Gonorrhea Treatment Guidelines

Primary Treatment Regimen

• The American College of Physicians recommends cefixime 400 mg orally once PLUS azithromycin 1 g orally once as an alternative regimen when ceftriaxone is unavailable, with a critical caveat that cefixime is less effective than ceftriaxone, particularly for pharyngeal infections, and requires a test-of-cure 1 week after treatment 1

Alternative Regimens

• The Centers for Disease Control and Prevention recommends azithromycin 2 g orally once for patients with severe cephalosporin allergy, which requires a test-of-cure 1 week after treatment 1

Special Populations

• The Infectious Diseases Society of America recommends using only ceftriaxone for men who have sex with men due to higher prevalence of resistant strains, and quinolones are contraindicated in this population 1
• The American College of Obstetricians and Gynecologists recommends ceftriaxone as the preferred treatment for pregnant women, and quinolones and tetracyclines are contraindicated 1

Partner Management

• The Centers for Disease Control and Prevention recommends evaluating and treating all sex partners from the preceding 60 days, and if the patient's last sexual contact was >60 days before symptom onset or diagnosis, treat the most recent partner 1
• The MMWR Recommendations and Reports suggest that if the patient's last sexual contact was >60 days before symptom onset or diagnosis, treat the most recent partner 2

Concurrent Testing Requirements

• The Centers for Disease Control and Prevention recommends screening for syphilis with serology at the time of gonorrhea diagnosis 3