From the Guidelines
The recommended treatment for uncomplicated gonorrhea is a single intramuscular injection 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 treatment regimen is based on the most recent and highest quality evidence available, as outlined in the study by 1. The use of ceftriaxone in combination with azithromycin or doxycycline is highly effective against Neisseria gonorrhoeae, the bacterium that causes gonorrhea.
Some key points to consider when treating uncomplicated gonorrhea include:
- Testing and treating for chlamydia at the same time, as co-infection is common, typically with doxycycline 100 mg orally twice daily for 7 days 1
- Patients should abstain from sexual activity for 7 days after treatment and until all sexual partners have been treated
- Follow-up testing is generally not needed if symptoms resolve, but a test of cure is recommended in pregnancy
- The high-dose ceftriaxone recommendation reflects increasing antibiotic resistance in gonorrhea strains worldwide, as the bacterium has developed resistance to multiple previously effective antibiotics including fluoroquinolones and some cephalosporins 1
It's also important to note that alternative regimens, such as gentamicin 240 mg intramuscularly plus azithromycin 2 g orally as a single dose, may be considered for patients with severe beta-lactam allergies who cannot take ceftriaxone 1. However, the use of these alternative regimens should be guided by susceptibility testing and clinical judgment.
In terms of emerging resistance and future directions, novel antimicrobials such as zoliflodacin and gepotidacin are being developed and tested in clinical trials 1. These new treatments may offer alternative options for patients with uncomplicated gonorrhea, particularly in cases where resistance to current treatments is a concern.
From the FDA Drug Label
For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. Uncomplicated gonococcal infections in adults (except anorectal infections in men) 100 mg, by mouth, twice a day for 7 days.
The recommended treatment for uncomplicated gonorrhea is ceftriaxone 250 mg IM as a single dose and doxycycline 100 mg PO twice a day for 7 days 2 3.
- Ceftriaxone is used to treat the gonorrhea infection.
- Doxycycline is used to treat possible co-infection with Chlamydia.
From the Research
Treatment for Uncomplicated Gonorrhea
The recommended treatment for uncomplicated gonorrhea is a single 500 mg intramuscular (IM) dose of ceftriaxone 4, 5.
- This treatment is effective against uncomplicated urogenital, anorectal, and pharyngeal gonorrhea.
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 4, 5.
Alternative Treatments
Previous studies have compared the efficacy of single-dose treatments with azithromycin and ceftriaxone 6, as well as cefixime and ceftriaxone 7.
- Azithromycin 2.0 g orally and ceftriaxone 250 mg intramuscularly were found to be equally effective in the treatment of uncomplicated gonorrhea 6.
- Cefixime (400 or 800 mg) given orally was found to be as effective as ceftriaxone (250 mg given intramuscularly) in the treatment of uncomplicated gonorrhea 7.
Historical Context
Ceftriaxone has been recommended for the treatment of uncomplicated gonorrhea since the 1980s due to its effectiveness against penicillinase-producing Neisseria gonorrhoeae 8.
- The Centers for Disease Control and Prevention (CDC) has updated its treatment guidelines to reflect the rising resistance of Neisseria gonorrhoeae to azithromycin and the need for antimicrobial stewardship 5.