From the Guidelines
Gonorrhea is treated with a combination of ceftriaxone and azithromycin, with the current recommended regimen being a single intramuscular injection of ceftriaxone 250mg, plus a single oral dose of azithromycin 1g, as the most reliably effective treatment for uncomplicated gonorrhea. This dual therapy approach helps prevent antibiotic resistance, as highlighted in the study by 1. The use of ceftriaxone and azithromycin is recommended due to the increasing resistance of Neisseria gonorrhoeae to other antibiotics, such as cefixime, which is no longer recommended as a first-line treatment 1.
Some key points to consider when treating gonorrhea include:
- Completing the full course of antibiotics, even if symptoms improve before finishing treatment
- Testing and treating sexual partners from the past 60 days to prevent reinfection
- Abstaining from sexual activity until both the patient and their partners have completed treatment and are symptom-free, typically for 7 days after treatment
- Follow-up testing is recommended 1-2 weeks after treatment completion to ensure the infection has cleared
- Gonorrhea can infect multiple sites, including the genitals, rectum, and throat, so appropriate testing and treatment for all potentially infected sites is important
In cases where treatment failure occurs, alternative regimens may be considered, as discussed in the study by 1. However, the current recommended regimen of ceftriaxone and azithromycin remains the most effective treatment for uncomplicated gonorrhea. It's essential to note that pharyngeal infections can be more challenging to treat due to unfavorable pharmacokinetics of cephalosporins in pharyngeal tissues, and may require additional considerations and approaches 1.
Overall, the treatment of gonorrhea requires careful consideration of the increasing resistance of Neisseria gonorrhoeae to antibiotics, and the use of combination therapy with ceftriaxone and azithromycin is currently the most effective approach, as supported by the study by 1.
From the FDA Drug Label
For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. The treatment for Neisseria gonorrhoeae (gonorrhea) infection is a single intramuscular dose of 250 mg of ceftriaxone 2.
- The dose is administered intramuscularly.
- This treatment is for uncomplicated gonococcal infections. Note that azithromycin may also be used to treat gonorrhea, specifically urethritis and cervicitis due to Neisseria gonorrhoeae 3.
From the Research
Treatment for Neisseria gonorrhoeae (Gonorrhea) Infection
The treatment for Neisseria gonorrhoeae (gonorrhea) infection is typically a dual therapy regimen. The recommended first-line regimen for the treatment of gonorrhea in the United States is dual therapy with ceftriaxone and azithromycin 4, 5. This dual therapy should be administered together on the same day, preferably simultaneously, and under direct observation.
Dual Therapy Regimen
The dual therapy regimen with ceftriaxone and azithromycin has been shown to be effective in treating gonorrhea, with high cure rates 6, 7. This regimen is also recommended for pregnant women who are infected with N gonorrhoeae 4, 5.
Alternative Treatment Options
Alternative treatment options, such as gentamicin plus azithromycin, have also been studied and shown to be effective in vitro 8. However, the in vivo activity and efficacy of these combinations remain unknown and prospective clinical studies are needed to determine their effectiveness.
Follow-up and Retesting
A test-of-cure is not needed for individuals diagnosed with uncomplicated urogenital or rectal gonorrhea who are treated with the recommended or alternative regimens 4, 5. However, repeat N gonorrhoeae infection is prevalent among patients who have been diagnosed with and treated for gonorrhea in the preceding several months, and clinicians should advise patients with gonorrhea to be retested 3 months after treatment 4, 5. Pregnant women with antenatal gonococcal infection should be retested in the third trimester unless recently treated 4, 5.
Key Points
- Dual therapy with ceftriaxone and azithromycin is the recommended first-line regimen for the treatment of gonorrhea in the United States 4, 5.
- This dual therapy should be administered together on the same day, preferably simultaneously, and under direct observation 4, 5.
- Alternative treatment options, such as gentamicin plus azithromycin, have been studied and shown to be effective in vitro 8.
- A test-of-cure is not needed for individuals diagnosed with uncomplicated urogenital or rectal gonorrhea who are treated with the recommended or alternative regimens 4, 5.
- Clinicians should advise patients with gonorrhea to be retested 3 months after treatment 4, 5.