From the Guidelines
The recommended treatment regimen for simultaneous infection with gonorrhea, chlamydia, and trichomoniasis is ceftriaxone 1 g intramuscularly or intravenously, plus azithromycin 1 g orally as a single dose, plus metronidazole 2 g orally as a single dose or tinidazole 2 g orally as a single dose. This regimen is based on the most recent and highest quality study, which suggests that ceftriaxone is effective against gonorrhea, azithromycin is effective against chlamydia, and metronidazole or tinidazole is effective against trichomoniasis 1.
Key Considerations
- Ceftriaxone is the preferred treatment for gonorrhea due to its high efficacy and safety profile, as well as its ability to be administered intramuscularly or intravenously 1.
- Azithromycin is the preferred treatment for chlamydia due to its high efficacy and convenience of a single oral dose 1.
- Metronidazole or tinidazole is the preferred treatment for trichomoniasis due to its high efficacy and safety profile, as well as its ability to be administered as a single oral dose 1.
Treatment Regimen
- Ceftriaxone 1 g intramuscularly or intravenously as a single dose
- Azithromycin 1 g orally as a single dose
- Metronidazole 2 g orally as a single dose or tinidazole 2 g orally as a single dose
Additional Recommendations
- Sexual partners should also be treated to prevent reinfection, and patients should abstain from sexual activity until they and their partners complete treatment and are symptom-free.
- Follow-up testing is recommended 3 months after treatment to ensure cure, particularly for chlamydia and gonorrhea. It's worth noting that, the provided evidence from other years and studies 1 is not as recent or of the same quality as the 2024 study, and therefore, the treatment recommendations from those studies are not considered the most up-to-date or effective.
From the FDA Drug Label
The recommended dose in both females and males is a single 2 g oral dose taken with food. Uncomplicated gonococcal infections in adults (except anorectal infections in men):100 mg, by mouth, twice a day for 7 days. Uncomplicated urethral, endocervical, or rectal infection in adults caused by Chlamydia trachomatis: 100 mg, by mouth, twice a day for 7 days.
The treatment for simultaneous infection with Neisseria gonorrhea, Chlamydia trachomatis, and Trichomonas vaginalis involves:
- Doxycycline 100 mg, by mouth, twice a day for 7 days to treat gonorrhea and chlamydia 2
- Tinidazole single 2 g oral dose taken with food to treat trichomoniasis 3 3 It is essential to note that these infections are sexually transmitted, and sexual partners should be treated simultaneously to prevent re-infection.
From the Research
Treatment Regimens for Simultaneous Infections
To treat simultaneous infections with Neisseria gonorrhea, Chlamydia trachomatis, and Trichomonas vaginalis, the following regimens are recommended:
- For gonorrhea, a single 500-mg dose of intramuscular ceftriaxone is recommended 4, 5, 6, 7.
- For chlamydia, doxycycline is the preferred treatment, with a recommended dosage of 100 mg taken orally twice a day for 7 days 4, 5, 6, 7.
- For trichomoniasis, a seven-day regimen of metronidazole is recommended 4, 8.
Considerations for Concurrent Treatment
When treating concurrent infections, it is essential to consider the potential interactions between medications and the risk of antimicrobial resistance.
- Concurrent treatment with doxycycline for chlamydia is recommended if chlamydial infection has not been excluded 6.
- Metronidazole is effective against trichomoniasis, but its use in combination with other medications should be carefully considered to minimize the risk of adverse effects 4, 8.
Screening and Follow-up
Regular screening for sexually transmitted infections is crucial to prevent complications and transmission.
- All sexually active individuals, especially those under 25 years old, should be screened annually for chlamydia and gonorrhea 5.
- A test-of-cure is recommended for all cases of pharyngeal gonorrhea and for rectal chlamydia if treated with azithromycin 4.
- Pregnant patients diagnosed with chlamydia or gonorrhea should have a test of cure four weeks after treatment 5.