Gonorrea 2020

CDC Guidelines Recommend Ceftriaxone Monotherapy for Uncomplicated Gonorrhea

By Kelly Young

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

The CDC now recommends treating uncomplicated gonorrhea with a single 500-mg intramuscular dose of ceftriaxone, according to updated guidelines in MMWR. The recommendation applies to urogenital, anorectal, and pharyngeal infections.

Previously, the CDC recommended ceftriaxone plus oral azithromycin. The authors note that azithromycin resistance is "an increasing concern." Nationwide, the percentage of N. gonorrhoeae isolates with reduced susceptibility to azithromycin increased from 0.6% in 2013 to 4.6% in 2018.

Among the recommendations:

• People weighing ≥150 kg should be given a single 1-g dose of ceftriaxone. 
• In patients for whom a chlamydial infection has not been ruled out, doxycycline 100 mg orally twice a day for 7 days is also recommended.
• For patients with cephalosporin allergy, an intramuscular dose of gentamicin (240 mg) plus an oral dose of azithromycin (2 g) may be considered.
• In cases where intramuscular ceftriaxone can't be given, an oral dose of cefixime (800 mg) is an option, but the authors note it may not be as effective.
• For pharyngeal gonorrhea, there are no reliable alternative therapies and test-of-cure is recommended.

MMWR article (Free)

Background: NEJM Journal Watch coverage of gentamicin and ceftriaxone (Your NEJM Journal Watch subscription required)

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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