Recommended Treatment for Gonorrhea and Chlamydia in Outpatient Settings
For uncomplicated gonorrhea and chlamydia co-infections, the recommended treatment is ceftriaxone 500 mg IM as a single dose plus doxycycline 100 mg orally twice daily for 7 days. 1
First-line Treatment Regimen
Gonorrhea Treatment
- Ceftriaxone 500 mg IM as a single dose 1, 2
- Provides high and sustained bactericidal levels in the blood
- Half-life of 5.8-8.7 hours, allowing for sustained activity 1
- Effective for urogenital, rectal, and pharyngeal infections
Chlamydia Treatment
- Doxycycline 100 mg orally twice daily for 7 days 1, 3
- Should be added when chlamydial infection has not been excluded
- Complete the full 7-day course even if symptoms resolve earlier
Alternative Oral Regimen
If injectable ceftriaxone is unavailable or patient refuses injection:
- Cefixime 400 mg orally in a single dose 1, 4
- Efficacy of 95-98% for urogenital and rectal infections
- Plus doxycycline 100 mg orally twice daily for 7 days
- Note: Cefixime is less effective than ceftriaxone for pharyngeal infections 1
Special Populations
Pregnant Patients
- Ceftriaxone 500 mg IM as a single dose
- Azithromycin 1g orally in a single dose (instead of doxycycline which is contraindicated in pregnancy) 1
Pediatric Patients
- Children >45 kg: Use adult dosing
- Children <45 kg: Weight-based dosing 1
- For cefixime, refer to the following weight-based dosing:
| 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 |
| >45 | 400 mg |
Follow-up Recommendations
- Test of cure is not routinely needed for uncomplicated infections treated with recommended regimens 1
- Retest approximately 3 months after treatment due to high reinfection rates 1
- All sex partners from the previous 60 days should be evaluated and treated 1
- Patients should abstain from sexual activity until:
- Therapy is completed
- Both patient and partners are asymptomatic 1
Important Clinical Considerations
Antimicrobial Resistance
- Increasing concern for antimicrobial resistance necessitates proper treatment selection 2
- The CDC has updated recommendations from previous dual therapy with azithromycin to ceftriaxone monotherapy (for gonorrhea) plus doxycycline (if chlamydia not excluded) 2
- Fluoroquinolones should only be used if susceptibility is confirmed due to high resistance rates 1
Treatment Efficacy
- Ceftriaxone has shown 97.7-98% efficacy in clinical trials 5, 6
- Cefixime has demonstrated 96-98% efficacy in clinical trials 6
- Pharyngeal infections are more difficult to eradicate and may require higher doses or injectable therapy 1
Common Pitfalls to Avoid
- Underdosing ceftriaxone: The current recommended dose is 500 mg IM (increased from previous 250 mg recommendation) 2
- Incomplete treatment of partners: Failure to treat partners leads to high reinfection rates
- Inadequate treatment of pharyngeal gonorrhea: Oral cephalosporins are less effective for pharyngeal infections
- Premature cessation of doxycycline: The full 7-day course must be completed
- Relying on symptoms resolution: Asymptomatic infections can persist despite clinical improvement
By following these evidence-based recommendations, clinicians can effectively treat gonorrhea and chlamydia infections while helping to prevent antimicrobial resistance and reduce complications.