From the Guidelines
The first-line treatment for gonorrhea in pregnancy is ceftriaxone 250 mg as a single intramuscular dose, as recommended by the most recent guidelines 1. This antibiotic is preferred because it effectively crosses the placenta, is safe for both mother and fetus, and has high efficacy against Neisseria gonorrhoeae, including strains that have developed resistance to other antibiotics. Due to increasing antibiotic resistance patterns, previous treatments like oral cefixime or dual therapy with azithromycin are no longer recommended as first-line options 1. Some key points to consider in the treatment of gonorrhea in pregnancy include:
- Testing for other sexually transmitted infections, particularly chlamydia, which commonly co-occurs with gonorrhea 1
- Treating partners simultaneously to prevent reinfection 1
- Follow-up testing is recommended 3-4 weeks after treatment to ensure cure 1
- Untreated gonorrhea during pregnancy can lead to serious complications including preterm birth, premature rupture of membranes, and transmission to the newborn during delivery, potentially causing ophthalmia neonatorum 1 It's also important to note that pregnant women with gonorrhea should be treated with caution and under the guidance of a healthcare provider, as the use of certain antibiotics during pregnancy can have potential risks and benefits that need to be carefully considered 1.
From the Research
First Line Treatment for Gonorrhea in Pregnancy
The first line treatment for gonorrhea in pregnancy is a crucial aspect of preventing maternal and neonatal complications. According to the available evidence:
- Ceftriaxone is a commonly recommended antibiotic for the treatment of gonorrhea in pregnancy 2, 3, 4, 5.
- A study published in 2001 found that both intramuscular ceftriaxone 125 mg and oral cefixime 400 mg were effective in treating gonococcal infection in pregnancy, with an overall efficacy of 95.8% 3.
- Another study published in 1993 found that ceftriaxone 250 mg intramuscularly was effective in 95% of cases, while amoxicillin 3 g orally plus probenecid 1 g orally was effective in 89% of cases 5.
- A more recent study published in 2024 suggested that a single dose of ceftriaxone 1 g intramuscularly may be effective in eradicating ceftriaxone-susceptible and ceftriaxone-resistant Neisseria gonorrhoeae strains, and recommended this dose as the first-line empiric treatment for gonorrhea 4.
Key Findings
- Ceftriaxone is a safe and effective treatment for gonorrhea in pregnancy 2, 3, 4, 5.
- The efficacy of ceftriaxone is high, with cure rates ranging from 89% to 98.9% 3, 6, 4.
- Cefixime is also an effective treatment for gonorrhea in pregnancy, but its efficacy may be lower than that of ceftriaxone 3.
- Amoxicillin with probenecid is not recommended as a first-line treatment for gonorrhea in pregnancy due to its lower efficacy 5.