From the Guidelines
The recommended treatment regimen for gonorrhea 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 guidelines from the Centers for Disease Control and Prevention (CDC), as reported in the Morbidity and Mortality Weekly Report 1. The use of ceftriaxone in combination with azithromycin or doxycycline is recommended due to the increasing resistance of Neisseria gonorrhoeae to cephalosporins, including cefixime.
Key points to consider in the treatment of gonorrhea include:
- The importance of testing for and treating co-infections, such as chlamydia, due to the high frequency of dual infections 1.
- The need for patients to abstain from sexual activity until they and their partners have completed treatment and symptoms have resolved, usually about 7 days after treatment.
- The recommendation for follow-up testing 3 months after treatment to ensure cure, especially in high-risk individuals.
- The importance of notifying, testing, and treating all sexual partners from the previous 60 days to prevent reinfection and further transmission.
It's crucial to note that the treatment of gonorrhea has been complicated by the ability of Neisseria gonorrhoeae to develop resistance to antimicrobials used for treatment, highlighting the need for ongoing surveillance and updates to treatment guidelines 1.
From the FDA Drug Label
For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. The recommended treatment regimen for gonorrhea is a single intramuscular dose of 250 mg of ceftriaxone 2.
- Key points:
- The dose is administered intramuscularly.
- The treatment is for uncomplicated gonococcal infections. Alternatively, a single oral dose of 400 mg of cefixime can be used 3.
- Key points:
- The dose is administered orally.
- The treatment is for uncomplicated cervical/urethral gonococcal infections.
From the Research
Gonorrhea Treatment Regimens
The recommended treatment regimens for gonorrhea are as follows:
- Dual therapy with ceftriaxone and azithromycin is the recommended first-line regimen for the treatment of gonorrhea in the United States 4, 5.
- A single 500 mg intramuscular (IM) dose of ceftriaxone is recommended for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 6.
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 6.
- Azithromycin in combination with gentamicin or spectinomycin has been recommended in treatment failure cases 7.
Alternative Treatment Options
Alternative treatment options include:
- Gentamicin plus azithromycin, which has shown additivity/indifference with a mean FICI of 1.7 8.
- Novel combinations such as gentamicin+ertapenem, moxifloxacin+ertapenem, spectinomycin+ertapenem, azithromycin+ moxifloxacin, and cefixime+gentamicin, which have shown high synergistic effects in overall strains and also for the XDR strain 7.
Treatment Administration
Treatment administration guidelines include:
- Dual therapy with ceftriaxone and azithromycin should be administered together on the same day, preferably simultaneously, and under direct observation 4, 5.
- A test-of-cure is not needed for individuals diagnosed with uncomplicated urogenital or rectal gonorrhea who are treated with the recommended or alternative regimens 4, 5.
- Patients with gonorrhea should be retested 3 months after treatment, and pregnant women with antenatal gonococcal infection should be retested in the third trimester unless recently treated 4, 5.