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Gonorrhea and Syphilis Treatment: Current Antibiotic Regimens

Both are bacterial STIs requiring prompt, correct treatment to prevent complications and resistance.

Gonorrhea (Neisseria gonorrhoeae)

  • CDC 2021 Guidelines: Ceftriaxone 500 mg IM single dose (1 g if weight ≥150 kg).
  • If chlamydia not ruled out: Add doxycycline 100 mg PO BID × 7 days.
  • Alternative (ceftriaxone allergy): Gentamicin 240 mg IM + azithromycin 2 g PO (single doses).
  • Test‑of‑cure: 7–14 days post‑treatment (NAAT) for pharyngeal gonorrhea; otherwise not routine.

Syphilis (Treponema pallidum)

  • Primary, Secondary, Early Latent (<1 yr): Benzathine penicillin G 2.4 million units IM single dose.
  • Late Latent (>1 yr) / Tertiary: Benzathine penicillin G 2.4 MU IM weekly × 3 weeks (7.2 MU total).
  • Neurosyphilis / Ocular / Otic: Aqueous crystalline penicillin G 18–24 MU/day IV × 10–14 days.
  • Penicillin allergy: Desensitization preferred (especially pregnancy, neurosyphilis). Alternatives: doxycycline 100 mg BID × 14 days (early) / 28 days (late); ceftriaxone 1 g IM/IV daily × 10–14 days (less data).
  • Follow‑up: RPR/VDRL titers at 6, 12, 24 months (4‑fold decline = response).

Critical Points

  • Expedited partner therapy (EPT) available for gonorrhea/chlamydia in many states.
  • Abstain until treatment complete + 7 days (gonorrhea) / until lesions heal (syphilis).
  • HIV/STI co‑testing at diagnosis.
  • Reportable diseases—public health notified.

Resistance monitoring (GISP) guides updates. Always follow current CDC/WHO guidelines.

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