From the Guidelines
The treatment for gonorrhea typically involves a single dose of an antibiotic, such as ceftriaxone or ciprofloxacin, and may also include concomitant therapy for chlamydia.
Key Treatment Options
- Ceftriaxone 125 mg IM in a single dose is a recommended regimen for uncomplicated gonococcal infections, including those of the pharynx 1.
- Ciprofloxacin 500 mg orally in a single dose is also a recommended regimen, but its use may be limited in areas with high rates of quinolone-resistant gonorrhea 1.
- Concomitant therapy with a regimen effective against chlamydia, such as azithromycin or doxycycline, is recommended due to the frequency of dual infections 1.
Considerations for Treatment
- Pharyngeal infections are more difficult to eradicate than infections at urogenital and anorectal sites, and may require alternative treatment regimens 1.
- Quinolone-resistant gonorrhea has been reported in certain regions, and alternative treatment regimens may be necessary for patients who have recently traveled to these areas 1.
- Culture and susceptibility testing should be done in patients with apparent treatment failure to guide further treatment 1.
- Patient education and referral of sex partners are important components of gonorrhea treatment, as reinfection is a common cause of persistent symptoms 1.
From the Research
Treatment Options for Gonorrhea
The treatment for gonorrhea has been complicated by antimicrobial resistance, with Neisseria gonorrhoeae developing resistance to each of the antimicrobials that were previously recommended as first-line treatment regimens 2. The current treatment options are severely limited, and the Centers for Disease Control and Prevention (CDC) has updated its treatment guidelines to address the rising concern of antimicrobial resistance.
Recommended Treatment Regimens
The CDC recommends a single 500 mg intramuscular dose of ceftriaxone for the treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 3, 4. If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 3, 4. A systematic review and network meta-analysis found that ceftriaxone and azithromycin were the most effective antibiotics for the treatment of gonorrhea, with ceftriaxone being the most effective injectable drug and azithromycin being the most effective oral drug 5.
Alternative Therapies
There are limited alternative therapies for persons with cephalosporin allergies, and no recommended alternative therapies for N gonorrhoeae infection of the throat 3. However, a review of recent therapeutic adaptations and scope to improve the prevailing condition of gonorrhea suggests that alternative strategies such as immunotherapy and phage therapy, as well as recent antibiotics researched for the treatment of gonorrhea, may be effective in treating the disease 6.
Key Considerations
- The treatment of gonorrhea should be guided by the CDC's updated treatment guidelines, which take into account the rising concern of antimicrobial resistance 3, 4.
- Ceftriaxone and azithromycin are the most effective antibiotics for the treatment of gonorrhea, but alternative therapies may be necessary for persons with cephalosporin allergies or other complications 5.
- The development of new antibiotics and alternative therapies is crucial to addressing the growing concern of antimicrobial resistance and improving the treatment of gonorrhea 6.