Practice alert: CDC no longer recommends quinolones for treatment of gonorrhea
Ceftriaxone is now the recommended treatment.
Associated conditions
Treat for chlamydia if chlamydial infection is not ruled out
The CDC continues to recommend concurrent treatment for chlamydia for all persons who have gonorrhea, unless coinfection has been ruled out.
Therapies for chlamydia include azithromycin 1 g as a single dose or doxycycline 100 mg twice a day for 7 days.
Pelvic inflammatory disease and epididymitis
The treatment of both pelvic inflammatory disease (PID) and epididymitis include an option of ceftriaxone 250 mg IM plus doxycycline for either 7 days (for epididymitis) or 10 days (for PID). There are several parenteral options for PID and disseminated gonorrhea; these can be found on the CDC’s STD web site.3
Should you always retest to ensure a cure?
It is still not necessary to retest patients who have had the recommended treatments. However, patients with persistent symptoms or rapidly recurring symptoms should be retested by cultures so that drug-resistance patterns can be checked if gonorrhea is documented.
Retest for recurrence
Consider retesting all treated patients after 3 to 6 months, since anyone with a sexually transmitted infection is at risk of being reinfected.
Summary
The ongoing challenges with the evolving resistance patterns of gonorrhea illustrate the importance of physicians accurately diagnosing gonorrhea, treating with recommended regimens, reporting positive cases to the local public health department, and assisting with partner evaluation and treatment.
