From the Guidelines
The recommended treatment for gonorrhoea is a combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days. This treatment approach is based on the most recent evidence from the CDC's Gonococcal Isolate Surveillance Project (GISP), which has shown that the effectiveness of cefixime, a previously recommended treatment, is waning due to increasing antibiotic resistance in Neisseria gonorrhoeae 1. The use of ceftriaxone in combination with azithromycin or doxycycline provides a more reliable and effective treatment for uncomplicated gonorrhea, and is necessary to prevent the development of further antibiotic resistance.
Key points to consider when treating gonorrhoea include:
- The importance of combination therapy to ensure effective treatment and prevent antibiotic resistance
- The need for patients to abstain from sexual activity for at least 7 days after treatment and until both they and their partners have completed treatment and are symptom-free
- The importance of notifying, testing, and treating all recent sexual partners (within the past 60 days) regardless of symptoms
- The recommendation for a test of cure 1-2 weeks after completing treatment to confirm the infection has cleared, particularly important given rising antibiotic resistance
- The need for patients to return for re-evaluation if symptoms persist after treatment, as this may indicate treatment failure or reinfection.
It is essential to follow the CDC's recommended treatment guidelines to ensure the best possible outcomes for patients with gonorrhoea, and to help prevent the spread of antibiotic-resistant strains of Neisseria gonorrhoeae 1.
From the FDA Drug Label
- 5 Uncomplicated Gonorrhea (cervical/urethral) Cefixime for oral suspension and cefixime capsule is indicated in the treatment of adults and pediatric patients six months of age or older with uncomplicated gonorrhea (cervical/urethral) caused by susceptible isolates of Neisseria gonorrhoeae (penicillinase-and non-penicillinase-producing isolates). For the treatment of uncomplicated cervical/urethral gonococcal infections, a single oral dose of 400 mg is recommended.
The recommended treatment for gonorrhea is a single oral dose of 400 mg of cefixime 2.
- The dose is the same for adults and pediatric patients six months of age or older.
- Cefixime is effective against susceptible isolates of Neisseria gonorrhoeae.
From the Research
Treatment Options for Gonorrhoea
The recommended treatment for gonorrhoea typically involves dual therapy with antibiotics. According to 3, the only recommended first-line regimen for the treatment of gonorrhea in the United States is dual therapy with ceftriaxone and azithromycin.
Key Considerations
- The treatment should be administered together on the same day, preferably simultaneously, and under direct observation 3.
- For pregnant women infected with N gonorrhoeae, the recommended dual therapy should be used 3.
- 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.
Alternative Treatments
- Gentamicin 240 mg plus azithromycin 2 g has been evaluated as an alternative treatment for rectal and pharyngeal gonorrhoea, showing promising results in a randomized controlled trial 4.
- In vitro studies have also examined the activity of antimicrobial combinations against clinical isolates of N. gonorrhoeae, including ceftriaxone, cefodizime, spectinomycin, or gentamicin in combination with azithromycin 5.
Current Guidelines
- The 2021 CDC STI Treatment Guidelines recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites, with cotreatment with doxycycline if coinfection with chlamydia has not been excluded 6.
- There are limited alternative therapies for persons with cephalosporin allergies, and no recommended alternative therapies for N gonorrhoeae infection of the throat 6.