Treatment for Gonorrhea
The recommended treatment for uncomplicated gonorrhea is ceftriaxone 500 mg IM as a single dose plus doxycycline 100 mg orally twice daily for 7 days. 1
First-Line Treatment
The Centers for Disease Control and Prevention (CDC) recommends the following regimen for uncomplicated gonorrhea:
- Primary regimen: Ceftriaxone 500 mg IM as a single dose plus doxycycline 100 mg orally twice daily for 7 days 1, 2
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline is essential 2
This dual therapy approach is designed to:
- Prevent development of antimicrobial resistance
- Treat possible co-infection with Chlamydia trachomatis
- Maximize treatment efficacy, particularly for pharyngeal infections which are more difficult to eradicate than urogenital or anorectal infections 1
Alternative Regimens
For patients with cephalosporin allergy or suspected cephalosporin-resistant infections:
- Cefixime 400 mg orally as a single dose plus doxycycline 100 mg orally twice daily for 7 days 1, 3
- Azithromycin 1 g orally as a single dose can be used instead of doxycycline, but is considered an alternative rather than preferred option due to increasing resistance concerns 1, 4
- Gentamicin 240 mg IM plus azithromycin 2 g orally as a single dose (for treatment failures) 1, 5
Important note: Cefixime is less effective for pharyngeal gonorrhea than ceftriaxone, making it a second-line option 3
Special Populations
Pregnant Women
- Pregnant women should receive the same dual therapy with ceftriaxone and azithromycin 6, 7
- Doxycycline is contraindicated in pregnancy; azithromycin should be used instead 1
- Pregnant women should be retested in the third trimester unless recently treated 6, 7
Pediatric Patients
For children weighing >45 kg: use adult dosing For children weighing <45 kg: adjust dosing based on weight 1:
| Patient Weight (kg) | Daily Dose (mg) |
|---|---|
| 5 to 7.5 | 50 mg |
| 7.6 to 10 | 80 mg |
| 10.1 to 12.5 | 100 mg |
| 12.6 to 20.5 | 150 mg |
| 20.6 to 28 | 200 mg |
| 28.1 to 33 | 250 mg |
| 33.1 to 40 | 300 mg |
| 40.1 to 45 | 350 mg |
Follow-up and Monitoring
- Test of cure is not routinely needed for uncomplicated gonorrhea treated with recommended regimens 1
- Patients should be retested approximately 3 months after treatment due to high reinfection rates 1, 6, 7
- Persistent symptoms after treatment warrant culture for N. gonorrhoeae with antimicrobial susceptibility testing 1
- Patients should avoid sexual activity until therapy is completed and both they and their partners no longer have symptoms 1
Partner Management
- All sex partners from the previous 60 days should be evaluated and treated to prevent reinfection 1
- Treatment failures are usually due to reinfection rather than antimicrobial resistance, highlighting the importance of partner treatment 1
Common Pitfalls to Avoid
- Using monotherapy: Single-drug treatment is no longer recommended due to increasing antimicrobial resistance 2
- Inadequate partner treatment: Failure to treat partners is a major cause of reinfection 1
- Neglecting pharyngeal infections: These are harder to eradicate and may require higher doses or different regimens 1
- Missing co-infections: Always consider testing and treating for chlamydia and other STIs 2
- Forgetting follow-up testing: The 3-month retest is essential due to high reinfection rates 1, 6, 7