Treatment for Gonorrhea and Chlamydia
For uncomplicated gonorrhea and chlamydia co-infection, the recommended treatment is ceftriaxone 500 mg IM as a single dose for gonorrhea plus doxycycline 100 mg orally twice daily for 7 days for chlamydia. 1, 2, 3
First-Line Treatment Regimen
- 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, 2
- Doxycycline 100 mg orally twice daily for 7 days is the preferred treatment for chlamydia 4, 5
- Dual therapy should be administered together on the same day, preferably simultaneously, and under direct observation 6
Rationale for Dual Therapy
- Patients with gonorrhea are frequently co-infected with chlamydia (10-30% of cases) 1, 4
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline is recommended 2
- Routine dual therapy is cost-effective when the cost of therapy for chlamydia is less than the cost of testing 1
- If chlamydial test results are negative using a highly sensitive NAAT test, treatment for chlamydia can be omitted 7
Alternative Treatment Options
- For chlamydia treatment, azithromycin 1 g orally in a single dose can be used as an alternative (97% efficacy) but is no longer the preferred option 1, 8
- For patients with cephalosporin allergy, spectinomycin 2 g IM in a single dose can be used for urogenital and anorectal gonorrhea, though it is less effective for pharyngeal gonorrhea (52% efficacy) 1
- For pregnant patients, azithromycin 1 g orally in a single dose is preferred for chlamydia treatment, as doxycycline is contraindicated during pregnancy 4
Important Clinical Considerations
- Quinolones (ciprofloxacin, ofloxacin) are no longer recommended for gonorrhea treatment due to widespread resistance 7, 1
- Medications should be dispensed on-site when possible, with the first dose directly observed to maximize compliance 4
- Patients should be advised to abstain from sexual activity for 7 days after single-dose therapy or until completion of a 7-day regimen 1, 4
- All sex partners from the previous 60 days should be evaluated, tested, and treated 1, 6
Follow-Up Recommendations
- A test-of-cure is not needed for individuals diagnosed with uncomplicated urogenital or rectal gonorrhea who are treated with the recommended regimens 6
- Consider retesting approximately 3 months after treatment due to high risk of reinfection, especially in women and adolescents 1, 9
- Pregnant women with antenatal gonococcal infection should be retested in the third trimester unless recently treated 6
Common Pitfalls to Avoid
- Using fluoroquinolones in areas with known resistance or in patients who have traveled to areas with high resistance 7
- Relying on azithromycin alone for gonorrhea treatment due to increasing resistance patterns 1, 3
- Failing to treat partners, which often leads to reinfection rather than treatment failure 1, 6
- Using lower doses of ceftriaxone (125 mg) which are no longer considered optimal due to evolving resistance patterns 1, 3
- Neglecting to obtain antimicrobial susceptibility testing in cases of persistent infection after treatment 7