Treatment for Chlamydia and Gonorrhea

Primary Treatment Regimen

The American College of Physicians recommends treating uncomplicated chlamydia and gonorrhea co-infection with ceftriaxone 500 mg intramuscularly as a single dose PLUS doxycycline 100 mg orally twice daily for 7 days, which provides superior efficacy compared to azithromycin-based regimens and addresses the high co-infection rate of 40-50% 1
Ceftriaxone achieves a 99.1% cure rate for uncomplicated urogenital and anorectal gonorrhea 1
Doxycycline provides more reliable chlamydia coverage than single-dose azithromycin 1
Co-infection occurs in 40-50% of gonorrhea cases, making presumptive treatment for both organisms essential 1

If ceftriaxone is unavailable, the Centers for Disease Control and Prevention recommends cefixime 400 mg orally single dose PLUS doxycycline 100 mg orally twice daily for 7 days 2, 1
For patients preferring single-dose therapy, the American College of Physicians recommends ceftriaxone 500 mg IM single dose PLUS azithromycin 1 g orally single dose 2, 1
Azithromycin alone has only 93% efficacy for gonorrhea and should never be used as monotherapy 1, 4

For pregnant patients, the American College of Obstetricians and Gynecologists recommends ceftriaxone 500 mg IM single dose PLUS azithromycin 1 g orally single dose 2, 1, 4
Never use doxycycline, quinolones, or tetracyclines in pregnancy 2, 5, 1

For pharyngeal infections, ceftriaxone is the only reliably effective treatment, with superior efficacy compared to oral alternatives 1, 4
Pharyngeal gonorrhea is significantly more difficult to eradicate than urogenital or anorectal infections 1, 4

Never use quinolones (ciprofloxacin, oflox understudy) for gonorrhea treatment due to widespread resistance 6, 1, 3
Never use azithromycin 1 g alone for gonorrhea - it has only 93% efficacy 1, 4

Patients treated with recommended regimens (ceftriaxone + doxycycline or azithromycin) do not need routine test-of-cure 1, 4
Rescreen all patients 3 months after treatment due to high reinfection rates 2, 1

All sexual partners from the preceding 60 days must be evaluated and treated 1, 4, 3
Partners should receive the same dual therapy regimen for both gonorrhea and chlamydia 1

Local resistance patterns should guide treatment decisions: quinolone resistance is widespread in the US 6, 1
Rising cefixime MICs have resulted in declining effectiveness 1
Dual therapy with different mechanisms of action helps delay emergence of cephalosporin resistance 1