From the Guidelines
The recommended treatment for Neisseria gonorrhoeae (Gonorrhea) infection is combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days. This treatment approach is based on the most recent and highest quality evidence from the Centers for Disease Control and Prevention (CDC) 1. The use of ceftriaxone and azithromycin or doxycycline is essential to prevent antibiotic resistance and ensure complete eradication of the infection.
Key Points:
- Cefixime is no longer recommended as a first-line treatment for gonorrhea due to declining susceptibility among urethral N. gonorrhoeae isolates 1.
- The combination therapy with ceftriaxone and azithromycin or doxycycline is the most reliably effective treatment for uncomplicated gonorrhea 1.
- It is crucial to treat both sexual partners simultaneously to prevent reinfection.
- Patients should abstain from sexual activity for 7 days after treatment completion and get retested 3 months after treatment to confirm cure.
- Consistent use of condoms is essential to prevent future infections.
Rationale:
The CDC's Gonococcal Isolate Surveillance Project (GISP) has monitored N. gonorrhoeae antimicrobial susceptibilities since 1986, providing valuable data on the effectiveness of various treatment regimens 1. The recent data suggest that cefixime susceptibility is declining, making it less effective as a treatment option. In contrast, the combination therapy with ceftriaxone and azithromycin or doxycycline has been shown to be highly effective in treating uncomplicated gonorrhea. This treatment approach is supported by the CDC's 2010 sexually transmitted diseases (STDs) treatment guidelines, which recommend combination therapy for gonorrhea to ensure treatment of co-occurring pathogens and prevent emerging gonococcal resistance 1.
From the FDA Drug Label
- 5 Uncomplicated Gonorrhea (cervical/urethral) Cefixime for oral suspension and cefixime capsule is indicated in the treatment of adults and pediatric patients six months of age or older with uncomplicated gonorrhea (cervical/urethral) caused by susceptible isolates of Neisseria gonorrhoeae(penicillinase-and non-penicillinase-producing isolates). Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.
The diagnosis of Neisseria gonorrhoeae (Gonorrhea) infection is typically made through culture and susceptibility tests. The treatment for uncomplicated gonorrhea (cervical/urethral) caused by susceptible isolates of Neisseria gonorrhoeae is:
- Cefixime: a single oral dose of 400 mg 2
- Azithromycin: may be used as an alternative treatment, however the dosage is not specified in the provided label for gonorrhea treatment 3 It is essential to note that antimicrobial therapy should be adjusted accordingly once culture and susceptibility test results become available.
From the Research
Diagnosis of Neisseria gonorrhoeae (Gonorrhea) Infection
- The diagnosis of gonorrhea is typically made through laboratory tests, such as nucleic acid amplification tests (NAATs) or culture 4, 5, 6, 7, 8
- These tests can detect the presence of Neisseria gonorrhoeae in urine, genital, or pharyngeal samples
Treatment of Neisseria gonorrhoeae (Gonorrhea) Infection
- The recommended treatment for gonorrhea is dual therapy with ceftriaxone and azithromycin 4, 5, 6, 7, 8
- Ceftriaxone is typically administered as a single intramuscular dose of 250-500mg, while azithromycin is given as a single oral dose of 1-2g 4, 5, 6
- Alternative treatments, such as gentamicin and ofloxacin, may be considered in cases of cephalosporin allergy or resistance 4, 5
- Pregnant women with gonorrhea should be treated with the recommended dual therapy, and retested in the third trimester unless recently treated 7, 8
Management and Prevention of Neisseria gonorrhoeae (Gonorrhea) Infection
- Repeat testing is recommended 3 months after treatment to detect potential reinfection 7, 8
- Antimicrobial stewardship and surveillance of infection, antimicrobial resistance, and treatment failures are essential for effective management and control of gonorrhea 5, 6
- Research into new antimicrobials, rapid molecular point-of-care detection of gonococci and antimicrobial resistance, and an effective gonococcal vaccine is ongoing 5, 6