Podcast #226 - 10 Key Points from the CDC's Update on Gonorrhea Management

Recently, the Centers for Disease Control (CDC) released updated guidelines for treating gonococcal infections.  Given the increase in antibiotic resistance, this provides an important change in the recommended management for not only gonorrhea but also chlamydia.  

To see the full updated guidelines follow THIS LINK.  However, we will summarize the key updates here:

1. For uncomplicated gonococcal infections of the cervix, urethra, or rectum treat with a single dose of ceftriaxone 500 mg intramuscularly (IM) and 1 gram if the patient weighs 150 kg or more.
2. When ceftriaxone cannot be used due to an allergy, gentamicin 240 mg IM and azithromycin 2 grams orally should be given.
3. Alternatively, if ceftriaxone is not available, cefixime 800 mg orally may be given.
4. Cefixime should not be routinely used because it does not provide as high, or as sustained, bactericidal blood levels as ceftriaxone.
5. There is no reliable alternative treatments to pharyngeal gonorrhea and those with a reported beta-lactam (especially ceftriaxone) allergy should be more thoroughly evaluated for anaphylaxis or other severe reaction such as Stevens-Johnson Syndrome (SJS).
6. In all forms of uncomplicated gonococcal infection (cervix, urethra, rectum, or pharyngeal), if chlamydia has not been excluded treat with doxycycline 100 mg orally twice daily for 7 days.
7. Azithromycin is no longer recommended for routine use due to significantly increasing resistance.
8. However, in pregnancy,  1 gram of azithromycin orally may be used to treat chlamydia.
9. In cases where the law permits it, expedited partner treatment should be cefixime 800 mg once orally and doxycycline 100 mg orally twice daily  for 7 days.
10. A test of cure is recommended for pharyngeal gonorrhea 7-14 days after the initial treatment regardless of what antibiotic regimen is used.

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