Treatment Guidelines - Gonorrhea

Sex can lead to nasty things like herpes, gonorrhea, and something called relationships - Sacha Baron Cohen

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Extra! Extra! Read all about it! 2021 Guideline Updates for Treatment of Chlamydia & Uncomplicated Gonorrhea

per CDC’s new 2021 update, a single 500 mg IM dose of ceftriaxone is the new recommended regimen. For patients weighing ≥150 kg (300 lbs.), a higher dose is needed, and a single 1 gram IM dose of ceftriaxone should be administered. If ceftriaxone is not available, the alternative regimen is a single 240 mg IM dose of gentamicin plus a single 2 g oral dose of azithromycin or monotherapy of cefixime 800 mg orally in a single dose. If there is a coinfection with Chlamydia trachomatis, the recommended regimen of doxycycline 100 mg twice daily orally for 7 days should be added to the treatment plan. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.

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STI Treatment Guidelines

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.

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.

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.

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).