New Gonorrhea Treatment Guidelines from the CDC
January 14, 2021
CDC has updated its recommendation for the treatment of uncomplicated gonorrhea in adults. Gonorrhea should now be treated with just one higher dose (500 mg) injection of ceftriaxone, and dual therapy is no longer the recommended approach. The new recommendations, briefly summarized below, are available in 2020 Update to CDC's Treatment for Gonococcal Infections, a special policy note published on December 17 in MMWR, and this new recommendation supersedes the gonorrhea treatment recommendation included in the 2015 STD Treatment Recommendations
Updated Treatment Recommendations:
Regimen for uncomplicated gonococcal infections of the cervix, urethra, or rectum:
  • Ceftriaxone 500 mg IM as a single dose for persons weighing <150 kg (300 lb).
  • For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.
  • If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.
  • A test-of-cure is not needed for people who receive a diagnosis of uncomplicated urogenital or rectal gonorrhea unless symptoms persist.
  • Patients who have been treated for gonorrhea should be retested three months after treatment to ensure there is no reinfection.

Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, or rectum if ceftriaxone is not available:
  • Gentamicin 240 mg IM as a single dose plus azithromycin 2 g orally as a single dose OR
  • Cefixime 800 mg orally as a single dose. If treating with cefix­ime, and chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.

Recommended regimen for uncomplicated gonococcal infections of the pharynx:
  • Ceftriaxone 500 mg IM as a single dose for persons weighing <150 kg (300 lb).
  • For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.
  • If chlamydia coinfection is identified when pharyngeal gonorrhea testing is performed, providers should treat for chlamydia with doxycycline 100 mg orally twice a day for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.
  • A test-of-cure is recommended in people with pharyngeal gonorrhea 7-14 days after the initial treatment, regardless of the regimen.

Contact Information:
 Feel free to contact Dr. Christopher Ried, STD Controller of Orange County, if you need assistance in the care of your patients with gonorrhea or if you suspect gonorrhea treatment failure. He can be reached at (714) 834-8598.
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