What are the treatments for chlamydia and gonorrhea?

Treatment for Chlamydia and Gonorrhea

For uncomplicated chlamydia and gonorrhea infections in adults, the recommended treatment is ceftriaxone 500 mg IM as a single dose for gonorrhea, plus either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days for chlamydia. 1

Treatment Regimens

For Chlamydia:

Recommended Regimens:

• Azithromycin 1 g orally in a single dose OR
• Doxycycline 100 mg orally twice daily for 7 days

Alternative Regimens (if primary options cannot be used):

• Erythromycin base 500 mg orally four times a day for 7 days
• Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days
• Levofloxacin 500 mg orally once daily for 7 days
• Ofloxacin 300 mg orally twice a day for 7 days

For Gonorrhea:

Recommended Regimen:

• Ceftriaxone 500 mg IM in a single dose

Special Populations

Pregnant Women:

• Chlamydia: Azithromycin 1 g orally in a single dose or Amoxicillin 500 mg orally three times a day for 7 days
• Gonorrhea: Ceftriaxone 500 mg IM in a single dose

Children:

• Weight ≤45 kg:

  • Chlamydia: Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into four doses daily for 14 days
  • Gonorrhea: Ceftriaxone 25-50 mg/kg IV or IM (not to exceed 250 mg)

• Weight >45 kg but age <8 years:

  • Chlamydia: Azithromycin 1 g orally in a single dose

• Age ≥8 years:

  • Chlamydia: Same as adult regimens

Clinical Considerations

Dual Therapy Rationale:

Patients infected with N. gonorrhoeae are often coinfected with C. trachomatis (10-30% of cases). Routine dual therapy helps prevent complications from undiagnosed chlamydial infection and may reduce the development of antimicrobial resistance in gonorrhea 1.

Medication Selection Factors:

• Azithromycin advantages: Single-dose therapy improves compliance and allows for directly observed treatment
• Doxycycline advantages: Lower cost, equally effective when adherence is good
• Erythromycin disadvantages: Less efficacious than azithromycin or doxycycline, with more gastrointestinal side effects that may reduce compliance 1

Post-Treatment Recommendations:

• Patients should abstain from sexual intercourse until therapy is completed (7 days after single-dose regimen or after completion of a 7-day regimen)
• Sex partners should be evaluated and treated
• Test-of-cure is generally not recommended except in pregnant women
• Consider retesting approximately 3 months after treatment due to high rates of reinfection 1

Common Pitfalls and Caveats

1. Quinolone Resistance: Fluoroquinolones are no longer recommended for gonorrhea treatment in many areas due to increasing resistance 1.

2. Medication Adherence: For multi-day regimens, poor adherence can lead to treatment failure. Consider directly observed therapy with azithromycin when compliance is a concern 1, 2.

3. Partner Treatment: Failure to treat partners is a major cause of reinfection. All recent sexual partners should be notified, tested, and treated 3.

4. HIV Co-infection: Patients with HIV should receive the same treatment regimens as those who are HIV-negative 1.

5. Test of Cure Timing: If performed, testing should be delayed until at least 3-4 weeks after treatment completion to avoid false-positive results from non-viable organisms 1.

6. Pregnancy Considerations: Doxycycline and fluoroquinolones are contraindicated during pregnancy. Azithromycin or amoxicillin are the preferred options for chlamydia treatment in pregnant women 1.

By following these evidence-based treatment guidelines, clinicians can effectively treat chlamydia and gonorrhea infections while minimizing the risk of complications and ongoing transmission.