From the Guidelines
The best treatment for Chlamydia and gonorrhea in males is a 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 recommendation is based on the most recent guidelines from the Centers for Disease Control and Prevention (CDC), which emphasize the importance of treating both infections simultaneously due to their frequent co-occurrence 1. The use of ceftriaxone in combination with azithromycin or doxycycline is supported by data from the CDC's Gonococcal Isolate Surveillance Project (GISP), which has monitored Neisseria gonorrhoeae antimicrobial susceptibilities since 1986 1.
Key Considerations
- The treatment regimen should include a cephalosporin, such as ceftriaxone, due to the increasing resistance of N. gonorrhoeae to other antibiotics 1.
- Azithromycin or doxycycline should be used in combination with ceftriaxone to ensure effective treatment of co-occurring Chlamydia trachomatis infections 1.
- Patients should be advised to abstain from sexual activity for 7 days after treatment and to notify all recent sexual partners, who should also be treated to prevent reinfection.
- A follow-up test is recommended 3 months after treatment to confirm cure, as these infections can be asymptomatic.
Rationale
The CDC's recommendation for combination therapy is based on the increasing resistance of N. gonorrhoeae to cephalosporins, such as cefixime, which is no longer recommended as a first-line treatment 1. The use of ceftriaxone in combination with azithromycin or doxycycline provides a reliable and effective treatment for uncomplicated gonorrhea and chlamydia infections. This approach helps to prevent the development of antimicrobial resistance and ensures the best possible outcomes for patients in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. 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).
The best treatment for Chlamydia and gonorrhea in a male is azithromycin for Chlamydia and cefixime for gonorrhea, as indicated by the drug labels 2 and 3.
- Azithromycin is effective against Chlamydia trachomatis.
- Cefixime is effective against Neisseria gonorrhoeae.
From the Research
Treatment for Chlamydia and Gonorrhea in Males
- The recommended treatment for uncomplicated gonorrhea is a single 500 mg intramuscular dose of ceftriaxone 4, 5, 6.
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 4, 5, 6.
- For the treatment of chlamydia, a seven-day course of doxycycline (100 mg taken by mouth twice per day) is the preferred treatment 5, 7, 8.
- Azithromycin is not recommended as the first-line treatment for chlamydia due to its lower efficacy compared to doxycycline 7, 8.
- It is essential to test for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment 5.
Considerations for Treatment
- The treatment recommendations are based on the priority of treating the individual, protecting the population, and preventing antimicrobial resistance 6.
- The rise of antimicrobial resistance, particularly to azithromycin, has led to the reevaluation of treatment recommendations 4, 6.
- Ceftriaxone remains an effective treatment for gonorrhea, with minimal inhibitory concentrations remaining stable in the United States 6.