Gonorrhea and Chlamydia Treatment Guidelines

Introduction to Treatment

The Centers for Disease Control and Prevention (CDC) recommends a single dose of ceftriaxone 125 mg IM, cefixime 400 mg orally, ciprofloxacin 500 mg orally, or ofloxacin 400 mg orally, PLUS either azithromycin 1 g orally in a single dose OR doxycycline 100 mg orally twice daily for 7 days to cover concurrent chlamydial infection in patients with gonorrhea 1, 2

The CDC established dual therapy as the standard approach by 1997 because patients with gonorrhea were frequently coinfected with Chlamydia trachomatis, and this strategy was cost-effective in populations where 20-40% of gonococcal infections were accompanied by chlamydial infection 1, 2

Ceftriaxone 125 mg IM provided sustained, high bactericidal blood levels and cured 99.1% of uncomplicated urogenital and anorectal infections 1, 2
Cefixime 400 mg orally cured 97.1% of uncomplicated urogenital and anorectal infections, with the advantage of oral administration 1, 2
Ciprofloxacin 500 mg orally cured 99.8% of uncomplicated urogenital and anorectal infections 1, 2
Ofloxacin 400 mg orally was an equally effective alternative fluoroquinolone 1, 2

Spectinomycin 2 g IM was effective but expensive, curing 98.2% of urogenital and anorectal infections 3
Ceftizoxime 500 mg IM was the most effective of the alternative injectable cephalosporins 3

Azithromycin 1 g orally in a single dose was the preferred treatment for chlamydial coverage due to its high compliance rate 3
Doxycycline 100 mg orally twice daily for 7 days was a less expensive alternative for chlamydial coverage 1

Quinolone-resistant N. gonorrhoeae (QRNG) comprised less than 0.05% of isolates in the United States according to 1996 surveillance data, but the guidelines noted that QRNG was becoming widespread in parts of Asia and importation would likely continue 1, 2
Pharyngeal gonorrhea was recognized as more difficult to eradicate, with many regimens unable to reliably cure >90% of infections 3
Pregnant women could not receive quinolones or tetracyclines and should be treated with a recommended cephalosporin (ceftriaxone preferred) 3
Patients with cephalosporin allergies should generally be treated with quinolones, and if unable to tolerate both cephalosporins and quinolones, spectinomycin was recommended (except for pharyngeal infections) 3

Patients treated with recommended regimens did not require test-of-cure unless symptoms persisted, and persistent infections after treatment were more commonly due to reinfection rather than treatment failure 1, 2, 3
All sex partners within 30 days of symptom onset (or 60 days for asymptomatic patients) required evaluation and treatment for both gonorrhea and chlamydia, and patients were instructed to avoid sexual intercourse until both they and their partners completed therapy and were asymptomatic 1, 2, 3