From the Guidelines
The recommended treatment for gonorrhea is a single intramuscular injection of ceftriaxone 500 mg, as it is highly effective against Neisseria gonorrhoeae, the bacterium that causes gonorrhea, as supported by the most recent study 1. Due to increasing antibiotic resistance, previous dual therapy recommendations with azithromycin have been modified, though in some cases providers may still add azithromycin 1 gram orally as a single dose or doxycycline 100 mg orally twice daily for 7 days, especially if chlamydial co-infection is suspected or confirmed, as suggested by 1 and 1. Some key points to consider in the treatment of gonorrhea include:
- The importance of using ceftriaxone due to its effectiveness and the development of resistance to other antibiotics, including fluoroquinolones, tetracyclines, and some macrolides, as highlighted in 1.
- The need to abstain from sexual activity for 7 days after treatment completion and until all sexual partners have been treated to prevent reinfection.
- Notifying, testing, and treating all sexual partners from the past 60 days, regardless of symptoms.
- Retesting 3 months after treatment due to the high rate of reinfection, as recommended in 1. It's essential to follow these guidelines to ensure effective treatment and prevent the spread of gonorrhea, as emphasized in 1.
From the FDA Drug Label
For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. For the treatment of uncomplicated cervical/urethral gonococcal infections, a single oral dose of 400 mg is recommended.
The recommended treatment regimen for gonorrhea is a single dose of 250 mg of ceftriaxone administered intramuscularly or a single oral dose of 400 mg of cefixime.
From the Research
Recommended Treatment Regimen for Gonorrhea
The recommended treatment regimen for gonorrhea is dual therapy with ceftriaxone and azithromycin 4, 5, 6. This regimen is recommended for the treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea.
Dosage and Administration
- Ceftriaxone: a single 500 mg intramuscular (IM) dose 7
- Azithromycin: a single 1 g oral dose 4, 5, 6
- Dual therapy should be administered together on the same day, preferably simultaneously, and under direct observation 5, 6
Alternative Regimens
- Gentamicin plus azithromycin: this regimen has been shown to be effective for the treatment of uncomplicated gonorrhea 8
- Gemifloxacin plus azithromycin: this regimen has also been shown to be effective for the treatment of uncomplicated gonorrhea 8
Special Considerations
- Pregnant women: should be treated with the recommended dual therapy 5, 6
- Test-of-cure: not needed for individuals diagnosed with uncomplicated urogenital or rectal gonorrhea who are treated with the recommended or alternative regimens 5, 6
- Repeat infection: patients with gonorrhea should be retested 3 months after treatment 5, 6