From the Guidelines
The recommended treatment for gonorrheal urethritis is a dual therapy approach consisting of a single dose of ceftriaxone 1 g intramuscularly or intravenously, plus oral azithromycin 1 g as a one-time dose, as suggested by the European Association of Urology guidelines 1. This combination therapy is necessary because of increasing antibiotic resistance in Neisseria gonorrhoeae strains. Ceftriaxone targets the bacterial cell wall while azithromycin inhibits protein synthesis, providing complementary mechanisms of action. Some key points to consider in the treatment of gonorrheal urethritis include:
- Testing for and treating chlamydial infection, which commonly co-occurs with gonorrhea
- Patients should abstain from sexual activity for 7 days after treatment completion and until all symptoms have resolved
- Sexual partners from the previous 60 days should be notified, tested, and treated regardless of their test results to prevent reinfection
- A test of cure is not routinely recommended for uncomplicated urethritis if symptoms resolve, but patients with persistent symptoms should be re-evaluated
- Antibiotic resistance monitoring is ongoing, so treatment guidelines may change over time as resistance patterns evolve, as seen in the European Urology guidelines 1 which provide the most recent and highest quality evidence for the treatment of gonorrheal urethritis. Alternative regimens, such as cefixime 400 mg orally plus azithromycin 1 g orally as a single dose, or gentamicin 240 mg intramuscularly plus azithromycin 2 g orally as a single dose, may be considered in cases of cephalosporin allergy or other specific situations, as outlined in the guidelines 1.
From the FDA Drug Label
- 5 Uncomplicated Gonorrhea (cervical/urethral) 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). For the treatment of uncomplicated cervical/urethral gonococcal infections, a single oral dose of 400 mg is recommended.
The recommended treatment for gonorrheal urethritis is a single oral dose of 400 mg of cefixime.
- The dose is the same for both cervical and urethral infections.
- This treatment is indicated for adults and pediatric patients six months of age or older with uncomplicated gonorrhea caused by susceptible isolates of Neisseria gonorrhoeae 2.
From the Research
Treatment Options for Gonorrheal Urethritis
The recommended treatment for gonorrheal urethritis includes:
- Dual antimicrobial therapy, mainly ceftriaxone 250-500 mg plus azithromycin 1-2 g, which has high cure rates and has likely decreased the level of cephalosporin resistance internationally 3
- A single-dose regimen of 1 g of ceftriaxone, which has been shown to be microbiologically effective against gonococcal urethritis and is safe and tolerable 4
- Combination therapy with ceftriaxone 250 mg plus azithromycin 1 g, which is recommended as a first-line regimen for gonorrhea by the Centers for Disease Control and Prevention (CDC) 5
Antimicrobial Resistance
There is a growing concern about antimicrobial resistance in Neisseria gonorrhoeae, with reports of high-level azithromycin resistance and ceftriaxone-resistant strains 6, 3
- The emergence of high-level azithromycin-resistant Neisseria gonorrhoeae has been reported in South Africa, highlighting the need for continued antimicrobial resistance surveillance 6
- Ceftriaxone-resistant strains are currently spreading internationally, predominately associated with travel to Asia 3
Alternative Treatment Regimens
Alternative treatment regimens, such as spectinomycin, have been shown to be effective against uncomplicated gonorrhoea in men 7
- A comparative study of ceftriaxone and spectinomycin for treatment of uncomplicated gonorrhoea in men found that both treatments were effective, with cure rates of 100% for ceftriaxone and 97% for spectinomycin 7