From the Guidelines
For gonorrhea and chlamydia of the throat, testing is recommended via nucleic acid amplification tests (NAATs) using throat swabs, and treatment should consist of a single 500mg intramuscular injection of ceftriaxone for gonorrhea, and doxycycline 100mg taken orally twice daily for 7 days for chlamydia, with both infections being treated simultaneously due to common co-infection 1. The recommended treatment for pharyngeal gonorrhea is a single 500mg intramuscular injection of ceftriaxone, while pharyngeal chlamydia is treated with doxycycline 100mg taken orally twice daily for 7 days.
- It's essential to treat both infections simultaneously since co-infection is common.
- Patients should abstain from oral sex for at least 7 days after completing treatment and until symptoms resolve.
- Partners from the past 60 days should also be notified and treated.
- A test-of-cure is recommended 2-4 weeks after treatment completion, particularly for pharyngeal gonorrhea which can be more difficult to eradicate than genital infections. These recommendations target the specific bacteria - ceftriaxone is effective against Neisseria gonorrhoeae which has developed resistance to many antibiotics, while doxycycline works well against Chlamydia trachomatis by inhibiting protein synthesis, as noted in the guidelines for treatment of gonorrhea and chlamydia 1. Regular screening is advised for sexually active individuals with multiple partners, as these infections are often asymptomatic in the throat but can still be transmitted. The use of ceftriaxone is recommended due to its effectiveness against Neisseria gonorrhoeae, which has developed resistance to many antibiotics, including oral cephalosporins like cefixime, as reported in the study on the declining cefixime susceptibility among urethral N. gonorrhoeae isolates 1.
From the FDA Drug Label
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 recommended testing for gonorrhea and chlamydia of the throat is not directly stated in the provided drug labels.
- Testing: Not specified in the labels.
- Treatment: For uncomplicated gonococcal infections and chlamydia, doxycycline 100 mg, by mouth, twice a day for 7 days is recommended 2. However, the labels do not explicitly address the treatment of gonorrhea and chlamydia of the throat.
From the Research
Testing for Gonorrhea and Chlamydia of the Throat
- The recommended testing for gonorrhea and chlamydia of the throat involves nucleic acid amplification tests (NAATs) due to their high sensitivity and specificity 3, 4, 5, 6.
- NAATs can be used on self-collected specimens, such as throat swabs, and can detect both gonorrhea and chlamydia infections 3, 6.
- The Centers for Disease Control and Prevention (CDC) recommends using NAATs to detect chlamydia and gonorrhea, except in cases of child sexual assault or when evaluating a potential gonorrhea treatment failure, in which case culture and susceptibility testing may be required 5.
Treatment for Gonorrhea and Chlamydia of the Throat
- The recommended treatment for uncomplicated gonorrhea at all anatomic sites, including the throat, is 500mg ceftriaxone intramuscularly once 7.
- If coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added 7.
- There are no recommended alternative therapies for N gonorrhoeae infection of the throat in persons with cephalosporin allergies 7.
Diagnostic Tests
- NAATs, such as PCR, SDA, and LCR, have been shown to be superior to culture and non-amplified non-culture tests for detecting gonorrhea and chlamydia infections 3, 4, 6.
- The performance characteristics of NAATs, including sensitivity and specificity, are highly dependent on the type of specimen used and the population being tested 3, 5.