Treatment of Uncomplicated Gonorrhea

For uncomplicated gonorrhea, the recommended treatment is ceftriaxone 250 mg IM in a single dose PLUS azithromycin 1 g orally in a single dose. 1

Primary Treatment Recommendation

Ceftriaxone 250 mg IM in a single dose is the preferred first-line treatment for uncomplicated gonococcal infections of the cervix, urethra, rectum, and pharynx 2, 1
This should be combined with azithromycin 1 g orally in a single dose to improve treatment efficacy and potentially delay emergence of resistance to cephalosporins 2, 1
Azithromycin is preferred over doxycycline due to convenience of single-dose therapy and lower prevalence of gonococcal resistance to azithromycin compared to tetracycline 2, 1

If ceftriaxone is unavailable, cefixime 400 mg orally in a single dose PLUS azithromycin 1 g orally in a single dose can be used, but a test-of-cure should be performed 1 week after treatment 2, 1
For patients with severe cephalosporin allergy, azithromycin 2 g orally in a single dose can be used, with a test-of-cure performed 1 week after treatment 2, 1
Spectinomycin 2 g IM in a single dose is useful for treatment of patients who cannot tolerate cephalosporins and quinolones, though it is expensive and must be injected 2

Pharyngeal gonorrhea is more difficult to eradicate than urogenital or anorectal infections 2, 1
For pharyngeal infections, ceftriaxone 250 mg IM is strongly preferred over oral alternatives due to higher efficacy 2, 1
Cefixime has limited efficacy for pharyngeal gonorrhea (78.9% cure rate) compared to ceftriaxone 2

Rising antimicrobial resistance patterns necessitate combination therapy to improve treatment efficacy 2, 1
Dual therapy addresses possible chlamydial co-infection, which is common in patients with gonorrhea 1
Quinolones (ciprofloxacin, ofloxacin) are no longer recommended as first-line treatment due to widespread resistance 2
Penicillins, tetracyclines, and macrolides are not adequately effective against N. gonorrhoeae in the United States 2

Patients treated with recommended regimens do not need a test of cure 2
Patients should be retested 3 months after treatment due to high reinfection rates 2
Persistent symptoms after treatment warrant culture for N. gonorrhoeae with antimicrobial susceptibility testing 2

All sex partners from the preceding 60 days should be evaluated and treated for both N. gonorrhoeae and C. trachomatis infections 2, 1
If a patient's last sexual contact was >60 days before symptom onset or diagnosis, the most recent partner should be treated 2
Patients should avoid sexual intercourse until therapy is completed and both they and their partners are asymptomatic 2, 1

Azithromycin 1 g alone is insufficient for gonorrhea treatment, with only 93% cure rate 2
Using older antibiotics like penicillins or tetracyclines as monotherapy will likely result in treatment failure due to resistance 2
Quinolones should not be used for infections in men who have sex with men (MSM) or in those with history of recent foreign travel due to high resistance rates 2
Cefixime is less effective than ceftriaxone, particularly for pharyngeal infections, and should only be used when ceftriaxone is unavailable 2