From the Guidelines
Ceftriaxone is a first-line treatment for gonorrhea, and the current recommended regimen is a single 1 g intramuscular or intravenous injection of ceftriaxone for uncomplicated gonorrheal infections, as indicated in the most recent guidelines 1. The use of ceftriaxone for treating sexually transmitted diseases (STDs), particularly gonorrhea, is well-established due to its efficacy against Neisseria gonorrhoeae, including drug-resistant strains.
- Ceftriaxone works by inhibiting bacterial cell wall synthesis, leading to rapid bacterial death.
- It is effective for the treatment of uncomplicated gonorrhea at all anatomic sites, with a high cure rate of 99.1% for uncomplicated urogenital and anorectal infections, as reported in earlier studies 1.
- For patients with severe penicillin/cephalosporin allergies, alternative treatments should be considered, such as spectinomycin or gemifloxacin plus azithromycin, as suggested in various guidelines 1.
- Ceftriaxone is also part of combination therapy for certain STDs, often paired with doxycycline or azithromycin to cover potential co-infection with chlamydia.
- Additionally, ceftriaxone can be used in the treatment of syphilis when penicillin (the preferred treatment) cannot be used, highlighting its versatility in STD management.
- Patients should be advised that while ceftriaxone effectively treats gonorrhea, it does not prevent reinfection, so safer sex practices and partner treatment are essential components of comprehensive STD management, as emphasized in public health guidelines 1.
From the FDA Drug Label
Ceftriaxone for Injection, USP is indicated for the treatment of the following infections when caused by susceptible organisms: ... UNCOMPLICATED GONORRHEA (cervical/urethral and rectal) caused by Neisseria gonorrhoeae, including both penicillinase- and nonpenicillinase-producing strains, and pharyngeal gonorrhea caused by nonpenicillinase‑producing strains of Neisseria gonorrhoeae. PELVIC INFLAMMATORY DISEASE caused by Neisseria gonorrhoeae
Ceftriaxone is used to treat uncomplicated gonorrhea and pelvic inflammatory disease caused by Neisseria gonorrhoeae.
- It is effective against both penicillinase- and nonpenicillinase-producing strains of Neisseria gonorrhoeae.
- However, it has no activity against Chlamydia trachomatis, so additional antichlamydial coverage should be added when treating pelvic inflammatory disease. 2
From the Research
Role of Ceftriaxone in Treating STDs
- Ceftriaxone is a recommended treatment for uncomplicated gonococcal infections, including those of the cervix, urethra, and rectum 3.
- The Centers for Disease Control and Prevention (CDC) recommends a single 500 mg intramuscular dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 3.
- Ceftriaxone has been shown to be effective in eradicating gonococcal infections, with cure rates of 96-98% in clinical trials 4, 5, 6.
Comparison with Other Treatments
- Ceftriaxone has been compared to other treatments, including cefixime and azithromycin, and has been found to be equally effective in treating uncomplicated gonorrhea 6, 7.
- Cefixime, an orally absorbed cephalosporin, has been shown to be as effective as ceftriaxone in treating uncomplicated gonorrhea, with cure rates of 96-98% 6.
- Azithromycin, a long-acting azalide antibiotic, has also been shown to be effective in treating uncomplicated gonorrhea, with a cure rate of 98.9% 7.
Considerations for Treatment
- The choice of treatment for gonorrhea should take into account the potential for antimicrobial resistance and the need for concurrent treatment of possible coinfections, such as chlamydia 3.
- Ceftriaxone is not effective against chlamydial infections, and concurrent treatment with doxycycline may be recommended if chlamydial infection has not been excluded 3.