New Regimen for Gonorrhea and Chlamydia

Written by Clay Smith

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The new regimen for treating gonorrhea is ceftriaxone 500mg IM, and in patients with unknown chlamydia status, add doxycycline 100mg po bid x 7 days. Azithromycin is out.

Why does this matter?
Since 2010, the CDC has recommended treatment of uncomplicated gonorrhea of the cervix, urethra, or rectum with ceftriaxone 250mg IM, and if chlamydia status is unknown (which it often is), azithromycin 1g po is added. But changes are needed. Here’s why.

STI Dx and Tx UTD
N. gonorrhea is increasingly resistant to azithromycin. Not only was azithromycin considered important in empirically treating possible co-infection with chlamydia, it was thought that having dual agents working by a different mechanism may have been important in reducing N. gonorrhea resistance to ceftriaxone. Now, that is no longer an effective strategy. Also, there is increasing resistance of Mycoplasma genitalium to azithromycin and concern about the efficacy of treating chlamydia, especially rectal disease, with azithromycin. Now, instead of azithromycin, doxycycline 100mg po bid x 7 days is recommended. Finally, to achieve higher MICs and optimize effectiveness, especially with gonococcal disease of the pharynx, ceftriaxone 500mg IM as a single dose is now recommended.

Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep. 2020 Dec 18;69(50):1911-1916. doi: 10.15585/mmwr.mm6950a6.

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From the CDC. Click to see full text of the article.

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