Gonorrhea Treatment Guidelines
Sex can lead to nasty things like herpes, gonorrhea, and something called relationships - Sacha Baron Cohen
image by: CDC NPIN
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The recommended treatment for gonococcal infection of the cervix, urethra and rectum is ceftriaxone 500 mg intramuscularly (IM) in a single dose. For patients over 150 kilograms (kg), the ceftriaxone dose should be increased to 1 g. If ceftriaxone is not available, gentamicin 240 mg IM in a single dose plus azithromycin 2 g orally in a single dose, or cefixime 800 mg orally in a single dose are both alternative regimens. If chlamydial co-infection cannot be excluded, doxycycline 100 mg orally twice daily for seven days should be added.
Gonococcal pharyngeal infections are common among certain populations and can be a source of community transmission. Pharyngeal infections are more difficult…
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Doxycycline vs Azithromycin: Think Twice About the 2020 CDC Guideline Update...
When the new Centers for Disease Control and Prevention (CDC) recommendations1 regarding the treatment of uncomplicated gonorrhea (and indirectly chlamydia) debuted like a slice of antibiotic resistance doom, it felt like another “gift” had arrived from 2020. Intramuscular (IM) ceftriaxone dosing has increased from 250 mg to 500 mg (or 1 g for weight ≥150 kg). Empiric chlamydia coverage switched from a single dose of 1 g of azithromycin to doxycycline 100 mg PO BID for 7 days. Being deferential to CDC expertise, many providers accepted them uncritically. Compliance rates with a switch from a 1-time to a 7-day regimen are not addressed, especially worrisome for a condition that can be minimally or asymptomatic.
Expedited Partner Therapy
In cases where gonorrhea expedited partner therapy (provision of prescriptions or medications for the patient to take to his or her sex partner without the health care provider first examining the partner) is permissible by state law and the partner is unable or unlikely to seek timely treatment, the partner may be treated with a single 800 mg dose of cefixime, if a chlamydia infection in the patient has been excluded. If a chlamydia test result has not been documented, the partner may be treated with a single dose of oral cefixime 800 mg plus oral doxycycline 100 mg 2 times/day for 7 days.
Extra! Extra! Read all about it! 2021 Guideline Updates for Treatment of Chlamydia & Uncomplicated Gonorrhea
In conclusion, CDC STI guidelines were recently updated in July 2021 and include new recommendations for the treatment of chlamydia and gonorrhea. Be sure to treat chlamydia with a 7-day treatment course of doxycycline 100 mg twice daily (do not use azithromycin 1 g orally in a single dose as the first line).
GC and Chlamydia: Update on Testing and Treatment
For cephalosporin allergic, 2 options: – Gentamicin 240 mg IM (or 5mg/kg IM) with azithromycin 2g orally OR – Gemifloxacin 320 mg orally with azithromycin 2g orally.
CDC updates guidelines on treatment of sexually transmitted infections
Antibiotic resistance remains a challenge and complicates gonococcal treatment. With the emergence of azithromycin resistance and optimization of antimicrobial stewardship, dual treatment for gonococcal infection is no longer recommended.
CDC
Ceftriaxone 500 mg* IM in a single dose for persons weighing <150 kg. If chlamydial infection has not been excluded, treat for chlamydia. For persons weighing ≥150 kg, 1 g ceftriaxone should be administered.
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