The Bottom Line – A single 500mg IM dose of ceftriaxone is effective for treating uncomplicated urogenital, anorectal, and pharyngeal gonorrhea infections
Citing increasing resistance and antibiotic stewardship the CDC has revised its recommendations for the treatment of gonorrhea. Recall that the previous treatment recommendation from 2010 included a dose of 250mg ceftriaxone given as an intramuscular injection and a single 1g oral doze of azithromycin for the treatment of gonorrhea. N. gonorrhoeae continues to be highly susceptible to ceftriaxone – but azithromycin resistance is increasing. There are some updated recommendations which I’ll briefly discuss below. You can read the full report in the MMWR.
Ceftriaxone for gonorrhea is now 500mg IM
N. gonorrhoeae continues to be highly susceptible to ceftriaxone – but azithromycin resistance is increasing. This new recommendation doubles the previous dose and removes the 1g of oral azithromycin that has existed since that 2010 recommendation. The dose is 1g for people who are ≥150kg (300 pounds). If you are concurrently treating chlamydia, then add doxycycline 100 mg orally twice a day for 7 days. Pregnant patients get get a single dose of 1g Azithromycin orally for chlamydia.
If patients have cephalosporin allergy you should give gentamicin 240mg IM plus a single 2 g oral dose of azithromycin. This regimen causes GI upset and emesis in 3-4% of patients. If you don’t have IM ceftriaxone you could give 800mg of cefixime orally.
Expedited partner therapy for gonrrohea is Cefixime
If your state permits it, expedited partner therapy can be delivered via a single dose of 800mg cefixime orally for isolated gonorrheal infections. Use oral doxycycline 100 mg twice daily for 7 days for concomitant chlamydia.
A test of cure is unnecessary unless the patient had gonococcal pharyngitis
No test of cure is needed for uncomplicated urogenital or rectal gonorrhea. However, patients who have had pharyngeal gonorrhea should have a NAAT or culture test of cure 7-14 days after initial treatment. Additionally, reinfection rates are approximately 1 in 10 patients, so retesting 3 months after treatment as a part of ongoing health maintenance is recommended.
