases the risk of transmission and the risk of becoming infected with HIV. Laboratory diagnosis of gonococcal infection depends primarily on the identification of NG in the infected site by microscopic examination of staining, culture, or by genetic detection of the organism. Treatment of anorectal gonorrhoea is similar to urogenital gonorrhoea therapy where combination of antibiotic therapy is still the first line treatment. This paper reports a case in a 26-year-old male patient diagnosed with anorectal gonorrhoea in an HIV patient who showed clinical improvement with single dose Azithromycin 2 g monotherapy for 4 weeks.