Management of Chlamydia and Gonorrhea Co-infection

Treatment Regimen

The Centers for Disease Control and Prevention recommends dual antimicrobial therapy for patients with positive lab tests for both chlamydia and gonorrhea, consisting of ceftriaxone 250mg IM single dose for gonorrhea plus either azithromycin 1g orally single dose or doxycycline 100mg orally twice daily for 7 days for chlamydia 1, 2, 3
Ceftriaxone 250mg IM in a single dose is recommended for gonorrhea treatment 1, 2, 3
Azithromycin 1g orally in a single dose is a recommended treatment for chlamydia 4
Doxycycline 100mg orally twice daily for 7 days is a recommended treatment for chlamydia 4

Quinolones, such as ciprofloxacin, should not be used for gonorrhea treatment due to widespread quinolone-resistant N. gonorrhoeae (QRNG) 1, 2, 3
QRNG is particularly common among men who have sex with men (MSM), in certain geographic regions, and in infections acquired during international travel 3, 5

Culture and susceptibility testing should be performed in cases of persistent infection after treatment 1, 3
Test-of-cure is not routinely recommended for uncomplicated infections if recommended treatment is used and symptoms resolve 4

All sex partners from the past 60 days should be referred for evaluation and treatment 4
Patients and partners should abstain from sexual intercourse until therapy is completed and symptoms have resolved 4, 6

All patients with gonorrhea or chlamydia should also be tested for other STIs, including syphilis and HIV 1, 3

Pregnant women should receive the same treatment regimens, with the exception that doxycycline is contraindicated during pregnancy 7
Azithromycin is the preferred treatment for chlamydia during pregnancy 7