Treatment for Gonorrhea and Chlamydia in 2001
In 2001, the standard treatment for gonorrhea was cefixime 400 mg orally as a single dose OR ceftriaxone 125 mg intramuscularly as a single dose OR ciprofloxacin 500 mg orally as a single dose OR ofloxacin 400 mg orally as a single dose, PLUS treatment for presumptive chlamydial co-infection with either azithromycin 1 g orally as a single dose OR doxycycline 100 mg orally twice daily for 7 days. 1
Gonorrhea Treatment Options in 2001
The CDC's 2002 guidelines (published in 2002 but reflecting 2001 practice) provided multiple equivalent first-line regimens 1:
Recommended Regimens for Uncomplicated Infections
Cephalosporin options:
Fluoroquinolone options (with geographic restrictions):
- Ciprofloxacin 500 mg orally in a single dose 1
- Ofloxacin 400 mg orally in a single dose 1
- Levofloxacin 250 mg orally in a single dose 1
Critical Geographic Considerations
Quinolones were already contraindicated in Hawaii and for infections acquired in Asia or the Pacific by 2001-2002 due to quinolone-resistant N. gonorrhoeae (QRNG) comprising 14.3% of isolates in Honolulu, despite representing only 0.2% in continental U.S. cities 1. California was also showing increased QRNG prevalence, making fluoroquinolone use inadvisable in that state 1.
Alternative Regimens
For patients unable to tolerate first-line options 1:
- Spectinomycin 2 g intramuscularly in a single dose (98.2% efficacy for urogenital/anorectal infections) 1
- Ceftizoxime 500 mg intramuscularly in a single dose 1
- Cefoxitin 2 g intramuscularly with probenecid 1 g orally 1
- Cefotaxime 500 mg intramuscularly in a single dose 1
Chlamydia Treatment in 2001
Mandatory co-treatment for chlamydia was required unless chlamydial infection was definitively ruled out 1:
- Azithromycin 1 g orally in a single dose (preferred for compliance) 1
- Doxycycline 100 mg orally twice daily for 7 days 1
Rationale for Dual Therapy
The presumptive treatment approach was driven by high co-infection rates and the practical difficulty of excluding chlamydial infection at the time of gonorrhea diagnosis 1. This dual therapy strategy ensured coverage of both pathogens while awaiting confirmatory testing.
Important Contraindications
Quinolones (ciprofloxacin, ofloxacin, levofloxacin) were absolutely contraindicated in 1:
- Pregnant women
- Nursing women
- Persons ≤17 years of age
For these populations, cephalosporin-based regimens were mandatory 1.
Clinical Efficacy Data from 2001 Era
Published clinical trial cure rates for uncomplicated urogenital and anorectal gonorrhea 1:
- Ceftriaxone 125 mg: 99.1% cure rate
- Ciprofloxacin 500 mg: 99.8% cure rate
- Ofloxacin 400 mg: 98.6% cure rate
- Cefixime 400 mg: 97.4% cure rate
- Spectinomycin 2 g: 98.2% cure rate
Follow-Up Recommendations
Patients treated with any recommended regimen did not require routine test-of-cure unless symptoms persisted or re-exposure was suspected 1. This represented a significant departure from earlier practices that mandated follow-up cultures.