STI Treatment Guidelines

Treatment Recommendations

The CDC recommends ceftriaxone (125-250 mg IM in a single dose) as the preferred first-line treatment for gonococcal urethritis, cervix, and rectal infections, with ciprofloxacin (500 mg PO in a single dose) as an alternative option, but with caution due to increasing resistance 1, 2
The CDC recommends dual therapy with ceftriaxone plus azithromycin for uncomplicated gonococcal infections to address possible chlamydial co-infection and combat antimicrobial resistance 2
Azithromycin (1 g PO in a single dose) is a recommended first-line treatment for non-gonococcal urethritis, according to the American College of Obstetricians and Gynecologists 1, 3
Doxycycline (100 mg PO twice daily for 7 days) is an alternative first-line treatment for non-gonococcal urethritis, as recommended by the American College of Obstetricians and Gynecologists 1, 3

Quinolone-resistant N. gonorrhoeae is increasingly prevalent, limiting ciprofloxacin's utility, as reported by the Journal of Microbiology, Immunology and Infection 1, 2
Dual therapy with two antimicrobials with different mechanisms of action is recommended to improve treatment efficacy and potentially delay emergence of resistance, according to the CDC 2

Pregnant women should not be treated with quinolones or tetracyclines, as recommended by the American College of Obstetricians and Gynecologists 2, 3
Men who have Sex with Men (MSM) should not receive quinolones due to higher prevalence of resistant strains, as reported by the CDC 2

For gonococcal infections, the first choice is ceftriaxone (125-250 mg IM) + azithromycin (1g PO), as recommended by the CDC 2
For non-gonococcal urethritis/chlamydial infections, the first choice is azithromycin 1g PO single dose, according to the American College of Obstetricians and Gynecologists 1, 3