What is the recommended treatment for the sexual partner of a patient diagnosed with gonorrhea (Neisseria gonorrhoeae infection)?

Treatment for Sexual Partners of Patients with Gonorrhea

All sexual partners from the preceding 60 days must be evaluated and treated with the same dual therapy regimen used for the index patient: ceftriaxone 500 mg intramuscularly plus azithromycin 1 g orally as a single dose, regardless of symptoms or test results. 1, 2

Partner Management Protocol

Who Should Be Treated

• Evaluate and treat all sex partners whose last sexual contact with the index patient occurred within 60 days before symptom onset or diagnosis 3, 1, 2
• If the patient's last sexual intercourse was more than 60 days before diagnosis, treat the most recent sex partner 3, 4
• Partners should receive treatment for both gonorrhea AND chlamydia, as coinfection occurs in 40-50% of gonorrhea cases 1, 4

Recommended Treatment Regimen for Partners

The same dual therapy regimen as the index patient:

• Ceftriaxone 500 mg intramuscularly as a single dose
• PLUS azithromycin 1 g orally as a single dose 1, 2

This dual therapy addresses both gonorrhea and presumptive chlamydial coinfection, which is critical given the high coinfection rates 1, 4. The 500 mg dose of ceftriaxone is particularly important for pharyngeal infections, where extended-spectrum cephalosporins have marked variability in clearance 2.

Expedited Partner Therapy (EPT)

When partners cannot be linked to timely clinical evaluation:

• Consider EPT using cefixime 400 mg orally plus azithromycin 1 g orally as a single-dose oral combination 1, 2
• Mandatory test-of-cure at 1 week is required when using the cefixime-based regimen due to rising cefixime MICs and declining effectiveness 1

Critical caveat: EPT is NOT recommended for men who have sex with men (MSM) due to high risk of undiagnosed coexisting sexually transmitted diseases or HIV 1, 2

Behavioral Instructions

• Partners must avoid sexual intercourse until therapy is completed and both the index patient and all partners are asymptomatic 3, 1, 4
• This prevents reinfection, as most post-treatment infections result from reinfection rather than treatment failure 3, 1

Alternative Regimens for Partners

If Ceftriaxone Is Unavailable

• Cefixime 400 mg orally plus azithromycin 1 g orally as a single dose 1, 2
• Mandatory test-of-cure at 1 week is required with this regimen 1, 2

For Severe Cephalosporin Allergy

• Azithromycin 2 g orally as a single dose 1, 2
• This regimen has lower efficacy (93% cure rate) and causes significant gastrointestinal side effects 1, 5
• Mandatory test-of-cure at 1 week is required 1

For Pregnant Partners

• Ceftriaxone 500 mg intramuscularly plus azithromycin 1 g orally 2
• Never use quinolones, tetracyclines, or doxycycline in pregnancy 3, 2, 4

Additional Testing Requirements for Partners

• Screen for syphilis with serology at the time of gonorrhea diagnosis 1
• Perform HIV testing, as gonorrhea facilitates HIV transmission 1, 2
• Consider testing for other sexually transmitted infections given the high-risk exposure 6

Follow-Up for Partners

• Partners treated with the recommended first-line regimen (ceftriaxone 500 mg plus azithromycin 1 g) do NOT need routine test-of-cure 1, 2
• Retest all partners at 3 months due to high risk of reinfection 1, 2
• If symptoms persist after treatment, obtain culture with antimicrobial susceptibility testing 1, 2

Critical Pitfalls to Avoid

• Never use fluoroquinolones (ciprofloxacin, ofloxacin) due to widespread resistance 1, 2, 6
• Never use azithromycin 1 g alone for gonorrhea treatment—it has only 93% efficacy 3, 1
• Never use spectinomycin for pharyngeal infections—it has only 52% efficacy at this site 3, 1, 2
• Failure to treat partners is the most common cause of reinfection and continued transmission 4
• Do not assume partners are uninfected based on lack of symptoms—many gonorrhea infections are asymptomatic, particularly in women 6