What is the recommended treatment for oral gonorrhea and chlamydia?

Treatment for Oral Gonorrhea and Chlamydia

For oral gonorrhea and chlamydia infections, the recommended treatment is ceftriaxone 500 mg IM as a single dose plus doxycycline 100 mg orally twice daily for 7 days. 1, 2

Treatment Regimens

Primary Recommended Regimen

• Gonorrhea: Ceftriaxone 500 mg IM as a single dose 1, 2
• Chlamydia: Doxycycline 100 mg orally twice daily for 7 days 1, 3

Alternative Regimens (for patients with cephalosporin allergy)

• Gonorrhea: Azithromycin 2 g orally as a single dose 4, 1
• Chlamydia: Azithromycin 1 g orally as a single dose 4, 5

Special Considerations

Pharyngeal Infections

• Pharyngeal gonorrhea infections are more difficult to eradicate than urogenital or rectal infections 1
• Injectable ceftriaxone is preferred for pharyngeal infections due to higher efficacy 1
• Oral cephalosporins (like cefixime) have lower efficacy for pharyngeal infections 1

Pregnancy

• Doxycycline is contraindicated in pregnancy 4, 3
• For pregnant patients, use:
  • Ceftriaxone 500 mg IM single dose (for gonorrhea)
  • Azithromycin 1 g orally single dose (for chlamydia) 4, 5

Treatment Follow-up

• 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, 6
• All sex partners from the previous 60 days should be evaluated and treated 1
• Patients should avoid sexual activity until therapy is completed and both they and their partners no longer have symptoms 1

Antimicrobial Resistance Considerations

• The CDC has updated treatment guidelines due to increasing antimicrobial resistance concerns 2
• Ceftriaxone provides high and sustained bactericidal levels in the blood, effective for treating gonococcal infections 1
• Combination therapy helps prevent development of resistance and treats potential co-infections 1

Common Pitfalls to Avoid

1. Inadequate dosing: Using older, lower dose recommendations for ceftriaxone (250 mg) instead of the current 500 mg dose 2
2. Treating only one infection: Failing to treat for both gonorrhea and chlamydia, as co-infection is common 1, 2
3. Improper follow-up: Not advising retesting at 3 months post-treatment 1, 6
4. Partner treatment: Failing to ensure all recent sexual partners are evaluated and treated 1
5. Using oral cephalosporins for pharyngeal infections: Pharyngeal infections require injectable therapy for optimal clearance 1

The most recent CDC guidelines emphasize the importance of using ceftriaxone at appropriate doses due to increasing antimicrobial resistance concerns, particularly for pharyngeal infections which are more difficult to eradicate than infections at other sites.