Prophylactic Treatment for Chlamydia and Gonorrhea After STD Exposure

Primary Recommendation

The CDC recommends dual therapy for empiric treatment when STD exposure has occurred, using ceftriaxone 500 mg IM as a single dose PLUS doxycycline 100 mg orally twice daily for 7 days to cover both gonorrhea and chlamydia prophylactically 1

Co-infection rates are extremely high, with 40-50% of gonorrhea patients also having chlamydia, making presumptive treatment for both organisms essential when empiric therapy is indicated 1
Single-dose azithromycin 1g alone is insufficient for gonorrhea, with only 93% efficacy, and should never be used as monotherapy 1

If ceftriaxone is unavailable, cefixime 400 mg orally single dose PLUS doxycycline 100 mg twice daily for 7 days can be used, but requires test-of-cure 1 week after treatment due to inferior efficacy 1
For severe cephalosporin allergy, azithromycin 2g orally single dose can be used, but has high GI side effects in 35% of patients and requires test-of-cure 1 week after treatment 1
Spectinomycin 2g IM is an option, but has poor pharyngeal coverage, with only 52% effectiveness 2, 3

In pregnancy, ceftriaxone 500 mg IM single dose is safe, but doxycycline, quinolones, and tetracyclines should never be used 2, 4, 1, 3
For chlamydia coverage in pregnancy, azithromycin 1g orally single dose or amoxicillin 500 mg three times daily for 7 days can be used 4, 3

Quinolones, such as ciprofloxacin and ofloxacin, should never be used for gonorrhea due to widespread resistance 1
Azithromycin 1g alone should never be relied upon for gonorrhea treatment due to insufficient efficacy 1
Spectinomycin should not be used if pharyngeal exposure is suspected, due to only 52% effectiveness 2, 3

All sexual partners from the preceding 60 days should be evaluated and treated for both N. gonorrhoeae and C. trachomatis 2, 5, 1, 3
Patients should avoid sexual intercourse until therapy is completed and both patient and partners are asymptomatic 2, 5, 3
Routine test-of-cure is not needed for patients treated with recommended regimens unless symptoms persist 2, 5, 1
All patients should be retested approximately 3 months after treatment due to high reinfection risk 1