What is the recommended treatment for gonorrhea and chlamydia in a male?

Treatment for Gonorrhea and Chlamydia in Males

For uncomplicated gonorrhea and chlamydia infections in males, the recommended treatment is ceftriaxone 500 mg IM in a single dose, plus doxycycline 100 mg orally twice daily for 7 days if chlamydial infection has not been excluded. 1

First-Line Treatment Recommendations

• The Centers for Disease Control and Prevention (CDC) recommends ceftriaxone 500 mg IM as a single dose for the treatment of uncomplicated gonorrhea infections of the urethra, rectum, and pharynx 1
• If chlamydial infection is present or has not been excluded, add doxycycline 100 mg orally twice daily for 7 days 1, 2
• This updated recommendation replaces the previous regimen of ceftriaxone 250 mg IM plus azithromycin 1 g orally in a single dose 3, 1

Rationale for Current Recommendations

• The shift from dual therapy with azithromycin to monotherapy with a higher dose of ceftriaxone is due to:
  • Increasing azithromycin resistance 1
  • Antimicrobial stewardship concerns 1
  • Continued low incidence of ceftriaxone resistance 1
• Doxycycline is now preferred over azithromycin for chlamydia treatment due to better efficacy 2

Alternative Regimens

• If ceftriaxone is unavailable, cefixime 400 mg orally in a single dose can be used, but is less effective for pharyngeal gonorrhea 3, 4
• For patients with severe cephalosporin allergy, azithromycin 2 g orally in a single dose is an option, but requires a test-of-cure 1 week after treatment 3, 5

Special Considerations

• Pharyngeal gonorrhea is more difficult to eradicate than urogenital or anorectal infections 3
• Ceftriaxone has superior efficacy for pharyngeal infections compared to alternative treatments 3
• Men who have sex with men (MSM) should only be treated with ceftriaxone due to higher prevalence of resistant strains 3

Follow-Up Recommendations

• Test for reinfection approximately 3 months after treatment or at the first visit within 12 months after treatment 2
• Patients with persistent symptoms after treatment should be evaluated by culture for N. gonorrhoeae, and any isolates should be tested for antimicrobial susceptibility 3
• Patients treated with the recommended regimen do not need a test of cure 3

Partner Management

• All sex partners from the preceding 60 days should be evaluated and treated 3, 5
• Patients should avoid sexual intercourse until therapy is completed and both they and their partners are asymptomatic 3

Important Clinical Considerations

• Single-dose treatment with azithromycin 1 g alone is insufficient for gonorrhea treatment, with only 93% efficacy 3
• High-dose ceftriaxone monotherapy (1 g) has been shown to be as effective as dual therapy for extragenital gonorrhea in MSM, with 98.1% efficacy 6
• The efficacy of ceftriaxone for uncomplicated gonorrhea approaches 99% for urogenital and anorectal infections 7