From the Guidelines
The recommended treatment for oropharyngeal gonorrhea is a single intramuscular injection of ceftriaxone 250 mg, plus a single 1-g oral dose of azithromycin. This treatment regimen is based on the most recent and highest quality evidence, which suggests that ceftriaxone is highly effective against Neisseria gonorrhoeae, including strains found in the throat, and that the addition of azithromycin can help to improve treatment efficacy and delay the emergence of resistance to cephalosporins 1. The use of ceftriaxone is preferred due to its ability to achieve high tissue concentrations and its resistance to beta-lactamases produced by gonococci, making it the preferred first-line treatment as resistance to other antibiotics has increased globally.
Key Considerations
- Ceftriaxone is the preferred first-line treatment for oropharyngeal gonorrhea due to its high efficacy and resistance to beta-lactamases produced by gonococci 1.
- The addition of azithromycin to ceftriaxone can help to improve treatment efficacy and delay the emergence of resistance to cephalosporins 1.
- Patients with severe cephalosporin allergy should be referred to an infectious disease specialist for alternative treatment options.
- Following treatment, patients should abstain from oral sex for at least 7 days and until all symptoms have resolved.
- Testing for cure is not routinely recommended for pharyngeal gonorrhea if the recommended ceftriaxone regimen is used, but patients should be screened for other sexually transmitted infections including HIV, syphilis, and chlamydia.
Treatment Regimen
- Ceftriaxone 250 mg IM in a single dose
- Azithromycin 1 g orally in a single dose
Additional Recommendations
- All sexual partners from the past 60 days should be notified, tested, and treated if necessary.
- Patients should be screened for other sexually transmitted infections including HIV, syphilis, and chlamydia.
- Regular screening for oropharyngeal gonorrhea is important for individuals with risk factors, as the infection is often asymptomatic.
From the FDA Drug Label
Uncomplicated Gonorrhea (cervical/urethral and rectal) caused by Neisseria gonorrhoeae, including both penicillinase- and nonpenicillinase-producing strains, and pharyngeal gonorrhea caused by nonpenicillinase-producing strains of Neisseria gonorrhoeae. For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended.
The treatment for uncomplicated gonococcal infections, including oropharyngeal gonorrhea (gonorrhea of the throat) caused by nonpenicillinase-producing strains of Neisseria gonorrhoeae, is a single intramuscular dose of 250 mg of ceftriaxone 2.
From the Research
Treatment for Oropharyngeal Gonorrhea
The treatment for oropharyngeal gonorrhea, also known as gonorrhea of the throat, is typically administered with antibiotics.
- The recommended treatment regimen includes a single 500 mg intramuscular (IM) dose of ceftriaxone 3.
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 3.
- Dual therapy with ceftriaxone and azithromycin is also effective for the treatment of gonorrhea, including pharyngeal gonorrhea 4, 5, 6, 7.
- A systematic review and meta-analysis found that regimens containing ceftriaxone or azithromycin 2g, alone or as part of dual therapies, are the most efficacious for pharyngeal gonorrhea 7.
Efficacy of Treatment Regimens
- The overall treatment efficacy for pharyngeal gonorrhea was found to be 98.1% (95% CI: 93.8%-100%) 7.
- Efficacy was similar for single and dual therapies, with summary efficacy estimates of 97.1% and 98.0%, respectively 7.
- Ceftriaxone was found to be the most effective injectable drug, with a p score of 0.924, while azithromycin was the most effective oral drug, with a p score of 0.8633 6.