What is the recommended treatment for gonorrhea (Neisseria gonorrhoeae infection) in a male whose partner has been diagnosed?

Treatment of Gonorrhea in Males with Infected Partners

The recommended treatment for a male whose partner has been diagnosed with gonorrhea is ceftriaxone 250 mg IM in a single dose PLUS azithromycin 1 g orally in a single dose, regardless of whether chlamydial infection has been ruled out. 1

Primary Treatment Recommendation

• Ceftriaxone 250 mg IM in a single dose is the preferred cephalosporin for gonorrhea treatment due to its high efficacy (98.9% cure rate for uncomplicated urogenital and anorectal infections) 2, 1
• Azithromycin 1 g orally should be added as part of dual therapy to address possible chlamydial co-infection and to potentially delay emergence of cephalosporin resistance 1
• This combination therapy is effective against infections at all anatomic sites, including pharyngeal infections which are more difficult to eradicate 2, 1

Alternative Regimens (if ceftriaxone unavailable)

• Cefixime 400 mg orally in a single dose PLUS azithromycin 1 g orally in a single dose 1
• A test-of-cure should be performed 1 week after treatment with this alternative regimen 2
• For patients with severe cephalosporin allergy, azithromycin 2 g orally in a single dose can be used, but requires a test-of-cure 1 week after treatment 1

Partner Management

• Since the patient's partner has already been diagnosed with gonorrhea, the male patient should be treated presumptively even if asymptomatic 2
• Both partners should be instructed to avoid sexual intercourse until therapy is completed and until they and their partners no longer have symptoms 2
• Any additional sex partners of the patient from the preceding 60 days should also be evaluated and treated for gonorrhea and chlamydia 2

Follow-Up Recommendations

• Patients treated with the recommended regimen do not need a test-of-cure 2
• If symptoms persist after treatment, the patient should be evaluated by culture for N. gonorrhoeae, and any isolated gonococci should be tested for antimicrobial susceptibility 2
• Persistent symptoms might also be caused by C. trachomatis or other organisms 2
• Consider retesting all patients 3 months after treatment due to the high risk of reinfection 2

Special Considerations

• Pharyngeal gonorrhea is more difficult to eradicate than urogenital or anorectal infections and requires the recommended dual therapy 2, 1
• Azithromycin 1 g alone is insufficient for gonorrhea treatment, with only 93% efficacy 2
• If treatment failure occurs with the recommended regimen, culture relevant clinical specimens, perform antimicrobial susceptibility testing, and consult an infectious disease specialist 1

Rationale for Current Recommendations

• Rising antibiotic resistance patterns necessitate combination therapy to improve treatment efficacy 1
• Ceftriaxone has demonstrated superior efficacy compared to other antibiotics, with cure rates of 99% in clinical practice 3
• The 250 mg dose of ceftriaxone provides sustained, high bactericidal levels in the blood 2
• Dual therapy addresses the frequent co-infection with chlamydia and helps prevent the emergence of resistant strains 1

This treatment approach ensures effective eradication of gonorrhea infection while addressing potential co-infections and minimizing the risk of treatment failure due to antimicrobial resistance.