From the Guidelines
The recommended prophylaxis regimen for gonorrhea and chlamydia is a single dose of ceftriaxone 1 g intramuscularly for gonorrhea, plus a single dose of azithromycin 1 gram orally or doxycycline 100 mg orally twice daily for 7 days for chlamydia, as per the latest guidelines from the European Association of Urology in 2024 1.
Key Considerations
- Ceftriaxone is the preferred treatment for gonorrhea due to its high efficacy and ability to target the bacterial cell wall of Neisseria gonorrhoeae.
- Azithromycin and doxycycline are effective against Chlamydia trachomatis by inhibiting protein synthesis.
- Co-infection with gonorrhea and chlamydia is common, making simultaneous treatment crucial.
- Alternative regimens, such as gentamicin 240 mg intramuscularly plus azithromycin 2 grams orally as a single dose, can be considered for patients with severe penicillin allergy.
- Local antibiotic susceptibility patterns should be taken into account when selecting treatment due to varying resistance patterns by region.
Treatment Rationale
The choice of ceftriaxone and azithromycin or doxycycline is based on their efficacy, safety profile, and the ability to address potential co-infections. Ceftriaxone's effectiveness against Neisseria gonorrhoeae, combined with azithromycin's or doxycycline's action against Chlamydia trachomatis, provides a comprehensive approach to treating these sexually transmitted infections.
Additional Recommendations
- Partners of patients diagnosed with gonorrhea or chlamydia should also be treated to prevent reinfection.
- Patients should abstain from sexual activity for 7 days after treatment completion.
- Follow-up testing is recommended 3 months after treatment to ensure cure, particularly in high-risk individuals.
- The use of doxycycline postexposure prophylaxis (doxy PEP) can be considered for certain high-risk populations, such as men who have sex with men (MSM) and transgender women (TGW), as outlined in the CDC's 2024 guidelines 1.
From the FDA Drug Label
For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. Uncomplicated urethral, endocervical, or rectal infection caused by Chlamydia trachomatis: 100 mg by mouth twice-a-day for 7 days. Uncomplicated gonococcal infections in adults (except anorectal infections in men): 100 mg, by mouth, twice-a-day for 7 days.
The recommended prophylaxis regimen for Gonorrhea (G) is a single intramuscular dose of 250 mg ceftriaxone. For Chlamydia (C), the recommended regimen is 100 mg doxycycline by mouth twice-a-day for 7 days 2.
From the Research
Recommended Prophylaxis Regimen for Gonorrhea (G) and Chlamydia (C)
The recommended prophylaxis regimen for Gonorrhea (G) and Chlamydia (C) is as follows:
- A single 500 mg IM dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 3
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 3
- Alternatively, a single dose of azithromycin 2 g can be used for treatment of uncomplicated gonorrhea, but it is associated with a relatively high frequency of gastrointestinal side effects 4
- A combination of cefixime and doxycycline can also be used, but it did not achieve noninferiority to ceftriaxone and azithromycin for treatment of gonorrhoea when including pharyngeal gonorrhoea 5
Postexposure Prophylaxis
- A one-time dose of 200 mg doxycycline taken within 72 hours of an unprotected sexual encounter may reduce transmission of syphilis, gonorrhea, and chlamydia by a combined two thirds in a high-risk population 6
Key Considerations
- The choice of prophylaxis regimen should be based on the individual's risk factors, medical history, and current guidelines 3, 7
- It is essential to monitor for emergence of ceftriaxone resistance through surveillance and health care providers' reporting of treatment failures 3
- The efficacy and safety of various antibiotic regimens should be evaluated regularly to ensure the continued efficacy of recommended regimens 7