What is the treatment for pharyngeal gonorrhea (Gonorrhea of the throat)?

From the Guidelines

The recommended treatment for gonorrhea of the throat is a single 1g intramuscular injection of ceftriaxone, as it is the most effective antibiotic against Neisseria gonorrhoeae, the bacterium that causes the infection, as supported by the most recent study 1. This treatment is based on the latest evidence from a 2024 study published in The Lancet Infectious Diseases, which suggests that higher doses of ceftriaxone are necessary to achieve the necessary antimicrobial effect, especially in cases of pharyngeal infections with elevated MICs 1. Some key points to consider when treating gonorrhea of the throat include:

• The importance of completing the full course of treatment, even if symptoms improve before finishing
• The need for follow-up testing to confirm that the infection has cleared
• The recommendation to notify and treat sexual partners from the past 60 days to prevent reinfection
• The importance of abstaining from oral sex until both the patient and their partners have completed treatment and are confirmed cured
• The fact that pharyngeal gonorrhea is more difficult to treat than genital infections due to the lower concentrations of antibiotics achieved in throat tissues, as noted in earlier studies 1. It's also worth noting that earlier studies, such as the 2002 CDC guidelines 1 and the 2012 MMWR report 1, recommended different treatment regimens, but the most recent evidence supports the use of a single 1g intramuscular injection of ceftriaxone as the most effective treatment for gonorrhea of the throat.

From the FDA Drug Label

For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. The treatment for gonorrhea of the throat is a single intramuscular dose of 250 mg of ceftriaxone, as it is used to treat uncomplicated gonococcal infections, which includes gonorrhea of the throat 2.

From the Research

Treatment Options for Gonorrhea of the Throat

• The recommended treatment for uncomplicated gonorrhea, including pharyngeal infection, is a single 500 mg intramuscular dose of ceftriaxone 3, 4.
• If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 3, 4.
• Cefixime, an orally absorbed cephalosporin, has been shown to be effective in treating uncomplicated gonorrhea, including pharyngeal infection, with a cure rate of 91% 5.
• However, the use of cefixime as a treatment for gonorrhea of the throat is not currently recommended by the CDC 3, 4.
• Alternative therapies for persons with cephalosporin allergies are limited, and there are no recommended alternative therapies for N gonorrhoeae infection of the throat 4.
• Research is ongoing to identify potential combination therapies with ceftriaxone to prevent the emergence of ceftriaxone resistance, including the use of zoliflodacin, delafloxacin, sitafloxacin, eravacycline, and gentamicin 6.
• High-dose ceftriaxone monotherapy has been shown to be effective in treating extragenital gonorrhea, including pharyngeal infection, with an efficacy rate of 97.8% 7.