Gonorrhea Treatment Protocols: Current Regimens, Resistance Concerns, and Follow-Up

Neisseria gonorrhoeae infection requires prompt, effective antimicrobial therapy to prevent complications (PID, epididymitis, disseminated gonococcal infection, infertility) and curb resistance.

Current CDC-Recommended Regimen (2021 Update)

• Uncomplicated urogenital/rectal/pharyngeal gonorrhea:
  • Ceftriaxone 500 mg IM single dose (1 g if weight ≥150 kg)
  • If ceftriaxone unavailable: Cefixime 800 mg PO single dose
• Concurrent chlamydia treatment (if not excluded): Doxycycline 100 mg PO BID × 7 days.

Alternative Regimens (Allergy/Intolerance)

• Gentamicin 240 mg IM + Azithromycin 2 g PO (single doses)
• Gemifloxacin 320 mg PO + Azithromycin 2 g PO (single doses)
• Fluoroquinolones (ciprofloxacin) no longer recommended due to widespread resistance.

Resistance Landscape

N. gonorrhoeae has developed resistance to every antibiotic class used. Ceftriaxone MIC creep is monitored globally. Dual therapy (ceftriaxone + azithromycin) was previously recommended to delay resistance but is no longer standard due to azithromycin resistance emergence and lack of additive benefit in trials.

Critical Follow-Up

• Test of cure (TOC): NAAT at 7–14 days (pharyngeal: 14 days) for all treated cases.
• Partner notification: All sex partners within 60 days should be evaluated/treated.
• Re-screening: At 3 months due to high reinfection rates.
• HIV/syphilis testing: Recommended at diagnosis.

Adherence to guidelines preserves treatment efficacy and prevents sequelae.