From the Guidelines
The recommended treatment for gonorrhea is a dual therapy approach consisting of a single intramuscular injection of ceftriaxone 250 mg, combined with oral azithromycin 1 gram taken as a one-time dose. This combination is necessary because gonorrhea bacteria (Neisseria gonorrhoeae) have developed resistance to many antibiotics over time, as reported in the Morbidity and Mortality Weekly Report 1. Ceftriaxone works by interfering with bacterial cell wall synthesis, while azithromycin inhibits bacterial protein synthesis, attacking the infection through different mechanisms. The use of azithromycin as the second antimicrobial is preferred to doxycycline because of the convenience and compliance advantages of single-dose therapy and the substantially higher prevalence of gonococcal resistance to tetracycline than to azithromycin among GISP isolates, particularly in strains with elevated cefixime MICs 1.
It's essential to complete the full treatment even if symptoms improve quickly. Sexual partners from the previous 60 days should also be tested and treated to prevent reinfection. Patients should abstain from sexual activity for 7 days after completing treatment and until all partners have been treated. Follow-up testing is recommended 1-2 weeks after treatment completion to confirm cure, especially important given increasing antibiotic resistance. If symptoms persist after treatment, patients should return for evaluation as this may indicate antibiotic resistance requiring alternative therapy.
Key points to consider:
- Ceftriaxone is the only remaining recommended antimicrobial class for the treatment of gonorrhea, and its effectiveness should be maintained for as long as possible 1.
- The emergence of fluoroquinolone-resistant N. gonorrhoeae in the United States during the 1990s also occurred initially in the West and predominantly among MSM before spreading throughout the United States within several years 1.
- The significant increase in the prevalence of U.S. GISP isolates with elevated cefixime MICs is of particular concern, as it may indicate early stages of the development of clinically significant gonococcal resistance to cephalosporins 1.
Given the increasing antibiotic resistance, it is crucial to follow the recommended treatment guidelines to ensure effective treatment and prevent further resistance development.
From the FDA Drug Label
For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. The recommended treatment for gonorrhea is a single intramuscular dose of 250 mg of ceftriaxone.
- Key points:
- The dose is administered intramuscularly.
- The treatment is for uncomplicated gonococcal infections.
- No dosage adjustment is necessary for patients with impairment of renal or hepatic function 2
From the Research
Treatment Options for Gonorrhea
The recommended treatment for gonorrhea is dual therapy with ceftriaxone and azithromycin, which should be administered together on the same day, preferably simultaneously, and under direct observation 3, 4, 5. This treatment regimen is effective against uncomplicated urogenital or rectal gonorrhea.
Alternative Treatment Options
Alternative treatment options include cefixime and azithromycin, which has been shown to be effective in treating gonorrhea 6, 7. Cefixime is an orally absorbed cephalosporin that is active against resistant gonococci and has pharmacokinetic activity suitable for single-dose administration 7.
Key Considerations
- Dual therapy with ceftriaxone and azithromycin is the recommended first-line regimen for the treatment of gonorrhea in the United States 3, 4, 5.
- Pregnant women who are infected with N gonorrhoeae should be treated with the recommended dual therapy 3, 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 3, 4, 5.
- Repeat N gonorrhoeae infection is prevalent among patients who have been diagnosed with and treated for gonorrhea in the preceding several months, and clinicians should advise patients with gonorrhea to be retested 3 months after treatment 3, 4, 5.
Treatment Efficacy
- The efficacy of dual therapy with ceftriaxone and azithromycin has been shown to be high, with cure rates of 96-98% 7.
- The efficacy of cefixime and azithromycin has also been shown to be high, with cure rates of 96-98% 7.
- The treatment efficacy is independent of the resistance pattern of the gonococcal isolates 7.