Gonorrhea Guidelines

Updated: Dec 19, 2017
  • Author: Brian Wong, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Guidelines

WHO Guidelines on the Treatment of Neisseria gonorrhoeae Infection

Guidelines on the treatment of Neisseria gonorrhoeae by the World Health Organization (WHO) are summarized below. [80]

Genital and anorectal gonococcal infections

Treatment recommendations by the WHO for genital and anorectal gonococcal infections are as follows:

  • Ceftriaxone 250 mg IM as a single dose plus azithromycin 1 g PO as a single dose
  • Cefixime 400 mg PO as a single dose plus azithromycin 1 g PO as a single dose
  • Single-drug therapy (one of the following, based on recent local resistance data confirming susceptibility to the antimicrobial): Ceftriaxone 250 mg IM as a single dose; cefixime 400 mg PO as a single dose; or spectinomycin 2 g IM as a single dose

Oropharyngeal gonococcal infections

In adults and adolescents with gonococcal oropharyngeal infections, the WHO suggests dual therapy over single therapy.

Dual therapy options are as follows:

  • Ceftriaxone 250 mg IM as a single dose PLUS azithromycin 1 g PO as a single dose or
  • Cefixime 400 mg PO as a single dose PLUS azithromycin 1 g PO as a single dose

Single-drug therapy (based on recent local resistance data confirming susceptibility to the antimicrobial) consists of ceftriaxone 250 mg IM as single dose.

Re-treatment of gonococcal infections after treatment failure

If treatment failure occurs after a WHO recommended dual therapy, re-treat with one of the following dual therapies:

  • Ceftriaxone 500 mg IM as a single dose plus azithromycin 2 g PO as a single dose or
  • Cefixime 800 mg orally as a single dose plus azithromycin 2 g PO as a single dose or
  • Gentamicin 240 mg IM as a single dose plus azithromycin 2 g PO as a single dose or
  • Spectinomycin 2 g IM as a single dose (if not an oropharyngeal infection) PLUS azithromycin 2 g PO as a single dose

Gonococcal conjunctivitis in neonates

In neonates with gonococcal conjunctivitis, the WHO STI guidelines suggest one of the following treatment options:

  • Ceftriaxone 50 mg/kg (maximum 150 mg) IM as a single dose or
  • Kanamycin 25 mg /kg (maximum 75 mg) IM as a single dose or
  • Spectinomycin 25 mg/kg (maximum 75 mg) IM as a single dose

For ocular prophylaxis, the WHO guidelines suggest one of the following options for topical application to both eyes immediately after birth:

  • Tetracycline hydrochloride 1% eye ointment or
  • Erythromycin 0.5% eye ointment or
  • Povidone iodine 2.5% solution (water-based) or
  • Silver nitrate 1% solution or
  • Chloramphenicol 1% eye ointment
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CDC Guidelines on the Treatment of Gonorrhea

The CDC treatment guidelines on gonorrhea infections are as follows: [1]

  • Uncomplicated gonorrhea infections of the urethra, cervix, pharynx, and rectum: Ceftriaxone 250 mg IM as a single dose plus azithromycin 1 g PO as a single dose
  • Gonococcal conjunctivitis: Ceftriaxone 250 mg IM as a single dose plus azithromycin 1 g PO as a single dose
  • Disseminated gonococcal infections with arthritis and/or dermatitis: Ceftriaxone 1 g IV or IM every 24 hours plus azithromycin 1 g PO as a single dose
  • Gonococcal meningitis and endocarditis: Ceftriaxone 1-2 g IV every 12-24 hours plus azithromycin 1 g PO as a single dose
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