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Gonorrhea

Regimen for uncomplicated gonococcal infections of the cervix, urethra, or rectum:

  • Ceftriaxone 500 mg IM as a single dose for persons weighing <150 kg (300 lb).
  • For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.
  • If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.

Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, or rectum if ceftriaxone is not available:

  • Gentamicin 240 mg IM as a single dose plus azithromycin 2 g orally as a single dose
  • Cefixime 800 mg orally as a single dose.
  • If treating with cefixime, and chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.

Recommended regimen for uncomplicated gonococcal infections of the pharynx:

  • Ceftriaxone 500 mg IM as a single dose for persons weighing <150 kg (300 lb)
  • For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.
  • If chlamydia coinfection is identified when pharyngeal gonorrhea testing is performed, providers should treat for chlamydia with doxycycline 100 mg orally twice a day for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.
  • No reliable alternative treatments are available for pharyngeal gonorrhea. For persons with a history of a beta-lactam allergy, a thorough assessment of the reaction is recommended.*
  • For persons with an anaphylactic or other severe reaction (e.g., Stevens Johnson syndrome) to ceftriaxone, consult an infectious disease specialist for an alternative treatment recommendation.

  • Organism: Gram negative diplococci bacterium, Neisseria Gonorrhoeae
  • Epidemiology:
    • Second most commonly reported STD with 583,405 cases in 2018 representing a 63% increase since 2014 (CDC)
  • Symptoms: May be asymptomatic.
    • Cervicitis Mucopurulent vaginal discharge and pruritis Dysuria Frequency PID Bartholinitis Fitz-Hugh-Curtis Syndrome  Epididymitis Urethritis Proctitis Pharyngitis Conjunctivitis Purulent arthritis Tenosynovitis Dermatitis Polyarthralgias Endocarditis Meningitis Osteomyelitis
  • Testing:
    • In women, sensitivity of testing of urine appears to be slightly lower compared with vaginal samples. Self-taken vulvovaginal swabs are as accurate as clinician-performed tests. In men, NAAT of the first-catch urine is the diagnostic test of choice. Both urine and urethral specimens are acceptable, as both specimens demonstrate a sensitivity and specificity > 97%.43

Source

Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020