From the Guidelines
Gonorrhea should be treated with a dual therapy approach consisting of ceftriaxone 250mg as a single intramuscular injection plus azithromycin 1g orally as a single dose, as recommended by the CDC 1. This combination is recommended due to increasing antibiotic resistance. For patients allergic to cephalosporins, alternatives include gentamicin 240mg intramuscularly plus azithromycin 2g orally, as suggested by the US Centers for Disease Control and Prevention and other international guidelines 1. Some key points to consider when treating gonorrhea include:
- Starting treatment immediately after diagnosis
- Abstaining from sexual activity for 7 days after completing treatment
- Notifying, testing, and treating all sexual partners from the past 60 days
- Recommending a test-of-cure 1-2 weeks after treatment completion, especially for pharyngeal infections which are harder to treat Gonorrhea can cause serious complications if left untreated, including pelvic inflammatory disease in women and epididymitis in men, potentially leading to infertility. The dual therapy approach is essential because Neisseria gonorrhoeae has developed resistance to multiple antibiotics over time, making previously effective single-drug treatments ineffective 1. It's also important to note that cefixime is no longer recommended as a first-line treatment due to declining susceptibility among N. gonorrhoeae isolates 1. In cases of suspected treatment failure, it's recommended to obtain a specimen for culture and antimicrobial susceptibility testing, report the case to local public health officials, and consider alternative treatment regimens, such as gentamicin 240mg intramuscularly plus azithromycin 2g orally 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). For the treatment of uncomplicated cervical/urethral gonococcal infections, a single oral dose of 400 mg is recommended.
The recommended treatment for gonorrhea is a single oral dose of 400 mg of cefixime.
- The dose is the same for adults and pediatric patients six months of age or older.
- This dosage is indicated for the treatment of uncomplicated gonorrhea (cervical/urethral) caused by susceptible isolates of Neisseria gonorrhoeae 2.
From the Research
Treatment Options for Gonorrhea
- The recommended treatment for uncomplicated gonorrhea is a single 500 mg intramuscular (IM) 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.
- Dual therapy with ceftriaxone and azithromycin was previously recommended, but due to increasing resistance to azithromycin, this recommendation has been reevaluated 5, 6, 4.
- For individuals with cephalosporin allergies, there are limited alternative therapies available, and no recommended alternative therapies for N gonorrhoeae infection of the throat 4.
Antimicrobial Resistance
- Neisseria gonorrhoeae has developed resistance to multiple antibiotics, including sulfonamides, tetracyclines, and penicillin 5, 6, 7.
- Resistance to ceftriaxone and azithromycin is also increasing, with reports of treatment failures internationally 4, 7.
- The Gonococcal Isolate Surveillance Project (GISP) has documented a rapid rise in the proportion of isolates with elevated minimum inhibitory concentrations (MICs) to azithromycin 4.
Prevention and Management
- Prevention, early diagnosis, contact tracing, treatment, test-of-cure, and additional measures are essential for effective management of anogenital and pharyngeal gonorrhea 7.
- Antimicrobial stewardship and surveillance of infection, antimicrobial resistance, and treatment failures are also crucial 4, 7.
- Research into new antimicrobials, rapid molecular point-of-care detection of gonococci and antimicrobial resistance, and an effective gonococcal vaccine is necessary for sustainable management and control of gonorrhea 7.