Gonorrhea and Chlamydia Treatment Guidelines

Introduction to Treatment Options

The CDC recommends cefixime 400 mg orally as a single dose OR ceftriaxone 125 mg intramuscularly as a single dose OR ciprofloxacin 500 mg orally as a single dose OR ofloxacin 400 mg orally as a single dose, PLUS treatment for presumptive chlamydial co-infection with either azithromycin 1 g orally as a single dose OR doxycycline 100 mg orally twice daily for 7 days, for the treatment of gonorrhea and chlamydia in 2001 1

The CDC's 2002 guidelines provided multiple equivalent first-line regimens for gonorrhea treatment, including cefixime 400 mg orally in a single dose, ceftriaxone 125 mg intramuscularly in a single dose, ciprofloxacin 500 mg orally in a single dose, and ofloxacin 400 mg orally in a single dose, with a cure rate of 97.4% for cefixime, 99.1% for ceftriaxone, 99.8% for ciprofloxacin, and 98.6% for ofloxacin 1
Quinolones, such as ciprofloxacin and ofloxacin, were contraindicated in Hawaii and for infections acquired in Asia or the Pacific due to high rates of quinolone-resistant N. gonorrhoeae, and their use was also inadvisable in California due to increasing QRNG prevalence 1

Mandatory co-treatment for chlamydia was required unless chlamydial infection was definitively ruled out, with recommended regimens including azithromycin 1 g orally in a single dose and doxycycline 100 mg orally twice daily for 7 days 1

Quinolones, such as ciprofloxacin, ofloxacin, and levofloxacin, were absolutely contraindicated in pregnant women, nursing women, and persons ≤17 years of age, and cephalosporin-based regimens were mandatory for these populations 1

Patients treated with any recommended regimen did not require routine test-of-cure unless symptoms persisted or re-exposure was suspected, representing a departure from earlier practices that mandated follow-up cultures 1