Gonorrhea

The treatment for uncomplicated gonorrhea (i.e., infections of the cervix, urethra, rectum, or pharynx without complications) is guided by the CDC guidelines. As of the most recent guidelines (2021):

Recommended treatment:

• Ceftriaxone 500 mg IM (intramuscularly) in a single dose

  • If the patient weighs ≥150 kg (300 lbs): Ceftriaxone 1 g IM in a single dose is recommended.

Additional consideration:

• Doxycycline 100 mg orally twice daily for 7 days should be added if chlamydial infection has not been excluded, since gonorrhea and chlamydia often occur together.

Alternative treatments (used if there's a cephalosporin allergy or other contraindications) are more complex and require specialist guidance.

1. Pregnant Individuals:

• Recommended treatment:

  • Ceftriaxone 500 mg IM in a single dose

• Chlamydia not ruled out:

  • Add Azithromycin 1 g orally in a single dose (instead of doxycycline, which is contraindicated in pregnancy)

• Important note:

  • Doxycycline is contraindicated during pregnancy due to risks to fetal bone and tooth development.

2. Pharyngeal Gonorrhea:

• Pharyngeal infections are harder to eradicate, so single-drug therapy must be carefully selected.

• Recommended treatment:

  • Ceftriaxone 500 mg IM in a single dose

  • If chlamydia not excluded: add Doxycycline 100 mg orally twice daily for 7 days

• Test-of-cure: Usually not required unless symptoms persist or reinfection is suspected. However, pharyngeal infections have higher failure rates, so test-of-cure in 7–14 days may be considered in certain cases.

3. Cephalosporin Allergy:

• Treatment requires consultation with an infectious disease specialist.

• Options may include gentamicin + azithromycin or gemifloxacin + azithromycin, but resistance and side effects must be considered.