Treatment of Gonorrhea in Patients with Chlamydia Infection
Yes, patients who test positive for Chlamydia should be treated for gonorrhea as well, due to the high rate of co-infection and to prevent complications from untreated gonorrhea. 1
Rationale for Dual Treatment
- Coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae is common, particularly at genital sites, making treatment for both infections necessary even when only one organism is detected 1
- Studies show that 20% of men and 42% of women with laboratory-confirmed N. gonorrhoeae also have C. trachomatis infection 2
- Untreated gonorrhea can lead to serious complications including pelvic inflammatory disease (PID), ectopic pregnancy, and infertility 3
- Treating only for chlamydia when gonorrhea is also present can lead to persistent symptoms and transmission of gonorrhea to partners 1
Recommended Treatment Regimens
For Uncomplicated Gonococcal Infections:
- Primary recommendation: Ceftriaxone 125 mg IM in a single dose PLUS treatment for chlamydia if chlamydial infection is not ruled out 1
- For patients with pharyngeal gonorrhea (which is more difficult to eradicate), the same regimen is recommended 1
- More recent guidelines have updated the ceftriaxone dosage to 500 mg IM in a single dose 3, 4
For Chlamydia Treatment (when treating both infections):
Special Considerations
- For pregnant patients: Cephalosporins are safe, but avoid quinolones and tetracyclines. Use azithromycin or amoxicillin for chlamydia treatment 1, 5
- For patients with cephalosporin allergies: Spectinomycin can be used, but it's less effective for pharyngeal infections (only 52% effective) 1
- For men who have sex with men (MSM) or those with recent travel history to areas with quinolone-resistant N. gonorrhoeae: Avoid quinolones and use ceftriaxone plus chlamydia treatment 1
Management of Sex Partners
- All sex partners from the previous 60 days should be evaluated and treated for both N. gonorrhoeae and C. trachomatis infections 1
- If a patient's last sexual contact was more than 60 days before diagnosis, the most recent partner should be treated 1
- Patients should avoid sexual intercourse until therapy is completed and until they and their partners no longer have symptoms 1, 5
Follow-Up Recommendations
- Patients treated with recommended regimens for uncomplicated gonorrhea do not need a test of cure 1
- Persistent symptoms warrant reevaluation with culture for N. gonorrhoeae and antimicrobial susceptibility testing 1
- Consider retesting all patients with gonorrhea approximately 3 months after treatment due to high risk of reinfection 1, 5
Common Pitfalls and Caveats
- Failure to treat partners is a common cause of reinfection and continued transmission 1, 5
- Using penicillin alone for gonorrhea treatment carries a high risk of postgonococcal chlamydial morbidity 7
- Azithromycin 1g alone is not recommended for gonorrhea treatment due to concerns about antimicrobial resistance 1
- Not treating for both infections can lead to complications like PID in women, which developed in 6 of 20 women given only penicillin plus probenecid in one study 7
By treating both infections simultaneously, you can prevent complications, reduce transmission, and improve patient outcomes while practicing good antimicrobial stewardship.