Treatment of Pharyngitis When Sexual History is Unknown

Rationale for Empiric Dual Therapy

The Centers for Disease Control and Prevention recommends treating empirically for gonococcal pharyngitis with ceftriaxone 125 mg IM plus azithromycin 1 g orally to cover both gonorrhea and chlamydia when sexual history is unknown 1, 2
Gonococcal pharyngitis is more difficult to eradicate than urogenital or anorectal infections, requiring regimens that can reliably cure >90% of infections 1, 2, 3
Chlamydial coinfection of the pharynx is unusual, but coinfection at genital sites occurs frequently, making presumptive treatment for both organisms essential when sexual history cannot be obtained 2, 3

The Centers for Disease Control and Prevention recommends ceftriaxone 125 mg IM single dose for the treatment of gonococcal pharyngitis 1, 2
Azithromycin 1 g orally single dose is recommended in addition to ceftriaxone for chlamydia coverage 1, 2

Azithromycin 1 g alone is insufficiently effective for gonorrhea treatment, with only 93% efficacy 1, 3
Spectinomycin is unreliable for pharyngeal infections, with only 52% efficacy, and should be avoided for suspected pharyngeal gonorrhea 1, 2, 3, 4

In pregnancy, ceftriaxone is recommended, and quinolones and tetracyclines should be avoided 1, 2, 4
For chlamydia coverage in pregnancy, azithromycin or amoxicillin is recommended instead of doxycycline 1, 4

Patients treated with recommended regimens do not need routine test-of-cure 1, 2, 4
If symptoms persist after treatment, culture for N. gonorrhoeae with antimicrobial susceptibility testing is recommended 1, 2, 4

All sex partners from the preceding 60 days should be evaluated and treated for both N. gonorrhoeae and C. trachomatis 1, 2, 3, 4
Patients should avoid sexual intercourse until therapy is completed and both patient and partners are asymptomatic 1, 2, 4