Treatment for Gonorrhea and Chlamydia
For uncomplicated gonorrhea and chlamydia co-infection, the recommended treatment is ceftriaxone 500 mg intramuscularly as a single dose for gonorrhea, plus doxycycline 100 mg orally twice daily for 7 days for chlamydia. 1, 2
First-Line Treatment Regimens
Gonorrhea Treatment:
- Ceftriaxone 500 mg IM as a single dose is the current recommended treatment for uncomplicated gonorrhea infections at all anatomic sites (urogenital, anorectal, and pharyngeal) 1, 3
- Previous recommendations of lower doses (125 mg) are no longer considered optimal due to evolving resistance patterns 4
- For patients weighing less than 150 kg, this single dose is sufficient 2
Chlamydia Treatment:
- Doxycycline 100 mg orally twice daily for 7 days is the preferred treatment for chlamydia 2
- Alternative: Azithromycin 1 g orally in a single dose (efficacy approximately 97%) 5, 6
Dual Therapy Rationale
- Patients with gonorrhea are frequently co-infected with chlamydia (10-30% of cases) 4
- Routine dual therapy is cost-effective when chlamydial infection accompanies gonococcal infections, as the cost of therapy for chlamydia is less than the cost of testing 4
- If chlamydial infection has not been excluded, treatment for both infections should be provided 7
Alternative Regimens
For patients with cephalosporin allergy:
- Spectinomycin 2 g IM in a single dose can be used for urogenital and anorectal gonorrhea 4
- Note: Spectinomycin is less effective for pharyngeal gonorrhea (only 52% effective) 4
For pregnant patients:
- Ceftriaxone remains the recommended treatment for gonorrhea 7
- For chlamydia in pregnancy, azithromycin 1 g orally in a single dose is preferred 5
- Doxycycline is contraindicated during pregnancy 5
Important Clinical Considerations
- Quinolones (ciprofloxacin, ofloxacin) are no longer recommended for gonorrhea treatment due to widespread resistance 4
- Azithromycin 2 g as monotherapy for gonorrhea is not recommended despite effectiveness due to high cost, gastrointestinal side effects, and concerns about antimicrobial resistance 4
- Medications should be dispensed on-site when possible, with the first dose directly observed to maximize compliance 5
Follow-Up Recommendations
- Test-of-cure is not routinely recommended for uncomplicated gonorrhea or chlamydia treated with recommended regimens 7, 5
- Patients should be advised to abstain from sexual activity for 7 days after single-dose therapy or until completion of a 7-day regimen 5
- All sex partners from the previous 60 days should be evaluated, tested, and treated 4
- Consider retesting approximately 3 months after treatment due to high risk of reinfection, especially in women and adolescents 5, 7
- Pregnant patients with gonorrhea should be retested in the third trimester 7
Common Pitfalls to Avoid
- Using fluoroquinolones in areas with known resistance or in patients who have traveled to areas with high resistance 4
- Relying on azithromycin alone for gonorrhea treatment 4
- Failing to treat partners, which often leads to reinfection rather than treatment failure 4
- Using the tablet or capsule formulation instead of suspension for otitis media in pediatric patients 8
- Neglecting to screen asymptomatic patients, as many infections (especially in women) are asymptomatic until complications occur 4