What is the first line treatment for gonorrhea?

From the Guidelines

The first line treatment for gonorrhea is a dual therapy approach consisting of a single intramuscular dose of ceftriaxone 250 mg plus either a single dose of azithromycin 1 g orally or doxycycline 100 mg orally twice daily for 7 days. This combination therapy is recommended because gonorrhea has developed resistance to multiple antibiotics over time, and using two different antibiotics helps prevent further resistance development, as noted in the study published in the Morbidity and Mortality Weekly Report 1. Ceftriaxone targets the bacterial cell wall while azithromycin inhibits protein synthesis, attacking the infection through different mechanisms. It's essential that patients complete the full treatment even if symptoms improve quickly, and they should abstain from sexual activity for at least 7 days after treatment completion. Partners from the previous 60 days should also be notified and treated regardless of symptoms to prevent reinfection. A test-of-cure is not routinely needed for uncomplicated gonorrhea if the recommended regimen is used, but patients with persistent symptoms should be reevaluated, as suggested by the CDC's guidelines 1. Additionally, patients diagnosed with gonorrhea should be tested for other sexually transmitted infections including HIV, syphilis, and chlamydia.

Some key points to consider when treating gonorrhea include:

• The importance of using a dual therapy approach to prevent further resistance development
• The need for patients to complete the full treatment, even if symptoms improve quickly
• The importance of notifying and treating partners from the previous 60 days to prevent reinfection
• The recommendation to test patients diagnosed with gonorrhea for other sexually transmitted infections

It's also important to note that the CDC's recommendations for treating gonorrhea have changed over time due to the development of antibiotic resistance, as discussed in the study published in the Morbidity and Mortality Weekly Report 1. Therefore, it's essential to stay up-to-date with the latest guidelines and recommendations for treating gonorrhea.

From the FDA Drug Label

For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. The first line treatment for gonorrhea is a single intramuscular dose of 250 mg of ceftriaxone 2.

• The dose is administered via intramuscular injection.
• This treatment is recommended for uncomplicated gonococcal infections.

From the Research

First Line Treatment for Gonorrhea

The first line treatment for gonorrhea is a dual therapy regimen, which typically includes an injectable cephalosporin (such as ceftriaxone) plus oral azithromycin 3.

Recommended Treatment Regimens

• Ceftriaxone 500mg intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites 3
• If coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added 3
• Alternative regimens, such as gentamicin 240mg plus azithromycin 2g, may be considered for patients with cephalosporin allergies or other specific situations 4, 5

Efficacy of Treatment Regimens

• Studies have shown that ceftriaxone and azithromycin are highly effective in treating uncomplicated gonorrhea, with cure rates of 98-100% 6, 7
• Gentamicin plus azithromycin has also been shown to be effective, with cure rates of 100% for rectal and pharyngeal gonorrhea 5
• Cefixime, an orally absorbed cephalosporin, has been shown to be effective in treating uncomplicated gonorrhea, with cure rates of 96-98% 7

Considerations for Treatment

• The choice of treatment regimen should be based on the patient's medical history, allergy status, and other factors 3
• Antimicrobial resistance is a major concern, and treatment regimens should be chosen to minimize the risk of resistance development 3